You might expect to find our country’s largest mental illness center to be a hospital in New York or California. But it’s actually in Illinois, and it’s not a hospital— it’s Cernak, an infirmary in the Cook County Jail. On any given day, between 25 and 30 percent of its 10,600 inmates suffer from serious mental illnesses. Most have been charged with nonviolent offenses, and they “would be far better served by treatment rather than incarceration,” says Cook County Sheriff Thomas J. Dart. So why are they in jail? It’s the only option available. Sheriff Dart explains, “They end up here (the criminal justice system), because we are the only system that can’t say no. When they are charged with crimes, no matter how minor, we have to take them.”
Cernak does an exceptional job with its mentally ill inmates. While in jail, inmates are diagnosed and treated, and often they stabilize. But the costs are high—$50,000 per inmate annually—and often the results are only temporary: After offenders are released, many stop taking their medication and cycle through the criminal justice system repeatedly.
“Fiscally, this is the stupidest thing I’ve seen government do,” Sheriff Dart said, noting it would be far cheaper to manage the mentally ill with a caseworker on the outside than to spend such sums incarcerating them. “It’s criminalizing mental illness.” One example is a “chronic self-mutilator” who has been arrested more than 100 times, at a cost of more than a million dollars. But other options for treating mental illness are limited in Cook County. For example, Chicago closed six of its twelve outpatient mental health clinics in 2012.
The problems at the Cook County jail are all too familiar to criminal justice professionals. In the US more than three times as many mentally ill people are housed in prisons and jails as in hospitals, according to a 2010 study by the National Sheriffs’ Association and the Treatment Advocacy Center. It’s a national problem—and an expensive one: Offenders with psychiatric disorders cost taxpayers $300 or $400 a day because they require costly medication and extra supervision and care.
In a recent USA Today report, journalist Kevin Johnson recounted a story that’s typical of what police must deal with: A 57-year-old woman in Newport, Rhode Island has called 911 more than 60 times to report three imaginary intruders who are pursuing her.
National statistics about the extent of the problems are shocking:
- According to a 2006 Justice Department study, more than half of prisoners in the United States have a mental health problem, but two-thirds of state prisoners receive no treatment during their incarceration. The figures are even more dismal in federal prisons (25 percent receive treatment) and local jails (one-sixth are treated).
- Female inmates are more likely than males to have mental health problems, and the rates are high (73% vs. 55% in state prisons, 61% of females vs. 44% in federal prisons, and 75% vs. 63% in local jails).
- According to the Justice Department, mentally ill inmates are much more likely than other inmates to be injured in a fight in jail. Other studies show that they have a high likelihood of being preyed on by other inmates or exhibiting behavior that results in discipline.
- Some 40 percent of people with serious mental illnesses have been arrested at some point in their lives.
Although mental issues can be seen across the criminal justice system, local jails bear the brunt of the problem. Amy Fettig from the American Civil Liberties Union’s National Prison Project describes jails as “the new social safety net for individuals with mental illnesses.” According to Fettig, “The incredibly high intake rate makes it very difficult (for jailers) to do their job well because they operate in environments that are so chaotic.” The ACLU sued a number of jails to demand them to provide federally mandated care and improve conditions for inmates with mental illnesses.
Why is law enforcement involved in the mental health field at all? The answer lies in the history of mental illness in the US. In the 18th and 19th centuries, there was little distinction between mental illness and criminality: Imprisonment was the usual remedy. Dorothea Lynde Dix (1802 – 1887) was a persuasive advocate for more humane treatment of the mentally ill. Through her influence, asylums were established and new methods of treatment were adopted.
By the 1970s, however, serious questions were being raised about whether mentally ill patients belonged in institutions, where they were often confined for long periods against their will. When new drugs were developed that allowed patients to function in society, states began closing their psychiatric hospitals. Seriously mentally ill patients were released to communities that promised to establish adult day programs, drop-in centers, transitional housing, and other programs for them.
But over time those promises were largely forgotten, and many mentally ill patients had no alternatives but life on the streets and—all too often—socially unacceptable behavior. Sheriff Dart explains, “The only way we could justify shutting down hospitals is to make way for the emergence of new medication or treatment that allowed for sick people to be treated in another way. That didn’t happen.”
People picked up repeatedly for minor crimes become what jail personnel call “frequent flyers.” For example, at the Volusia County Detention Center in Daytona Beach, Florida, administrators compiled a list of offenders who’d been booked into the jail at least 20 times over five years. The 19 worst had been collectively jailed 894 times, mostly for minor offenses. Nearly half had a history of mental illness.
The county jail in Wichita, Kansas, reports similar problems. On a recent afternoon, 407 of its 1,400 prisoners had some kind of mental illness. One of those inmates had been booked into the jail 27 times over an 18-month period.
A related problem is that many citizens have begun thinking of police departments as multi-service social agencies. Police Lieutenant William Fitzgerald from Newport, Rhode Island says, “Some are looking to the police department to do things that you never imagined. Dealing with the mentally ill is part of that. And we’ve never been equipped to do half of these things.”
Instead of finding solutions, jails and prisons are reporting that the problems keep getting worse. In the 1980s, researchers found about 6 percent of jail and prison inmates showed signs of serious mental illness. By 2009, 17 percent of male jail inmates had serious mental illnesses, with significantly higher rates among women. Now jails are saying that far greater numbers of mentally ill inmates stay locked up longer, for a variety of reasons. One is that they often lack the money and family ties needed to make bail; another is that they don’t cooperate with jail rules and procedures.
