VI. Prisons and Jails and the Mentally Ill
The final actor in the criminal justice system with which a mentally ill offender comes into contact is the corrections system. In the United States, the corrections system is composed, at its core, of jails, prisons, probation, and parole. In addition, there are numerous ancillary components, such as community-based correctional facilities, halfway houses, electronic monitoring, home incarceration, and global positioning satellite tracking supervision. These are all broken down into two basic categories: (1) incarceration and (2) community supervision. Incarceration typically refers to jails and prisons, whereas community supervision refers to probation and parole.
Inmates with mental illness make up an increasing number of the U.S. inmate population. In 1999, the jail population of people with mental illness in the United States swelled to 285,000 and approximately 16% of those inmates reported a mental condition or an overnight stay in a mental hospital (U.S. Department of Justice, 1999) According to a 2006 Bureau of Justice Statistics report, 56% of state prison inmates and 64% of inmates in local jails reported mental health problem. According to that same study, half of mentally ill inmates reported three or more prior sentences. Among the mentally ill, 52% of state prisoners, and 54% of jail inmates, reported three or more prior sentences to probation or incarceration.
The National Institute of Corrections estimates the number of people booked into America’s jails at 10 million per year. Using the aforementioned 16% statistic from the U.S. Department of Justice, one can estimate that nearly 1.6 million people per year with a mental condition or mental illness will pass through America’s jails. According to the Bureau of Justice Statistics (2006), more than half of all prison and jail inmates had a mental health problem. This included more than 784,000 inmates in state and federal prisons and more than 479,000 inmates in local jails.
Characteristics of inmates with mental health problems are indicative of the systemic nature of the problems that arose with the deinstitutionalization of the mentally ill. According to the Bureau of Justice Assistance (2006), inmates 24 years of age and younger reported the highest incidence of mental health problems, and those age 55 and older reported the fewest (Bureau of Justice Statistics, 2006). Many of the inmates reported symptoms of a mental health disorder without a recent history of problems or treatment. This exemplifies the problem of the community-based approach to treating persons with mental illness identified by the Council of State Governments (2008) as letting “individuals with mental illness [slip] through the cracks.” More often than not, those who slip through the cracks end up involved with the criminal justice system.
Inmates with a mental health problem had a violent offense as their most serious conviction 49% of the time, compared with 46.5% of the time for other inmates. Although violent offenses were more prevalent among inmates with a mental health problem, the use of a weapon during the commission of the offense was relatively the same as other inmates: 37.2%and 36.9%, respectively. Reinforcing the notion that mentally ill inmates recidivate more often than other inmates is that fact that 61% of inmates with a mental health problem had a current or past violent offense, compared with 56% of other inmates (Bureau of Justice Statistics, 2006). In addition, according to Los Angeles County officials in 1991, 90%of the Los Angeles County jail inmates with mental illness are repeat offenders. Of these inmates, an estimated 31% have been incarcerated 10 or more times (see http://csgjusticecenter.org/mental-health/).
Another issue in dealing with mentally ill inmates is their adaptation to the correctional facility. Nearly 58% of inmates who reported a mental health problem were charged with a disciplinary rule violation, compared with 43% of other inmates. Almost 25% of inmates who reported a mental health problem were charged with a rule violation involving assault, and over 20% were injured in a fight. Only 13% of other inmates were involved in an assault, and 10% were injured in a fight (Bureau of Justice Statistics, 2006). Thus, mentally ill inmates are almost twice as likely as other inmates to be injured in a fight.
The costs of housing mentally ill inmates can quickly add up. According to the Pennsylvania Department of Corrections, housing a mentally ill inmate costs $140 per day, well above the $80 per day of other inmates (Wilkinson, 2003). This equates to a 75% increase in cost per day to house a mentally ill inmate. In addition, a Rikers Island study conducted in 2003 indicated that mentally ill inmates are incarcerated three to four times longer than other inmates (Insel, 2003). Some studies have reported that mentally ill inmates are incarcerated up to eight times longer and at a cost of more than seven times that of other inmates (Stephey, 2007). According to Butterfield (1998), the average length of stay in the New York City jail system is 215 days for inmates with a mental illness, compared with 42 days for other inmates. Thus, in addition to increased cost per day and increased time in prisons and jails, mentally ill inmates present operational problems for correctional facilities.
