Prisons as Mental Health Facilities

Prisons as Mental Health Facilities

The Offense of Mental Illness: Prisons as Mental Health Facilities Final Project Mary Cryer CM220-15: Effective Writing II

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The Offense of Mental Illness: Prisons as Mental Health Facilities Roaming the streets…talking incoherently to no one in particular…pushing a grocery cart full of aluminum cans…panhandling on the corner…spitting at pedestrians. Does this sound like a criminal to you? If this describes someone you have seen on the streets of your town, chances are this person is considered mentally ill. Odds are even better this person will be arrested at some point in his or her life. According to the U.S. Department of Justice, approximately 16 percent of the nation's prison and jail population is comprised of mentally ill inmates (Ditton, 1999). This is not due to the mentally ill being more prone to commit crimes, but rather it is due to factors including responses to the mentally ill by police and community members and lack of social services for these individuals (Pustilnik, 2005). To address this issue, many communities have developed alternative courts known as mental health courts. In this specialized court, a defendant who is mentally ill can receive psychiatric treatment as an alternative to a customary jail sentence (Davis, 2003). Utilization of the mental health court in the criminal justice system will reduce the number of mentally ill inmates incarcerated for minor offenses, will help these individuals receive proper treatment for their illness, and will keep the mentally ill from being incarcerated in overcrowded prisons at the expense of the taxpayer.

The first mental health court, established in Broward County, Florida in 1997, was a collaborative effort between local law enforcement officials, mental health facilities, and public officials (Casey & Hewitt, 2001). These groups recognized efforts by the criminal justice system

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to address mentally ill misdemeanor offenders were unsuccessful (Casey & Hewitt, 2001). These defendants were not being treated via social services and were frequently recycled through court "sometimes charged with more serious offenses" (Casey & Hewitt, 2001, 28). Thus, the specialized court was created to quickly connect these people with the services they need and to observe their progress within the recommended treatment plan (Casey & Hewitt, 2001).

In a mental health or behavioral court, defendants who are mentally ill are given the option to receive treatment for their disorder as an alternative to a standard sentence imposed by the court (Davis, 2003). For example, in exchange for a guilty plea to a misdemeanor crime the defendant is offered medical treatment, counseling services and other social services in an effort to treat the underlying cause of the criminal activity. If the defendant does not comply with the treatment program, he or she can then be incarcerated or otherwise reprimanded. If the defendant completes treatment, continues taking his or her medication and receives regular counseling – all monitored by the court – the charges will generally be dropped (Davis, 2003; Koopman, 2006).

While many individuals feel mental health courts are beneficial to both mentally ill defendants and the criminal justice system in general, critics of mental health courts argue individuals in need of social services who have obeyed the law are overlooked in favor of those who have broken the law. The National Mental Health Association (NMHA) feels "[m]ental health courts should never be a way to 'jump the line' and get preferential access to existing resources" (2006, Discussion section, para. 3). In response to this argument, Judge Mark Chow

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of the King County (Seattle), Washington Mental Health Court states, "These are people who would qualify, anyway, for mental health services and [they are] people who are committing crimes"; he adds this criminal behavior provides sufficient evidence of the need to allow these individuals precedence over others (Davis, 2003). This could also indicate there are not enough social services available to meet the needs of all mentally ill, whether law-abiding or not (Davis, 2003).

Deinstitutionalization, or the closing of state-run mental hospitals, has lead to the current situation of an overabundance of mentally ill in jails and prisons (Human Rights Watch, 2003).

This is mainly due to the lack of treatment for members of the community (Crick & Potter, 2006). The Community Mental Health Centers Act of 1964 was to have replaced state run hospitals with community-based programs to treat the mentally ill (Council of State Governments, 2002) but in reality the local programs were never sufficiently developed or utilized by the public (Human Rights Watch, 2003). When state mental hospitals peaked in 1955, there were 559,000 people being treated; by 1999 the population was less than 80,000 (Kupers, 1999 as cited in Council of State Governments, 2002).

After deinstitutionalization, many former patients of the hospitals went untreated and wound up in jail for minor offenses. In an effort to ease the burden on the criminal justice system, the mental health court was created by allocating resources to help mentally ill defendants who would otherwise end up in jail. Today's system is capable of effectively treating

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the individuals who seek treatment but having access to the treatment and making the treatment accessible to those who would benefit from it remains a problem (Council of State Governments, 2002). Thus, those who want help cannot get it due to lack of access and facilities are unable to address this problem to make treatment more available to these individuals. It is thought the mental health court could be the key to providing access to individuals who are desperate for help and support.

