The goal of America's correctional facilities is supposed to be punishing criminals for wrongdoing, and preparing them to reenter our society. But the successful transition of inmates back to their communities is severely hampered by many factors, including the poor quality of mental health treatment in jails and prisons and the inability of ex-convicts to obtain mental health counseling and medication once they are released.
Some experts argue that the root cause of this problem was a public policy decision several decades ago to deinstitutionalize mental health services, a process that has closed many institutions across the country that had housed and treated people for mental illnesses.
The unfortunate reality, probably unintended, is that the nation's prisons and jails now house far more people with mental illnesses than mental health facilities. This is fraught with problems: the nation's overcrowded correctional facilities lack the resources, training or medicine to properly treat inmates needing mental health treatment.
In 2006, the U.S. Justice Department's Bureau of Justice Statistics released a study noting that more than half of all prison and jail inmates, including 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of local jail inmates, were found to have mental health problems. Even more troubling, their report said that only one in three state prisoners, one in four federal prisoners and one in six jail inmates who had mental health problems received treatment while incarcerated.
Still, federal, state and local officials have been slow to address this serious issue. However, the courts are condemning the inhumane conditions in prisons and joining with health activists, reentry experts and community leaders to demand changes.
In California, for instance, federal judges issued an Aug. 4 order that the prison population must be reduced by 40,000 inmates, one-fourth of those incarcerated. The judges cited the horrible conditions, specifically referencing poor mental health treatment.
"The medical and mental health care available to inmates in the California prison system is woefully and constitutionally inadequate, and has been for more than a decade," the judges wrote in their ruling. "Tragically, California's inmates have long been denied… minimal level of medical and mental health care, with consequences that have been serious and often fatal... A significant number of inmates have died as a result."
At the Freedom Voices Conference sponsored recently by the Morehouse School of Medicine Community Voices Program, a panel of experts discussed the scope of the mental health problems at correctional facilities.
"Two of the largest mental health treatment facilities in the country are the Los Angeles County Jail and Rikers Island in New York," said Judge Stephen Goss, who oversees the Dougherty County Georgia Superior Court Mental Health/Substance Abuse Treatment Program. "Pick any state and you'll pretty much find that more people are treated for mental health issues in their jails and prisons than any single or collective group of state hospitals and clinical facilities."
Judge Goss related a typical scenario for repeat offenders:
"We have people coming in. They're on medication. They're doing pretty good; holding down a job; taking care of their family…then something happens, a stress event - spouse loses their job, kid has a fender-bender in the parking lot, whatever it might be -- and things start piling on and then they either quit taking their medicine or they mix alcohol with their prescription meds, which is very volatile, or street drugs. Most folks that come into court with mental health issues have a co-occurring substance abuse disorder…they're loud, they're disoriented, the neighbors wear out with them, they call the paramedics, they tussle with the EMT, the sheriff's deputies get called, they land in the jail."
What's usually missing is some kind of intervention that recognizes the mental illness and that this person was fine when medication was used properly.
In Doughty County, Judge Goss established a treatment program where the courts, police, probation officers and mental health officials together address mental illnesses, with an eye towards keeping people out of jail. When the program started eight years ago, participants averaged approximately 130 days a year in the county jail. Three years later, 40 percent of the participants had not returned to jail, and the average jail time was reduced to 30 days a year.
The program demonstrates what can be accomplished when authorities, the community and mental health officials work together.
Clearly, if the nation's criminal justice system is ever going to rehabilitate inmates and send them back as productive citizens in their communities, mental health treatment must become a public policy priority. It's time for action by local, state and federal officials.
Dr. Henrie M. Treadwell is director of Community Voices at Morehouse School of Medicine, a nonprofit organization working to improve health services and health-care access for all Americans.
