Failed by two systems

Imagine that you had become gravely ill. You were so sick that you couldn’t function. Your family couldn’t take care of you; and nobody seemed to offer any meaningful treatment. Now assume that instead of being taken to the hospital, you were taken to prison. For a growing portion of our population that’s exactly what is happening.

According to a report by the National Alliance on Mental Illness (NAMI), states across the nation have cumulatively cut over $1.8 billion from their mental health services from 2009 to 2011. Another report by the National Association of State Mental Health Program Directors put the number as high as $4.35 billion from 2009 to 2012.

According to NAMI, this represents the largest reduction in state mental health services since the Community Mental Health Centers Act of 1963 sought to officially de-institutionalize mental health treatment by moving towards prescription medication, outpatient services, and other approaches that allow patients to remain in their communities.

While no one can rationally suggest that a return to the dark days of torturous asylums is an appropriate solution, the alternative we’ve constructed is equally inhumane. With a lack of in-patient treatment options, the prison system has become the catch basin for many of America’s mentally ill citizens. A 2006 U.S. Department of Justice study found that 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of local jail inmates suffered from some form of mental health problem. Moreover, the Kaiser Foundation observes that greater than 60 percent of adults with a mental disorder and 70 percent of children were not receiving the mental health services they needed.

From this paucity of treatment options, we have seen a tremendous spike in untreated mental illness, homelessness and substance abuse. The criminal justice system has unwittingly stepped in to fill the void that should be covered by more universal health care options.

While all of these latent consequences are bad, the de facto criminalization of mental illness is arguably the worst of them. If a person’s primary deficit is the presence of a mental illness, it’s difficult to imagine how incarcerating him is supposed to treat or cure the underlying problem. Prisons are, after all, not known as bastions of advanced medical care.

In an interview with CBS News, Cook County, Illinois Sheriff Tom Dart summarized the problem his county (that subsumes Chicago) faces: “This is something that happens all the time here and the heart of it is, we’re not a mental health facility. These people should not be here. These people by and large are not criminals. They’re people with mental illness, but when they act out, they end up in the jails because it’s the only place that’ll take them.”

Dart’s point is that jailers and most correctional staff are not mental health professionals —- nor should we expect them to be.

Also interviewed by CBS, Los Angeles County Sheriff Lee Baca says more mentally ill people end up in jail when they’re not getting the medications they need.

“I’m not a psychiatrist, but the jail has become a hospital, in a de facto way, for the mentally ill. They do commit serious crimes; we don’t deny that. What is the remedy, is it purely a criminal justice remedy? I don’t think so,” said Baca.

If we were to simply count the number of mentally ill persons housed inside the two largest jails in the United States, Cook County and LA County would be the largest mental institutions in the country.

Locally, we’ve begun to talk about treating the causes of crime, not just the symptoms. As these reports suggest, that conversation needs to be broadened and taken deeply to heart.