Having more programs available to those who need it most would reduce the need for mental health courts in the first place. Rather than providing funding for mental health courts, social policy should shift toward preventative measures by allocating funds to mental health care treatment facilities and other social services to meet the needs of these individuals before they end up in the criminal justice system. After all, this was the intention of deinstitutionalization though this strategy was never fully realized.

While most agree the mentally ill do not belong in prison, those opposed to these alternative courts feel mental illness cannot be accurately diagnosed by judges and attorneys in a court of law. Accordingly, there must be doctors, social workers, psychiatrists, and/or psychologists on the court staff to determine whether a defendant is indeed "mentally ill" and to decide whether a treatment program is the best option for the defendant (Center for Court Innovation, n.d.). In a study of mental health courts, researchers found most courts identify a defendant's eligibility for the program within two days of arrest (Griffin, Steadman & Petrila,

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2002). In the majority of the courts studied, teams of mental health clinicians representing the court determine if a defendant qualifies as mentally ill while in two courts the prosecutor decides this (Griffin et al., 2002). Participation in the alternative court is voluntary and the defendant can refuse treatment and accept sentencing instead. Unless participation is optional, some groups such as the NMHA worry mental health courts "may be used inappropriately as tools to coerce treatment" (2006, Background section, Diversion, para. 3). Therefore, it is important for these specialized courts to make defendants mindful of their options.

Once mental illness is identified and the defendant volunteers for the unconventional approach, mental health courts focus on treating the defendant's illness through communitybased treatment programs rather than sending him or her to jail. However, the charges are never dropped when a defendant voluntarily agrees to participate in the program (Griffin et al., 2002).

Rather, charges are suspended and later dropped upon program completion or a guilty plea is accepted and later dropped or reduced after program graduation (Center for Court Innovation, n.d.). While some mental health courts are "preadjudicatory and diversion-oriented," others necessitate a plea prior to eligibility (National Center for State Courts, 2002, 2). In opposition, the NMHA states, ". . . mental health courts can . . . be used to criminalize persons with mental illness, for 'lifestyle' offenses" (2006, Policy section, para. 4). The advocacy group opposes the use of these courts to mandate treatment but instead wants to see the courts used solely as a form of diversion. Either way, extensive coordination between the court and social services has

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occurred when treatment arrangements are finally determined (National Center for State Courts, 2002).

While this method of jail diversion is rather young, it appears to be effective in reducing recidivism and is more cost effective. The Substance Abuse and Mental Health Services Administration (SAMHSA), part of the federal government's Department of Health and Human Services (DHHS), recently carried out a study of a Connecticut court program that redirects some offenders who are considered to be severely mentally ill "into mental health treatment programs" (Human Rights Watch, 2003, 27). The results of the study indicated the typical cost of treating offenders for their illness was approximately 67 percent less than standard sentencing methods (Solnit, 2000 as cited in Human Rights Watch, 2003). The cost of incarcerating one inmate in a state prison is estimated to be $80 per day ($29,200 per year) while incarcerating one mentally ill inmate is about $140 per day ($51,100 per year) (Pustilnik, 2005). Given these estimates, diverting a mentally ill offender into treatment would cost approximately $46 per day ($16,863 per year), or one-third of the cost to incarcerate. This leads to an annual savings of $34,237 per mentally ill offender for mental health treatment in preference to incarceration. This is a significant cost savings for taxpayers and should become the focus of lawmakers when the time comes to approve state budgets.

