An Argument for Increased Mental Health Care in Our Jails and Prisons
Why our current system is an ineffective, unsustainable business model
In my time in the field of criminal justice, both as a teacher and a professional in the field, I have learned many things. Admittedly, I don’t have the 20–30 years of experience and subsequent wisdom that others in the field have, but in my time I’ve learned to do two things (I think) pretty effectively: ask good questions, and listen to the answers. This has helped me immensely so far as I’ve learned from others with more knowledge and wisdom, conveyed this to my students, and applied it to questions we currently face in our society.
I’ve worked in various roles in the field of criminal justice, and with a myriad of clients young and old, male and female, from all backgrounds and ethnicities, in prisons, jails, and community non-profits. Questions from others routinely arise regarding my thoughts on a newsworthy current event, a new policy, or a new law (legalized marijuana comes up a lot). Two such questions I hear quite often, from the public and from those in the field of criminal justice, and two I’ve also repeatedly asked myself is: Why do we have such a problem with prison overcrowding, and why such high recidivism rates? I’ve heard, and agree to varying degrees, with many of the answers given: high poverty rates, rising non-violent drug offenses, policing practices in high-crime areas, mandatory minimum sentencing, 3-strikes laws, an aging prison population, lack of employment upon release, the need for more facilities, and reduced budgets, among others.
The answer I seem to always come back to, one that addresses both the issues of prison overcrowding and recidivism simultaneously, is the lack of resources available for mental health programs in our communities and in our correctional system. With more resources devoted system-wide to mental health concerns, we can address both of these important issues at once, and save money in the long run.
The questions when discussing mental health in corrections
Are they criminals because they’re mentally ill, or is this something exasperated with onset symptoms occurring while incarcerated? Would people still have committed the criminal act if their mental illness had been treated before it lead to incarceration? It is another version of the age-old “chicken or the egg” conundrum. A 2014 report from the American Psychological Association, states that 64% of jail inmates, 54% of state prisoners and 45% of federal prisoners report mental health concerns, with substance abuse also rampant and often co-occurring. Would these numbers be reduced with adequate resources devoted to mental health treatment, prior to, and during, incarceration?
It’s no secret that because of decreased funding mental health facilities nationwide have closed their doors, leaving the criminal justice system as an inevitable catch-all for many people suffering from mental illnesses, especially the poor and minorities. Between 2009 and 2012, US States cut about $4.5B in funding for the mentally ill, even as patient intakes increased by about 10%. This leaves the criminal justice system to pick up the slack. One need to look no further than Cook County, Illinois to see the aggravating effects closing community mental health facilities had on the demographics of their jail. In 2011, budget cuts accounted for closing 6 of the 12 county mental health clinics, and further Illinois state budget cuts closed 3 of the state’s 9 mental health hospitals. Cook County Jail now maintains an average of 9,000–11,000 people per day and has become the largest mental health facility in the United States. There are now 10 times more individuals with serious mental illness in jails and state prisons than there are in state mental hospitals.
Our prisons are overcrowded
Every prison in the state of Wisconsin is over capacity. As of 2018 there were 23,657 individuals incarcerated in the Wisconsin State prison system. If the averages hold true, 12,161 inmates currently behind bars have a diagnosable mental illness. If each inmate costs roughly $36,000 a year (costs range between minimum to maximum offenders, male and female) that is approximately $437 million a year we potentially spend on inmates with mental illnesses, in Wisconsin alone. What else could this money be used for? Inmate education programs, job training, behavioral programming, staff raises, infrastructure improvements, investing in technology?
This is a serious problem. The inmates are already here, we have to deal with them more effectively. The current way of doing things is not working as evidenced by the 67.8% recidivism rate we currently experience nationwide. Two-thirds of offenders we release end up back in prison within 3 years. How many instances of re-incarceration could be eliminated with adequate mental health resources in the community? I heard a phrase growing up, “An ounce of prevention is worth a pound of cure.” A recent study, published in the December 2016 issue of the journal Social Science & Medicine found essentially that more mental health programming, both in the community and in the criminal justice system, equates to less jail inmates. With a 67% failure rate there is much room for improvement. Mental health lies at the epicenter of the solutions as to how to reduce the recidivism rate.
Objections I hear
I’ve heard many objections to increasing mental health programming in the community and in the criminal justice system. “You’re just being soft! You’re a bleeding-heart!” “They deserve it” “They did the crime, they do the time.” Believe me, I thought the same thing before I worked in a prison, until I was face to face with folks who were incarcerated suffering from severe mental illnesses. I’ll admit, before working in the field I had a skewed perception of the mentally ill. We see them in popular culture as crazed lunatics, blood-thirsty and violent (think Jack Nicholson in The Shining), but I soon learned that with the proper programming and medications they acted just like any other “normal” person. Without the green jumpsuit on you wouldn’t even know some of them were criminal offenders.
