The jails and the mentally ill

Tough story to read in the Chron today about mentally ill folks and the role the county jails have played as de facto health care provider for them.

At the Harris County Jail, deputies and health care workers have a name for them -- frequent fliers.

They are mentally ill homeless people who return to jail so often, sometimes on minor charges, that they become familiar to the psychiatric staff.

During a recent survey, county officials found that more than 400 of the jail's 11,000 inmates were homeless and suffered from a major mental illness: schizophrenia, bipolar disorder or a chronic depressive-psychotic disorder. They were among 1,900 inmates on psychotropic medications.

When the mentally ill homeless leave jail -- and leave behind its mental health care staff -- many stop taking medication and end up on the street again. Treatment resumes only when they commit a crime and return to jail or their dementia overwhelms them and they are brought to an emergency psychiatric center.

Treating the mentally ill as they cycle through jail and emergency psychiatric wards is expensive. A county budget analyst estimates that it costs $80,000 a year, per person.

At the jail, spending on mental health care has risen to $24 million annually, and the combined cost of incarcerating and treating the mentally ill is $87 million annually.

"The jails have become the psychiatric hospitals of the United States," said Clarissa Stephens, an assistant director of the county's budget and management services office who has been studying the jail's mental health costs.

The Commissioners Court is so concerned about the rising costs that it has retained a consultant -- psychiatrist Avrim Fishkind -- to study whether providing outpatient services and supervised housing would reduce the numbers of mentally ill revolving through the jail.

"The costs of reincarcerating and court costs far outweigh what the costs would be if you housed, clothed and supervised the mentally ill," Fishkind said.

[...]

Some of the mentally ill -- many of whom also are substance abusers -- keep committing crimes and getting rearrested, in part, because few are properly supervised when they are released, said David Buck, a Baylor College of Medicine associate professor and president of Healthcare for the Homeless-Houston.

Houston isn't alone in facing this issue. After many mental hospitals were closed in the 1970s and 1980s, countless patients were released in cities that were ill-equipped to house those who needed such care.

"What happens here happens in many communities. We are criminalizing mental illness," said Betsy Schwartz, president of Mental Health of America of Greater Houston, a nonprofit that promotes effective treatment for the mentally ill.

I hate to sound like a broken record, but I'm going to do it anyway. We spend all this money to lock people up, when it would be more humane, more cost-effective, and more in keeping with the principles of justice if we'd look for alternatives for many of them. I have some questions about how outpatient sevices and supervised housing would work, and how successful the county would be at overcoming the inevitable (and, let's face it, understandable) NIMBYism that would be the response to them, but the idea is solid.

Chief Deputy Mike Smith of the Sheriff's Office said the jail's mental health operation is comparable to the biggest non-jail mental health hospitals in the state.

Smith, as head of the jail, is among those credited with upgrading its mental health services.

"I've had people say I better watch what I say or I'll come across as a liberal," he said. "We shouldn't be treating our mentally ill in the jails. We should be treating them in the free world."

See, this is the sort of thing that shouldn't be a "liberal" idea or a "conservative" idea but simply a sensible and humane idea. What we're doing right now doesn't work on many levels. There's no compelling reason not to try something else. Let's make it happen.

Posted by Charles Kuffner on July 21, 2008 to Crime and Punishment