Although treatment of mental health disorders and substance abuse counseling would be beneficial to participating defendants, sometimes they do not follow court orders such as therapy

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and rehabilitation. To keep participants in the treatment plans, courts sometimes use sanctions against them if they do not adhere to therapy and/or medication. Many factors come into play when determining punishment for those who stray from treatment. Because most crimes participants are charged with are misdemeanors, judges feel it is unnecessary to incarcerate since public safety is not an issue (Griffin et al., 2002). Additionally, when mental illness has been deemed the reason for the criminal behavior in the first place many judges are hesitant to penalize the defendant (Griffin et al., 2002). The threat of jail works for participants in drug courts but does not work with those in mental health court. Those involved in drug courts apparently do not want to spend their weekends behind bars, whereas those in mental health courts use the time in jail to get some much-needed sleep in a controlled, secure setting (Griffin et al., 2002). A better strategy to encourage compliance by the mentally ill is to replace jail time with community service; this prompted those in mental health court to adhere to the court's ruling because they are not opposed to jail time and would rather be sleeping in a cell than cleaning up litter (Griffin et al., 2002). It seems sanctions must be distinctive to each individual mental health court participant in order for the penalty to be effective (Griffin et al., 2002). This gives judges some leeway to use creative disciplinary approaches based on the personality of each defendant. With input from mental health clinicians, judges can reprimand participants on a case-by-case basis to come up with the most beneficial solution to each specific problem.

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Mental health courts were created partly because studies have shown the rate of mentally ill who are imprisoned is disproportionately high. In 2000, the American Psychiatric Association (APA) estimated 20 percent of prisoners suffered from severe mental illness, and 5 percent of these individuals were considered "actively psychotic at any given moment" (as quoted in Human Rights Watch, 2003, 17). By comparison, the APA estimated approximately 5 percent of the United States population is considered mentally ill (as cited in Human Rights Watch, 2003).

This imbalance is indicative of the need for more mental health services available to members of the community before they wind up in the criminal justice system. In 2003, the President's New Freedom Commission on Mental Health stated in its report to President George W. Bush, Mental health delivery system is fragmented and in disarray‌lead[ing] to unnecessary and costly disability, homelessness, school failure and incarceration‌In many communities, access to quality care is poor, resulting in wasted resources and lost opportunities for recovery. More individuals could recover from even the most serious mental illness if they had access in their communities to treatment and supports that are tailored to their needs (as quoted in Human Rights Watch, 2003, 20).

Incarcerating these individuals contributes to the problem of prison overcrowding and further perpetuates the individual's illness. In the United States, more seriously mentally ill persons are held in prisons and jails than cared for in all mental health facilities en masse (Pustilnik, 2005). It is estimated that for every one mentally ill person in a medical facility, there

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are five mentally ill inmates in prison or jail (approximately 60,000 and 300,000, respectively) (Pustilnik, 2005). Many of those in jail have only committed minor "nuisance" offenses, such as disturbing the peace, public intoxication, or panhandling; some have not been charged with any offense and are being held "because there is no other place to accommodate them" (Pustilnik, 2005, 228). Although it is against the law for individuals to be detained as a criminal without charges against them, nearly 30 percent of jails across the country stated in a survey conducted by the National Association for the Mentally Ill (NAMI) that they practice this regularly (Torrey et al. as cited in Pustilnik, 2005). They are simply jailed because they openly demonstrated "the symptoms of untreated mental illness" (Council of State Governments, 2002, xii). Furthermore, some police officers admit to making up charges against individuals suspected of being mentally ill "in order to bring them to jail" (Pustilnik, 2005, 229).

This is not a sufficient reason to detain someone and is in fact a violation of the detainee's constitutional rights under the writ of habeas corpus (Pustilnik, 2005). Keep in mind if the so called "symptoms" are determined by an arresting officer, most police officers are not trained in the field of mental health and therefore cannot place someone under arrest for merely displaying odd behavior. Proper training for all first respondents – police officers and EMS crews in particular – should be implemented so officers and medical technicians are sensitive to the special needs of the mentally ill. Rather than arresting an individual who is somehow "acting weird," law enforcement officers could refer the person to a social worker or health care facility

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for evaluation. This eliminates the cost of manpower and red tape involved in taking the person into custody and could prove to be helpful in treating the person's disorder, if one exists. This form of diversion is supported by the National Mental Health Association because the mentally ill individual is not "criminalized" for his or her illness.

