My thoughts on the previously posted article...

Now that I have emerged from  a doggy crisis, a finance exam, a take home exam and quite a few papers, I am ready to discuss the article I posted last week and promised a follow up to, “For Mentally Ill Inmates, Health Care Behind Bars is Often Out of Reach”.  Sorry it took so long.

Let me start off by saying, I believe that the jailed mentally ill is a huge problem that needs to be dealt with on a large scale in the United States- although not likely to happen in a political time like this!

Reading through this article….

1.       I first thought, good for them for standing up for themselves!  They were at quite a disadvantage in the eyes of many by not only being mentally ill but also being convicted criminals.  It’s good that these individuals have been awarded money for their unfair treatment but a true shame that they were treated that way.

2.       I then thought, hopefully this will sway other jails from this same type of treatment towards mentally ill individuals.

3.       Then I went on to think, who am I kidding?  These few individuals being awarded money will not have any sort of large scale effect on the treatment of mentally ill in jail.

4.       I also wondered how many of those that had not received fair treatment for their mental illness in jail actually should have been in a prison setting to being with instead of a hospital setting.

5.       I thought it was extremely disturbing and unethical that basically any kind of doctor could be considered a “qualified professional” and whatever their “judgment” said to be adequate care would be considered adequate care for a mentally ill inmate.  ONLY a psychiatrist should be able to determine what adequate care for a mentally ill patient is. This “qualified professional” spends very little time at the jail, only about an hour a week and is not trained as a mental health professional yet what they say goes!

6.       I was just in total shock when I read how one mentally ill inmate was “punished” by not being given his medication for 2 weeks! Would they punish a diabetic by not giving him his insulin for 2 weeks? ABSOULTELY NOT!

7.       One inmate attempted suicide 4 times during his detainment which lasted from April 2007-February 2008.  Not one time was he provided treatment for the depression and suicidal thoughts and behaviors he was dealing with.  Instead he was punished.  Mental illness is NOT a punishable offense!

This quote from the article really puts it all into perspective….

“A jail like Dona Ana County was trying for years to cut costs, and nothing would force them to spend the money that they’re constitutionally required to,” Brendan Egan, Attorney for American Civil Liberties Union

Change under way….

Dona Ana County jail, the jail named in the lawsuits made some changes post lawsuits.  They renovated an entire section of the jail and “turned it into a very humane and real mental health unit”.  Beds at a mental health hospital staffed by jail guards were dedicated to the sickest of inmates.

Brendan Egan points out that even someone with the slightest bit of mental illness is going to get worse when you put them in a regular jail.  Recently Dona Ana County approved a $2 million plan for a crisis triage center that would offer an alternative to jail for mentally ill individuals.   The county had no mental health centers for the homeless to go to so people were being arrested on the streets basically for being mentally ill but were then provided no services in jail.  

2 jails in Maryland and 3 in New York were looked at and they found that 17% of the inmates met the criteria for mental illness.  When individuals with mental illness are not receiving proper treatment for their illness while they are incarcerated, it is a huge deal that 17% of inmates have a mental illness.

Jail diversion! Does not compromise public safety and can help alleviate the problem.  I have been saying this for years!!!!  I am a strong believer is this!

Jail diversion would include things like, drug court, mental health court, treatment programs, drug tests; mental health probation officers (would know how to direct them to mental health services). Montgomery County, Maryland was said to be a great example of diversion.  They do a great job in the screening and identifying process of individuals with mental illness.  The county works to get these individuals in psychiatric programs instead and assists them when it comes time to re-enter the community.  Helping them re-enter the community successfully decreases the chance that they will go back to jail.

The article discusses how multiple jails have made changes as a result of lawsuits against them- sad that it took lawsuits to make it happen though. Rikers Island, a jail in Baltimore, a Memphis jail, etc.

A huge point made at the very end of the article that I have found myself frustrated with time and time again… POLICE OFFICERS! They have no proper training when it comes to mental illness.  When I worked in the field I dealt with Baltimore City Police Officers on a regular basis.  I NEVER dealt with one that had a good working knowledge of mental illness and how to deal with a mentally ill individual.  It was always obvious that they felt like they were wasting their time or that they didn’t feeling like dealing with another “crazy” person today.  The article discusses the importance of training police officers and I couldn’t agree more.  Training police officers would give them the ability to recognize mental illness and would train them to know when a mentally ill individual should be taken to the hospital instead of jail.  This would keep individuals out of the criminal justice system completely whose behaviors are a direct result of being in need of proper treatment for their illness.  I myself would like to take this point from the article one step further to include judges, court personnel and public defenders as well.  All of them require more training in this arena as well.

Something that I believe should be noted that was not mentioned in the article at all is that individuals that are found “Not criminally responsible” (NCR) in a court of law are not getting off “easy” or “getting off the hook”.  They are going to state hospitals with an undefined sentence.  Many times they actually stay in the state hospitals longer than they would have in jail.  A state hospital is not a fun place to be by any means but it is a place where they are off the streets and receiving the treatment they need.  While someone from jail may go home on probation, someone leaving a state hospital will leave on “conditional release”.  I used to work with individuals who were on conditional release.  My job was to help them with their re-entry into the community, to keep them out of the hospital and to help them live as normal of a life as possible.  I would not have said that any one of my former clients belonged in jail at any point.  That was not the place for these individuals.  

It is by no means my belief that every individual with a mental illness that passes through the criminal justice system should avoid being jailed.  That would be a bold and blanket statement that I would never make.  What I do think is that there needs to be a complete overhaul of the criminal justice system in regards to the mentally ill. Certain things need to be considered before just throwing someone with a mental illness in jail.  Just to mention a few… 

1.  Will putting this individual in prison make their illness worse? 
2.   Is the crime this individual committed a direct result of them not having proper treatment for their mental illness?  If so, will proper treatment allow them to be a functioning member of society? 
3.  Is this individual a public safety threat?  If not, would treatment be a better option? 
4.  Is there an alternative that would fit this persons needs better than jail?

     Etc….

A quote from the article… "We're not giving people a pass because they have mental illness," Osher said. "We're not being soft on crime. For those individuals that don't pose a public safety risk, there are these alternatives. There are treatments that can be provided."

I can guarantee that A LOT of people differ with me on this topic but I challenge anyone who does to do some more research into the topic, you will learn fascinating things that may change the way you view this topic. I hope you do.

Placing an individual who has engaged in a particular act as a result of an illness they require treatment for in a place that will deny them the necessary treatment seams counterproductive doesn't it?

Instead of my usual ending quote, I’ll leave you with a statistic… In Maryland the odds of a seriously mentally ill individual being in jail compared to receiving treatment in a hospital is 2.6 to 1!

Thanks for reading!  Until next time….

Kissing Stigma Goodbye