Jul 09, 2015
The New Asylums
She’s a mother and a writer with a son who was recently diagnosed as bipolar. Like many people who become mental health advocates, Liza Long said she arrived at this role by accident.
Before her son’s erratic and dangerous behavior was diagnosed as bipolar, he had already been in juvenile detention four times, along with three stays in an acute mental hospital…He was only 13 years old.
“I did not know how to help him,” she said. “But I did know one thing for sure: my son was not a bad kid. He had behavioral symptoms of a brain disorder that had been with him since birth.”
Long quickly learned that she was not alone in her struggles, as all across America children and adults with serious mental illness are being sent to jail because of their illness.
Cook County Jail
Cook County Jail’s population consists of 9,000 inmates. Of them, 31 percent self-identify as mentally ill. Sheriff Tom Dart is trying to fix it. He started a Mental Health Transition Center on the grounds of the jail last year.
Just two months after the Chicago-based center opened, 34 inmates had enrolled in the program. For the first six weeks, inmates received therapy five days a week for two-and-a-half hours. The goal: change their negative thinking and criminal behavior patterns.
The second six weeks focused on job readiness training. One participant, Willie, turned 47 years old while in the Cook County Jail for drug delivery charges. “I learned how to cope with my inner thinking,” he said. “’Cause I always reacted; never thought about what I was going to do.”
Though still in its infancy, the Mental Health Transition Center is believed to be the only one of its kind in the United States.
“As one of the largest jails in the country, I think other systems will definitely be looking into programs like this to see if it’s something they can do to reduce the jail population,” said Matt Epperson, an assistant professor of social service administration at University of Chicago. “This is not a Chicago problem. It’s very concentrated in Chicago, but this is a national problem that lots of our jails are dealing with.”
Missouri is no different. According to Carrie Pettus-Davis, PhD, MSW, assistant professor at Washington University in St. Louis, Mo., 15 percent of Missouri’s male inmates are considered mentally ill upon admission. The stats are even worse for women at about 23 percent. Pettus-Davis said if you include other types of mental health conditions like depression, anxiety and other disorders that are still disruptive to life, the stats jump up to about 50 to 60 percent.
If that’s not enough, the history of traumatic experiences (experiencing or witnessing severe violence or threat to life) includes about 90 percent of all men and women prisoners. Pettus-Davis said they have experienced one, but more than likely two or more, traumatic experiences. “These have significant physical and mental implications,” she said.
When asked about the legitimacy of likening prisons to mental health asylums, Pettus-Davis said for the most part, it’s true. “People started getting incarcerated and jailed for things that aren’t threats to public safety. For instance, a judge may rule for a person who does not have a place to live to be jailed because they were actively psychotic and the judge was worried about their behavior putting [them] at risk and not necessarily other people.”
She said as those situations increased, more and more people with mental illness were sent to jails and prisons. Consequently, these institutions, much like the Cook County Jail, have started providing mental health treatment. “Now, what we see is more people with severe mental illnesses are in prison than psychiatric hospitals. So a person with a serious mental illness is more likely to be incarcerated in a jail or prison than living in a psychiatric hospital,” Pettus-Davis said.
But by some accounts, she believes Missouri is ahead of the curve compared with the rest of the country when it comes to inmate rehabilitation and reentry programs. Pettus-Davis explained that in the 1990s, Missouri was one of the first states in the country to “strategically and systematically” put comprehensive care around preparing inmates for a successful life after prison. “Missouri was one of four states in the country that the United States Department of Justice selected to work with to develop the process,” she said. Known today as the Missouri Reentry Process, the program strives to prepare inmates for community living, connect them with helpful resources and offer quality health care while incarcerated.
The caveat is that a lot of the programs and practices that the leadership of the Missouri Department of Corrections values and would like to implement are not always feasible due to fiscal constraints, she said. “The annual budget is legislatively determined for the Department of Corrections. They have to prioritize confinement and correctional supervision—over rehabilitation. So, if there is a big budget cut, they have to make sure that their correctional officers and parole and probation officers are staffed appropriately. Once that is taken care of, any monies left over can go into rehabilitation programs, which doesn’t happen often because corrections is very expensive.”
As a result, the rehabilitation programs are inconsistently offered. Pettus-Davis stresses that the leadership at the Missouri Department of Corrections lean heavily toward reentry and rehabilitation programs because 95 percent of people who go to prison are released.
As for Missouri’s recidivism rate (number of people who return to prison for the second time), it differs based on the year and the amount of time that transpires after the inmate’s first release.
Missouri has yet to conduct a study that focuses on the mentally ill who return to prison a second time. To take a page from Cook County Jail’s play book, many inmates wrestle with mood disorders and addiction. But some jail or prison inmates face much bigger challenges like schizophrenia or bipolar disorder.
This means if they have been released with no treatment and no means to seek help, the possibility of reincarceration is high. “When people come into the system, we now interview them,” Sheriff Dart said. “We treat them like clients—figure out ways to put them in another setting other than jail.”
Decriminalizing Mental Illness
As for Long, she said treated, her son is just like anyone else. Yet, children like her son are likely to join hundreds of thousands of other children with serious emotional disturbance diagnoses in the school-to-prison pipeline.
For this reason, Epperson believes Dart and his transition center are on the right track in their efforts to develop interventions for people with mental illness who end up in the criminal justice system. He said typical interventions only treat the mental illness, but there are other factors that coincide.
“Research is showing there are criminal risk factors,” Epperson said. “Most of that research has been done in the criminal justice system without mental illness. But recent research is showing that these criminal risk factors are just as prevalent in people with mental illnesses.”
He added that treatment for both criminal behavior and mental illness can be delivered at the same time in the same places. “I would argue that they should both be in mental health settings but also in the criminal justice side,” he said. “I think for too long these two systems have often argued about whose responsibility it is to really work with the population, and I would say that there’s plenty of work to go around.” Pettus-Davis agrees. She said that communities also need to step up to the plate, adding that support resources like housing, employment and medication assistance need to be available before and after people come in contact with the criminal justice system.
“The prison system’s primary purpose is to confine people,” she said. “And after they confine them and they get out, the prison has no purview of them…the community is where people live. I think that’s one of the number one issues.”
Pettus-Davis said that better coordination of care between prison officials and community mental health organizations during the transition period is needed. This includes sharing medical records, and providing prescription assistance to help the mentally ill maintain stability during the transition from prison to community. Long takes an even more hard-hitting stance on the matter. “I’m ashamed--not of my son and the millions of people like him who are courageously living the best lives they can despite significant challenges. I’m ashamed of the rest of us who tell ourselves that ‘those people’ got what they deserved. We don’t want those ‘weird kids’ in our children’s classrooms. We don’t accept that with the right supports, people can manage their diagnoses and live successful, productive lives in their communities. For those who cannot meet this worthy goal because their illness is too severe, we do not provide quality medical care, preferring instead the cold, harsh reality of a jail cell and solitary confinement.
“We can do better. We must do better. Our children are depending on us as a society to provide treatment before tragedy. People with mental illness should finally get what they deserve: compassion, admiration, support and hope,” Long said.