Prison as psych ward: The cost of incarcerating the mentally ill

Local officials say nearly 20 percent of inmates in the Albemarle-Charlottesville Regional Jail are on medication for mental illnesses, and that there are more who are going untreated. File photo. Local officials say nearly 20 percent of inmates in the Albemarle-Charlottesville Regional Jail are on medication for mental illnesses, and that there are more who are going untreated. File photo.

High-profile acts of violence tend to bring with them a spike in public awareness of mental illness, but the stigma associated with being mentally ill never subsides. The system still seems to favor locking people up rather than treating them.

My wife and I lived five minutes away from the Safeway in Tucson, Arizona, where Jared Loughner killed six people in 2011. We shopped there. Like many, I believe Loughner is a monster.

But the kinds of acts that garner 24/7 news coverage—from the Tucson killings to Gus Deeds’ attack on his father, State Senator Creigh Deeds, and subsequent suicide in Bath County last month—are also tragic examples of the failings of the mental health system in the U.S.

While our public mental health systems are chronically undersupported, our prisons aren’t. The U.S. has “enjoyed” an imprisonment boom during the past three decades, with ever-increasing incarceration rates. Virginia, like every other state, has directed more and more resources to prisons and jails due to the steady inmate population growth. The Commonwealth spent $1.1 billion on corrections in 2010, which breaks down to $11,858 per offender—over $2,000 above the national average.

One segment of society that has been disproportionately affected by the dramatic growth of America’s prison population are those suffering from mental illness. The largest mental health facilities in the United States are not hospitals or residential treatment centers—they’re jails.

“The criminal justice system’s role is not treatment, it’s for punishment and locking people away,” said local attorney Abigail Turner. “Inmates [with mental illness] need the same type of treatment people on the street receive but there’s not adequate funding to do this.”

Currently, Virginia has around 30,000 inmates in state prisons, served by 14 psychiatrists. Many of these inmates take medication for psychiatric conditions, yet many more suffer from mental illness without receiving any type of treatment.

“We have 400 inmates right now and about 17 to 19 percent of those are taking medication for mental illness,” said Juanita Morris, the director of health services at the Albemarle-Charlottesville Regional Jail. “There are more mentally ill inmates but they don’t take medication.”

Even inmates who receive medication may be poorly diagnosed and may not get the type of individualized treatment necessary for mental illness.

“Prisons and jails should not operate as first line treatment facilities,” said local public defender Jim Hingeley. “They get trapped doing this because of lack of resources for mental health treatment, but they’re not equipped and they don’t want to be doing this type of work.”

Hingeley stressed that it’s low-level offenders with mental illness that come into contact with the criminal justice system a lot more often than violent and dangerous offenders. Due to a lack of alternatives, the only viable option has been to lock these individuals up. This response shows that the criminal justice system doesn’t have a good way to address the needs of mentally ill low-level offenders.

The resulting costs could potentially be tolerated if it could be proven that incarceration prevented recidivism and effectively treated the offender dealing with mental illness. But no proof has been offered as of yet, and the evidence that has been offered proves quite the opposite.

However, some recent developments at the state and community levels may be cause for optimism.

The Virginia Supreme Court appointed the Commission on Mental Health Law Reform in 2006, which was tasked with finding ways to use the law more effectively to serve the needs and protect the rights of people with mental illness. One specific goal was to avoid criminalizing people with mental illness.

The community rallied around the idea of developing a local Crisis Intervention Team (CIT) that same year, which specially trains police officers on how to deal with confrontations involving mentally ill individuals. One crucial benefit of the CIT program is that trained officers can take a mentally ill subject directly to a hospital for treatment rather than the jail in appropriate situations.

Hingeley said the intersection of the mentally ill with the criminal justice system and the corresponding costs is really a subset of the greater debate over mental health resources in Virginia.

“The answer to this involves more things like the CIT program,” he said. There are good ideas out there, “but we need more resources to put [them] into effect.”

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