“They’ll just end up back in prison. What’s the point of wasting the money on mental health programming?” is another objection I often hear. Why do people reoffend though? Lack of mental health resources, lack of a job, lack of housing, lack of family support, and lack of access to medications are common reasons for reoffending. We need community resources and programming to change their habits and support them. Is prison the best place for that? Again, are they ill or are they a criminal? Mental health is the only public health problem we deal with criminally. If you have cancer, do you get locked up, or do you go to the hospital for treatment?
“They’re faking it! They’ll (the inmates) just say they have a mental illness to get better treatment in jail, to get more perks.” That’s exactly why we need more mental health resources: programs, psychologists, psychiatrists, case workers, etc. Who am I to say they’re faking it? How do I know, I’m not a doctor. I’d rather rely on professionals with years of education and experience to tell me something, rather than rely on my limited education in that particular field. If you go to court, you need a lawyer because you trust and value their expertise, based on their education and experience; you don’t represent yourself in court.
Is there a better way?
I’ve seen multiple cases where inmates, struggling with mental illness, become productive inmates when diagnosed and treated correctly. In one case, Josh (name changed) was originally sentenced for two-years for burglary and fleeing an officer. He stretched that initial two years into ten years due to behavioral violations and new charges incurred while incarcerated. He admitted to lashing out at other inmates and correctional staff due to anger, depression, and unmet mental health needs exasperated by past trauma/abuse as a child. Before he got the mental health treatment he actually needed he was getting into fights, lashing out verbally, distrustful of others, attacking officers, failing programs. While incarcerated he was charged with battery to an officer and criminal damage to property for fighting, both in adult prisons and going back to his time in juvenile facilities.
How many instances like this occur every day nationwide in our prisons? How many officers and staff are in harm’s way? How many could be prevented with adequate programming and addressing mental health needs?
We all want the same things: safer communities, less crime, less recidivism, a reduced prison population, safer environments for staff, and to have the resources we need to do our jobs safely and effectively. We all want offenders to be successful after release, to be contributing members of the community through working and paying taxes; a giver not a taker.
Once Josh’s mental health needs were addressed, he flourished, even while incarcerated. He led peer groups, he spoke to college students on group tours, and he mentored others in prison by telling his story, trying to give back. His goal when released is to work with youth in the juvenile justice system and in community programming, to prevent them from going down his path, he wants to give back to his community.
The fact is, these inmates are getting out sooner or later (97% will eventually get released, according to those I talk to). They will get released, and released back into our communities. They’re not like sex offenders (who, based on the communities statutes and ordinances can only live in certain areas and the public has a right to be notified of their impending move), there is no public meeting held to say “This offender who’s been diagnosed with schizophrenia and Oppositional Defiant Disorder who spent 5 years in prison for multiple thefts to support his drug habit is moving into your neighborhood, just so you know.”
A poor business model
I’d like to think of myself as a rational person, that we should do the most with what we have in order to help the most people possible. If you think of what we do in criminal justice in comparison to a business, as providing a service or a product, then what product do we want to put back into our community? A poor quality product (the offender) that has a great potential for warranty defects (reoffending) and will need to get sent back to the company (corrections) for repairs?
We have a 67% defect rate (recidivism) on product getting returned to the company within 3 yrs. Who pays for that? In business the company does, in the form of re-work (which as anyone knows is time consuming, less-productive, and expensive, not to mention poor customer service). In the case of corrections, we pay for it, we as a community in the form of taxes and resources spent “correcting” the maladaptive behavior. (The phrase “we never have time to do it right, but we always have time to do it over again” seems to apply here)
If I was a business owner, and 67% of my product was returned, defective, within 3 years, one of two things would occur: 1) I’d go out of business because the competition would provide a better quality product or service, or 2) I’d find a way to change my business model to provide better service and quality and stay competitive.
Focusing on mental health is a way to improve the quality of what we do, make us safer, and save us money. What have we got to lose? We’ve been doing it this way for over 40 years and are bursting at the seams, both in terms of financial viability and capacity to take in new inmates; inmates that may deserve to be incarcerated more based on the severity of their crimes. Tired of the “slap on the wrists” to the offender who commits a crime and gets a reduced/short prison sentence? Where else can you put them in an already over-crowded prison system?! They’re already full with the mentally ill!
The successes that will occur due to increased mental health spending won’t happen quickly. True success rarely does. True change takes resources, time, innovation, new perspectives, and effort to be successful. With a shift in perspective, one being proactive instead of reactive, we can reduce the number of incarcerated mentally ill, save money, create safer communities and in addition safer working environments for all the hard-working professionals in criminal justice, and change the landscape and quality of our society.
Call to Action
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