The day-to-day management of mentally ill inmates presents numerous problems for prisons and jails alike. One of the key issues surrounding prison and jail management of mentally ill inmates is that staff does not understand the dynamics involved. Most corrections staff are not appropriately trained to recognize the challenges associated with mentally ill inmates, such as maintaining medication compliance, behavioral issues, noncompliance with institutional rules, and so on. This is evidenced by the Dunn Decree in Ohio and numerous other court actions that have been previously mentioned.
In addition to prison issues, jails present a different challenge for the staff. The jail is often isolated from community mental health programs, or jail staff lack the knowledge of where to find services. The eight most important issues in managing mentally ill inmates, as delineated by the Standards for the Mentally Ill in Jails (Blough, 2004), are as follows: (1) reception, (2) housing, (3) programming and services, (4) medical services, (5) discipline, (6) physical plant (i.e., the jail facility itself), (7) linkage (i.e., continuity of care), and (8) staff training.
In attempting to alleviate some of the issues surrounding the management of mentally ill jail inmates, the Ohio Supreme Court Advisory Committee on the Mentally Ill in the Courts formed a subcommittee to address jail standards for the mentally ill. The Ohio Supreme Court Advisory Committee on the Mentally Ill in the Courts is composed of representatives from the Ohio Department of Mental Health, the Ohio Department of Alcohol and Drug Addiction Services, the Ohio Department of Rehabilitation and Correction, the Ohio Department of Mental Retardation and Developmental Disabilities, the Ohio Office of Criminal Justice Services, judges, law enforcement personnel, mediation experts, housing and treatment providers, consumer advocacy groups, and other officials from across the state. This committee, formed by Ohio Supreme Court Justice Evelyn Stratton, is working to establish local task forces in each county in Ohio to bring similar local representatives together to collaborate on the issues of mentally ill inmates in the criminal justice system. The Jail Standards Subcommittee developed the set of aforementioned model jail standards as a reference point for jail administrators across the nation.
The model jail standards are a professional guide of recommended practices for jail administrators to promote better care of mentally ill inmates while they are incarcerated and, perhaps most important, provide continuity of care throughout the transition from jail to community by implementing appropriate information sharing and safety net systems to ensure that inmates have the requisite services and community linkages to prevent recidivism.
The most important component of the Standards for the Mentally Ill in Jails is the first one: reception, when the initial screening of the inmate takes place. From this initial screening, inmates are classified and placed in housing of an appropriate security level. Inmates also are screened for medical and mental illness issues and placed in the appropriate programs or care on the basis of the jail’s medical services plan. Many studies have shown that inmates commit suicide within 72 hours of admission to a jail; thus, a comprehensive reception process is vital to the protection of mentally ill inmates.
Another difficult aspect of managing mentally ill inmates falls within the fifth function, discipline. Many mentally ill inmates spend time in disciplinary isolation or lockdown for infractions that, if the proper management team (including a mental health representative) were involved, would not have occurred or may have been viewed as a medical issue instead of a disciplinary issue. In addition, many jails lack the ability to institute therapeutic seclusion when directed by a qualified mental health or medical authority. Thus, the subcommittee has developed standards regarding the construction of a therapeutic seclusion cell that meets minimum guidelines for physical construction while allowing the mentally ill inmate to orient himself or herself to the time of day by providing natural light.
As stated previously, jail staff often lack training in supervising inmates with mental illness. Thus, training standards have been developed for jail staff, including the jail administrator, supervisors, and nonsecurity staff, in regard to recognition, de-escalation, privacy issues, medication responses, and medical contradictions to restraints. In the final analysis, these standards will enable the jail staff to more effectively recognize and properly supervise inmates with mental illness.
Along with drafting standards for mentally ill inmates, the Ohio Supreme Court Advisory Committee on the Mentally Ill in the Courts also advocates community-based treatment and jail diversion programs. These diversion programs are important for both altruistic and financial reasons. Several studies have shown that diverting mentally ill offenders from jails and prisons saves considerable money.
To highlight this cost savings, two programs that provide intensive community-based services to mentally ill individuals who have been involved with the criminal justice system have demonstrated their cost-effectiveness. The Thresholds Jail Program in Cook County, Illinois, demonstrated a cost savings of $18,873 per program participant. This savings was realized over a 2-year period with 30 participants (http://www.thresholds.org/). Another project, in Monroe County, New York, Project Link, demonstrated a cost savings of $39,518 per person over a 1-year period with 44 participants (http://csgjusticecenter.org/mental-health/).