“Even what we had when I started doing this work in 1988 was better than what we have now,” says Nancy Koenigsberg, legal director for Disability Rights New Mexico. In 2010 her organization sued the Dona Ana County Detention Center for mistreating inmates.
Problems abound when jails and prisons try to cope with the chaos and costs associated with a never-ending stream of mentally ill offenders:
- In June, federal officials cited “deplorable” conditions for mentally ill inmates in the Los Angeles County jails in connection with 15 suicides in 30 months. Although Los Angeles has been under federal supervision since 2002, the Justice Department says that it still fails to adequately supervise inmates with mental illnesses or provide care for “prisoners with clearly demonstrated needs.”
- In Pensacola, Florida, the county has taken operation of the jail away from the sheriff because of inadequate conditions for mentally ill inmates. A highly critical report from the Department of Justice officials noted that only one part-time psychiatrist was available to treat 1,314 inmates.
- In the Columbus jail in Nebraska, six inmates have already attempted suicide this year, equaling all attempts in the previous 10 years combined. Eighty percent of the inmates are reported to be under treatment for mental illness.
- At least 9 of the 11 suicides in New York City jails over the past five years came after operators failed to follow safeguards designed to prevent self-harm by inmates. In one case, a mentally ill man hanged himself from a pipe on his third attempt after orders to put him on 24-hour watch were apparently ignored.
- At the Rikers Island jail complex in New York City, the deaths of two mentally ill inmates have prompted oversight hearings. One inmate “essentially baked to death in a 101-degree cell in February,” according to an AP report, and the other sexually mutilated himself.
As the problems grow and receive more media attention, communities and agencies are beginning to search for solutions. One obvious need is for more community mental health centers.
Less obvious but just as urgent is the need for police officers with mental-health training. The National Alliance on Mental Illness (NAMI) in Washington has called for the creation of special units in law enforcement agencies across the country to help deal with calls involving those who are mentally ill or have disabilities or behavioral problems. “Police are often the first responders when a person is in psychiatric distress,” the NAMI says. “Every community owes it to them to provide the knowledge and training to handle safely and compassionately mental health crisis situations.” Crisis Intervention Team (CIT) programs have already been established by 2,700 police agencies, and more are coming.
Two news stories that received wide coverage in the media illustrate the need for specialized mental-health training for officers:
- On January 5, 2014, a police officer killed an 18-year-old teenager who had been diagnosed with schizophrenia. Keith Vidal was at home with his parents when they asked police to help calm their 90-pound son, who was threatening to harm his mother with a screwdriver. Two police officers came to the house and managed to calm Keith. But a third officer arrived and declared, “We don’t have time for this” before shooting Keith, who died moments later.
- On August 7, 2013, two police officers went to the Marriott Hotel in Newport, Rhode Island to talk to a mentally ill naval reservist who claimed that he was being controlled by “a microwave machine” that sent vibrations into his body and kept him from sleeping. A Newport police sergeant faxed a copy of the police report to naval station police, who saw no reason for concern. Six weeks later, on September 16, Alexis fatally shot twelve people at the Washington Navy Yard—the second deadliest mass murder on a US military base.
What changes can be expected as communities and agencies search for strategies for dealing with mentally ill offenders? Some jurisdictions have already begun to develop programs to meet these challenges. In Virginia, a program called VAbode (Associated Behavioral Outcomes & Developmental Experts of VA) provides services to mentally ill citizens in a variety of settings. Offenders are referred to paraprofessionals who help them stabilize and get medication. Similar programs are springing up in other areas.
Criminal justice professionals are hoping that the Affordable Care Act (“Obamacare”) will provide broadened services for citizens suffering from mental illness. Under the ACA, patients with existing conditions can no longer be denied coverage, and treatment options for mental illnesses have been expanded.
As more and more Americans qualify for health insurance, mental-health treatment is likely to be available to more patients with schizophrenia, alcohol dependence, depression, and bipolar disorder—conditions that are often seen in American jails and prisons. Most important, the ACA provides broadened services for young adults up to age 26. Experts say that half of all mental health and substance abuse issues begin by age 14.
Pharmaceutical advances are also likely to bring improvements. For example, subdermal medications are now available to sex offenders. Because only one dose is needed each month, offenders will be less likely to go off their medications and lapse into former behaviors.
The powerful American Psychiatric Association (APA) has made recommendations about the future course of mental health treatment in the US. It has called for “a new commission—either Presidential or Congressional—to conceptualize how our nation’s mental health system can meet the needs of all Americans in the twenty-first century.”
The Board of Directors of Crisis Team International has issued its own statement that it “strongly supports the suggestion of APA and is hopeful that a presidential or congressional commission will be appointed and that it will include: 1) representatives of first responders experienced with assisting persons with mental illness in crisis; (2) representatives of persons with mental illness and their family members; and (3) mental health providers.”
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Jean Reynolds, Ph.D. is Professor Emeritus of English at Polk State College, where she taught report writing and communication skills in the criminal justice program. She is the author of ten books, including Police Talk (Pearson), and she publishes a Police Writer Newsletter. Visit her website at www.YourPoliceWrite.com for free report writing resources. Go to www.Amazon.com for a free preview of her book Criminal Justice Report Writing. Dr. Reynolds is the police report writing expert for Law Enforcement Today.