The number of people with serious mental illnesses in prisons and jails now exceeds the number in state psychiatric hospitals tenfold, according to a new report by the National Sheriff’s Association and The Treatment Advocacy Center.
The Treatment Advocacy Center, a nonprofit organization focused on eliminating barriers to treating serious mental illnesses, published “The Treatment of Persons with Mental Illness in Prisons and Jails” in April, a report that consists of data from a nationwide survey conducted in 2012.
It estimated that there are close to 35,000 patients with severe mental illness in state psychiatric hospitals and 10 times that number in prisons and jails. Nationwide, there are 356,268 inmates with severe mental illness in prisons and jails.
In Oklahoma, nearly 12,000 of the 25,000 inmates in Oklahoma’s prisons have a history of or are currently exhibiting symptoms of severe mental illness, according to state corrections and mental health data.
About 79 percent of female inmates and 46 percent of male inmates have been diagnosed with a mental illness. Of these individuals, 57 percent were incarcerated for non-violent offenses. Out of all inmates in DOC custody, 33 percent were imprisoned for drug and alcohol offenses and at least 50 percent were incarcerated for a crime-related to substance abuse.
The new report by TAC found that most people with mental illnesses who are in prisons and jails would have been treated in state psychiatric hospitals in the years before the deinstitutionalization movement that led to the closing of hospitals, a trend that continues even today.
Oklahoma County District Attorney David Prater said he witnessed that trend, which began in the ‘60s and became very apparent in the ‘80s when he was a police officer in Norman. He said promised community mental health resources were not built in adequate numbers to accommodate the need.
The intent in closing hospitals was to engage people with serious mental illnesses like schizophrenia, bipolar disorder and major depression in society.
More than 30 years later, psychiatric hospitals have almost entirely closed. Oklahoma’s largest state-run psychiatric hospital is the Oklahoma Forensics Center in Vinita. Its 200 beds are used only for patients who are found not guilty by reason of insanity and for people who need mental health treatment in order to stand trial.
Many with serious mental illness are successfully functioning in society --but far too many have ended up living in extreme poverty, are homeless or are in jail or prison, according to the TACreport.
And more problems can arise for people who are in prison and have a mental illness. For example, people with mental illnesses might have longer stays in prison, according to TAC’s report. They have trouble making bail and trouble following the rules. Poor behavior by those not being treated or by those whose medication use has been interrupted by an arrest can cause a lot of disturbance. Those with mental illness are also at least three times more likely to be the victim of an assault while incarcerated.
Often, those with a mental illness become more symptomatic in the jail or prison environment. They also make up a disproportionate number of those who spend time in solitary confinement and who attempt or complete suicide.
The result is that those with a mental illness cost more while incarcerated, and they are more likely to return.
Intake screening, one of TAC’s recommendations, is routine at the Oklahoma County jail. Interview questions and observation at the time of booking help identify those with a mental health issue.
“Sometimes, incarceration makes symptoms more apparent,” Prater said. “If they were on medication and aren't on it now because they are in jail, and they haven't told anyone they need medication or just because of the incarcerated environment, they begin to deteriorate. They go to medical where doctors are able to determine if they are dealing with a significant issue. Many of the legal councilors are aware of signs of mental illness and can request a mental health evaluation for their client.”
Also on the list of TAC recommendations is the step of providing treatment to inmates with a mental illness. Oklahoma is one of 31 states that administer medication over the objection of the inmate if medical professionals determine that person needs medicine for a behavioral health issue.
"It is sad, but in some cases the identified inmate may get treatment for the first time,” Prater said.
He said he would also like to see earlier interventions, including services for children.
“We should be proactive in the mental health and substance abuse areas,” Prater said. “Investing in juvenile services is investing in the public safety of the state. Those dollars spent will decrease what needs to be spent in corrections later.”
In Oklahoma County, steps are being taken to reduce the number of nonviolent offenders with mental illness by implementing diversion programs, he said.
Prater said his office works to try to see when people might meet criteria for one of those diversion programs.
“My job is about increasing public safety and preventing crime,” Prater said. “Criminal law punishes the intersection of a guilty act with a guilty mind. In mental illness, sometimes you might have an act that is against the law but if you look at the intent it is not there.”
More funding could help decrease the number of individuals with a serious mental illness in prisons and jails, Prater said. And, proper treatment could reduce the likelihood that released inmates won’t return.
And it could also save the state of Oklahoma money.
Outpatient treatment in Oklahoma costs an average of $2,850 per year while incarceration costs $19,000 per year, according to an Oklahoma Department of Mental Health and Substance Abuse Services recent study.
“Unfortunately, we are not equipping them to succeed outside our walls,” Prater said. “Having a criminal record doesn't make it any easier for them to find a place to live or to find a job. We could do better.”
Jean Williams is a NewsOK Contributor and a volunteer with the Edmond North-OKC National Alliance on Mental Illness. Email: email@example.com
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