In April, the Treatment Advocacy Center (TAC) released its findings from a national survey that examined the treatment administered to individuals with a mental illness who are living in state prisons and county jails. The report shines a negative light on the situation, especially in New England.
According to the survey, in 2012 prisons and jails housed an estimated 356,000 inmates with severe mental illness, while public hospitals had 35,000 patients with severe mental illness. The survey explains that incarceration instead of hospitalization leads to associated problems including jail/prison overcrowding, behavioral issues, physical attacks, victimization, mental deterioration, isolation, jail/prison suicides, increased taxpayer burden and disproportionate rates of recidivism.
New England states fared poorly in the survey. Massachusetts “is among the states that make the least effort to divert mentally ill individuals from jail” and is one of only five states that do not have a law allowing assisted outpatient treatment (AOT), according to the report.
While the Massachusetts Department of Corrections (MA DOC) does not allow involuntary administration of psychotropic medication for inmates with the capacity to make an informed decision, it requires a court order to administer antipsychotics to an inmate who is incompetent. The report notes that the MA DOC policy “is uniquely comprehensive and detailed with respect to emergency mental health procedures, such as constant observation or therapeutic restraints.”
Rhode Island reflects the national trend with more inmates with mental illness in its single combined prison/jail system in Cranston than patients in its sole public inpatient mental hospital.
Twenty years ago, New Hampshire had one of the best public mental health services in the country, but conditions have worsened in recent years. In 2012, four of six police officer-related shootings involved individuals with mental health issues; that year the State Prison for Men in Concord also opened a special wing for inmates with mental illness, making a total of 100 beds.
Similarly, in past years, Vermont held a high ranking for its services for those with mental illness; today that status is reversed. Vermont is the only state without a public hospital for psychiatric patients, although the state legislature has approved the construction of a new 25-bed hospital, according to the survey. This new facility is scheduled to accept its first patients at the end of this June.
The Maine State Prison now has a special 32-bed unit within its walls, funded by the state legislature in 2013, to hold individuals with mental illness and too violent to be incarcerated or hospitalized. Riverview Psychiatric Center can accommodate 92 patients, but has difficulty handling violent patients and “the state’s public mental illness treatment programs continue to deteriorate,” according to the report.
The state of Connecticut presents a somewhat better picture, but its combined jail-prison system still holds more individuals with mental illness than the Connecticut Valley Hospital, the largest remaining state mental hospital. Approximately 18 percent of its prison population receive psychotropic medication, according to a 2011 survey, up from 13 percent in 2003. However, overcrowding persists and negatively affects taxpayers.
Mary Zdanowicz, JD, mental health attorney and former executive director of TAC, co-authored the study with E. Fuller Torrey, M.D., TAC founder. As she gathered data for the survey, she found a great deal of disparity in the ways inmates were treated. “Some jails have good mental health units and are able to medicate and stabilize inmates,” she says. “But not only is the number of people in jails increasing, the acuity of illness is also increasing substantially.”
She adds, “People don’t go to jail and the problem is solved. They go in and out, putting a tremendous burden on local law enforcement. The emergency rooms are also highly impacted. People can sit in the ER for days at ridiculous expense. The person deteriorates and there are cases where someone psychotic goes to the ER and injures or kills someone.”
The report recommends opening more state psychiatric beds, which Zdanowicz admits is unlikely to happen. TAC suggests passing AOT legislation, implementing court-ordered treatment, jail diversion programs, mental health courts and community interventions.
Zdanowicz advises psychologists try to understand the problem and become part of the solution. “Promote some type of a program. Start building a coalition and be an essential team member in training police and other professionals,” she says.