Because most prisons are already overcrowded and understaffed, they do not have the resources necessary to provide effective mental health treatment - including access to medications mentally ill prisoners need (Council of State Governments, 2002). Mentally ill inmates will reveal their illness by being disorderly, destructive, aggressive and violent, which leads to higher rates of policy violations (Butterfield, 2003). Because of this lack of control over their own behavior, these inmates are often placed in isolation or solitary confinement. This can be more detrimental to their psychological well-being than it would be for an inmate without a mental disorder (Butterfield, 2003) and could lead these individuals to become even more harmful to others or to themselves (Council of State Governments, 2002). Fred Cohen, a prison litigation expert, says, "People who are just so unsocialized and so psychologically fragile to begin with are deprived of any kind of social support, any kind of psychological stimulus. And they just fall apart" (Navasky & O'Connor, 2005). The unruly behavior also leads these inmates to be incarcerated for longer periods than other inmates without mental health conditions, thereby adding to the overall cost of incarceration (Council of State Governments, 2002).

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Many citizens and policy makers are calling for the construction of more prisons to deal with the overcrowding situation but building more prisons is not an appropriate solution to this social problem. Providing adequate mental health services in the community and in prisons and jails as part of the rehabilitation process will provide relief to the overburdened criminal justice system when dealing with the mentally ill. It will also prepare inmates for release back into the community, teaching the inmates to keep their illness in check through proper medication and counseling. Ensuring paroled inmates have access to public services is vital to the successful reentry of these individuals. These men and women will need adequate housing, a steady income and access to proper mental health care or they will simply be back in the criminal justice system at some point in the future.

While social services are necessary to the survival of many members of society – for instance paroled mentally ill prisoners – states have recently been faced with tightened budgets and federal cutbacks. Social services are sometimes the first victims of budget cuts; this can be harmful or even dangerous to those who benefit from these services the most. Some policy makers feel cutting the budgets of state mental health departments through privatization will save taxpayers money. They argue taxes will not need to be raised in order to pay the employees of the state-run departments, which in turn will boost the economy (Pecinovsky, 2004). In reality, it could cost them more in the long run because many former recipients of the public services will now be without access to treatment due to lack of private health insurance. Some of these

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individuals will eventually be placed in jail which will cost taxpayers more than keeping treatment accessible in the first place (Pecinovsky, 2004). Incarcerating a mentally-ill offender costs approximately 75 percent more than incarcerating people without mental illness (Pustilnik, 2005). In addition, more prisons would need to be built to house inmates; funding for prison construction would come directly from the taxpayer. It is quite a conundrum: pay for mental health services for mentally ill offenders now or pay to incarcerate mentally ill inmates later.

Direct costs to the public include costs of arrest, detainment, release, court hearings, police officers' salaries, court officials' salaries, and attorneys' fees; indirect costs include a person's illness being left untreated, confinement that exacerbates the problem, the possibility of suicide by the untreated individual, unpaid care provided to the person by family and friends, and lost productivity for all (Pustilnik, 2005). Direct costs of incarcerating nonviolent mentally ill prisoners are conservatively estimated to be about $4.75 billion every year for state prisons; this makes it impossible for state governments to ignore (Pustilnik, 2005). Treatment for these individuals is a better solution and would be far less expensive.

Mental health courts can reduce the number of nonviolent mentally ill offenders sentenced to prison, can provide proper treatment for these individuals, and can keep the costs to taxpayers down. Ignoring the problem will not make it go away and spending money on prison construction rather than on public health care will make the problem worse. Apathy and ignorance by the public and the bureaucracy have created this problem and now it is time to

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change the methods by which mental illness is handled in the public sector. By shifting attitudes with regard to caring for the mentally ill population in the United States, elected officials and citizens alike will make progress toward solving this national mental health care crisis.

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Resources Butterfield, F. (2003, October 22). Study finds hundreds of thousands of inmates mentally ill.

New York Times. [Electronic version]. Retrieved August 7, 2006 from HYPERLINK "http://www.commondreams.org/headlines03/1022-04.htm" http:// www.commondreams.org/headlines03/1022-04.htm Casey P. & Hewitt, W. (2001). Court responses to individuals in need of services: Promising components of a service coordination strategy for courts. National Center for State Courts. Williamsburg, VA. Retrieved August 27, 2006 from HYPERLINK "http:// www.ncsconline.org/WC/Publications/Res_ProSol_CrtResponsesPub.pdf" http:// www.ncsconline.org/WC/Publications/Res_ProSol_CrtResponsesPub.pdf Center for Court Innovation. (n.d.). Proliferation of mental health courts. Mental Health Court: Articles. New York. Retrieved August 27, 2006, from HYPERLINK "http:// www.courtinnovation.org/index.cfm? fuseaction=Document.viewDocument&documentID=605&documentTopicID=25&docu mentTypeID=10"http://www.courtinnovation.org/ Council of State Governments. (2002, June). Criminal justice/mental health consensus project.

