Decreased Budgets Result in Jails Becoming Mental Institutions

By S. Van McCrary, Health Law & Policy Institute

A recent New York Times report suggests that, by default, jails have become the only available mental health institutions for a large segment of the mentally ill population in the United States. The report notes that, on any particular day, more than one in ten of the total persons incarcerated are known to suffer from a severe mental illness, a rate approximately four times that of the general population.

Some of these persons have been arrested for serious crimes, but most are homeless individuals charged with trivial incidents that are largely a product of their illnesses. Others are picked up by the police for simply acting strangely, in what have been dubbed "mercy arrests."

This trend is the product of a number of complex factors, but is generally attributed by experts to the combined effect of budget reductions and facility closings in the public mental health care system and increased building of jails and prisons in an attempt to fight crime. Consequently, jails have become the only facilities still open to indigent mentally ill persons 24 hours a day. According to Dr. Eugene Kunzman, a former medical director of the mental health program at the Los Angeles County Jail, "[t]he inmates we see today in jail are the same people I used to see in psychiatric hospitals" (N.Y. Times, 3-5-98).

A major problem with this phenomenon is that jails were not designed to deal with mentally ill persons. For example, guards may not know how to respond to mentally ill inmates who are incapable of following the regimented life of incarcerated persons. As a result, many of the mentally ill find themselves in solitary confinement. Further, because judges are often reluctant to grant bail to disturbed inmates who need treatment, they tend to stay incarcerated for significantly longer periods than most other inmates. Paradoxically, however, it may take weeks for a mentally ill person in jail to be seen by an institutional psychologist, during which time the person's medication typically has been discontinued. Thus, being incarcerated may make the mental illness substantially worse for may inmates. The result is a "revolving door" syndrome, in which mentally ill persons constantly rotate between outpatient clinics and jail.

This problem may be even worse for young mentally ill persons. In many states, budgets for adolescent psychiatric hospitals have been reduced even more than those of adult facilities. Nationally, it is estimated that 20 percent of juveniles in jail are seriously mentally ill. This disproportionate incarceration is exacerbated by the fact that mentally ill juveniles tend to "act out" their illnesses in more aggressive and impulsive ways than some adults.

The Times report suggests that, although no one has calculated the cost of shifting the mentally ill into the criminal justice system, at the rate per inmate in New York ($30,000 per year), the annual cost to jails and prisons would be $3.7 billion, excluding the supplemental expenses of treatment for the mentally ill. Because of the adverse effects on mentally ill persons, even mental health professionals who formerly advocated deinstitutionalization of the mentally ill are reconsidering the large-scale closing of state mental hospitals. Reflecting on this problem, a number of professionals interviewed made a point similar to that of Linda Reyes, a psychologist at the Texas Youth Commission, which is that "[u]nless you are wealthy and can afford private doctors, you have to get arrested to get treatment."