Think outside the cell on the mentally ill

A recent National Sheriffs Association report states that one is three times more likely to find a mentally ill person in jail or prison than in a hospital. In Texas, the odds are even more pronounced: 7.8 to 1. A Texas county official is quoted: “[T]he combined cost of incarcerating and treating the mentally ill is $87 million annually” and “[t]he jails have become the psychiatric hospitals of the United States.”

During the 1950s, popular sentiment and litigation mounted against mandatory institutionalization in state-sponsored psychiatric hospitals, and those institutions were closed. However, the states never created a replacement, and so the mentally ill have been funneled into jails and prisons for lack of a better place to send them. The emphasis on incarcerating the mentally ill presents several problems:

a) Recidivism is high. In L.A. County Jail, 90% of mentally ill inmates are repeat offenders.

b) Mentally ill inmates are more expensive. In Texas, the average prisoner costs about $22,000 per year. Mentally ill prisoners cost between $30,000 and $50,000. They also cost more because they stay longer, partly because their illness often worsens behind bars.

c) Mentally ill inmates are more prone to commit suicide. Half of all prison suicides are by seriously mentally ill inmates. In California, about 77% of all attempted suicides involve the mentally ill.

d) Mentally ill inmates are sometimes abused as they confound correctional staff. One correctional officer justified punching a mentally ill inmate: “[y]ou need to instill fear in these inmates or they won’t listen to you…. Especially crazy inmates.”

Most recommended solutions in the report would require more funds. However, in tough budgetary times, measures that divert suitable mentally ill offenders from lockups to treatment, including home-based care, can actually produce net savings. Outsourcing to private mental health providers that are more efficient and cost effective is another promising strategy. Clearly, public safety and offender accountability must remain paramount, but relying almost exclusively on prisons to solve this perpetuates a revolving door that is costly for victims and taxpayers. Instead, we must break the cycle of illness and crime.

– A.J. SmullenIntern, Center for Effective Justice