Lexington, KY. Retrieved August 27, 2006 from HYPERLINK "http:// consensusproject.org/the_report/toc/" http://consensusproject.org/ the_report/toc/

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Crick, C. & Potter, R.H. (2006, July). The perception of health and mental health services: Benefits and barriers. Corrections Today, (68)4, 34-37. Retrieved August 19, 2006 from the ProQuest Criminal Justice database.

Davis, W. (2003, February). Special problems for specialty courts. ABA Journal, (89)2, 32-37.

Retrieved June 12, 2006 from the Academic Search Elite database.

Ditton, P. (1999, July). Mental health and treatment of inmates and probationers (NCJ Publication No. 174463). U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Washington, D.C. Retrieved August 7, 2006 from HYPERLINK "http://www.ojp.usdoj.gov/bjs/pub/pdf/mhtip.pdf" http://www.ojp.usdoj.gov/bjs/pub/pdf/ mhtip.pdf Griffin, P., Steadman, H. & Petrila, J. (2002, October). The use of criminal charges and sanctions in mental health courts. Psychiatric Services, 53(10), 1285-1289. American Psychiatric Association. Retrieved August 25, 2006 from HYPERLINK "http:// psychservices.psychiatryonline.org/cgi/content/full/53/10/1285" http:// psychservices.psychiatryonline.org/ cgi/content/full/53/10/1285 Human Rights Watch. (2003). Ill equipped: U.S. prisons and offenders with mental illness. New York. Retrieved August 27, 2006 from HYPERLINK "http://www.hrw.org/reports/2003/

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usa1003/usa1003.pdf" http://www.hrw.org/reports/2003/usa1003/ usa1003.pdf Koopman, J. (2006, January 23). An alternative to incarceration. San Francisco Chronicle [Electronic version]. Retrieved June 7, 2006 from HYPERLINK "http://www.sfgate.com/ cgi-bin/article.cgi?f=/c/a/2006/01/23/MNGBNGRIFC1.DTL&hw=an+alternative+to +incarceration&sn=003&sc=632" http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/ 2006/01/23/ National Center for State Courts. (2002, November). Strategies for court collaboration with service communities (NCJ Publication No. 196945). U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Assistance. Washington, D.C. Retrieved September 22, 2006 from HYPERLINK "http://www.ncjrs.gov/pdffiles1/bja/196945.pdf" http://www.ncjrs.gov/pdffiles1/bja/196945.pdf National Mental Health Association (NMHA). (2006). Mental health courts. Alexandria, VA. Retrieved September 9, 2006 from HYPERLINK "http://www.nmha.org/position/ mentalhealthcourts.cfm" http://www.nmha.org/position/mentalhealthcourts.cfm Navasky, M. & O'Connor, K. (Writers) & Navasky, M. & O'Connor, K. (Directors). (2005, May 10). The new asylums [Television series episode]. In M. Navasky & K. O'Connor (Producers), FRONTLINE. Boston: WGPH/PBS Television. Retrieved August 13, 2006 from HYPERLINK "http://www.pbs.org/wgbh/pages/frontline/shows/asylums/etc/

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synopsis.html" http://www.pbs.org/wgbh/pages/frontline/shows/asylums/etc/ synopsis.html Pecinovsky, T. (2004, March 6). Mental health battle in Missouri. People's Weekly World, 18(38).

Retrieved August 25, 2006 from HYPERLINK "http://www.pww.org/article/articleview/ 4887/0/" http://www.pww.org/article/articleview/4887/0/ Pustilnik, A. (2005). Prisons of the mind: Social value and economic inefficiency in the criminal justice response to mental illness. Journal of Criminal Law & Criminology, 96(1), 217-265. Retrieved August 9, 2006 from the Academic Search Elite database.

"A court order mandating that an imprisoned person be brought before the court for a hearing to determine whether or not he has been imprisoned with due process." (directly quoted from HYPERLINK "http:// www.thelawencyclopedia.com/term/habeas_corpus percent2C_writ_of" TheLawEncyclopedia.com)

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