Jails and prisons have become de facto psychiatric “hospitals” (institutions) which warehouse the seriously mentally ill.  We know that 20 percent of inmates in jails and 15 percent of inmates in state prisons have a serious mental illness (356,000), more than 10 times the number of those that remain at state psychiatric hospitals. Seventy percent of adolescents in juvenile correctional facilities have a mental health condition, and 40 percent of individuals with serious mental illnesses have been in jail or prison at some time in their lives.

 In 2016, the largest mental institutions in the United States are the Cook County Jail (Chicago) and the Los Angeles County Jail. Anestimate from the Vera Institute of Justice found that 80 percent of those booked in county jails don’t receive any treatment after they get there. To give you some perspective, in the 1950s, there were over 500,000 psychiatric beds in state hospitals and now we’re at around 35,000.  Inadvertently, our jails and prisons have taken the place of psychiatric hospitals. It’s an issue that NAMI has long been concerned with and has become a major focus of our advocacy work.

The title of Pete Earley’s presentation at the City Club is aptly titled-the mentally ill have been abandoned as well as abused and neglected  as they suffer through a new wave of holding environs that lack capacity for humane treatment. Human Rights Watch released a report, Callous and Cruel, on the “unnecessary, excessive, and even malicious force” used in jails and prison to control inmates with mental illness.  Jails and prisons are woefully inadequate when it comes to being able to treat and care for the mentally ill. Correction officers are not prepared to deal effectively with the mentally ill; they lack the training, the skills and are given few, if any resources to provide even minimal care. The result of this negligence is a norm of  “cruel and unusual punishment.”  In addition, mentally ill inmates see longer stays in prison, cost more money to take care of, present major management problems for correction officers, and are more likely to commit suicide. So, how did we end up getting in to this fix?

THE FIX IS BROKEN: ON DE-INSTITUTIONALIZATION

A system that set out to de-institutionalize the mentally ill in the 1970s and 1980s in order to provide a “less restrictive setting” has come full circle. Now we see the circle is broken.  Public policy from that time, and implementation that followed, failed miserably.  Perhaps the mass migration from the asylums of the early to mid-20^th century, to the institutions that housed the mentally ill in the late 20^th and now 21^st, century, that is,  jails and prisons, are expressions of institutional stigma. Perhaps the shift from state hospitals back then, to prisons nowadays, is a way we thoughtlessly and naively sweep the shadow of mental illness under the rug by stashing the mentally ill away, as we did in the 19^th  century. The hope of the legislation in that era was to integrate the mentally ill from state psychiatric hospitals into the community and community based care. It didn’t work! The money didn’t follow and communities weren’t ready, or “accepting” of the policies (nor population) back then. The question is: Are we ready now?

THERE’S LIGHT AT THE END OF THE JAIL HOUSE TUNNEL 

There is reason for hope as we begin to deconstruct deinstitutionalization and build a comprehensive system of care for the mentally ill. There’s a long way to go and it can’t come soon enough.  Criminalization of the mentally ill must end. Diversion from jails and prisons needs to be a central focus of mental health reform.   If we are housing the mentally ill in jails and prisons, as we have been, then at least we need to apply a quality standard of care that allows for adequate treatment and rehabilitation. This is a massive undertaking. We need to continue to pursue innovative and progressive mental healthcare public policy which includes adequate funding. At the local level, we’ve made some progress in improving the system of care for the mentally ill, below are examples:

• Expansion of Mental Health Courts to divert mentally ill from jails and prisons and ensure  individuals make the transition to community life, including housing; medical services; supported employment; and timely, continuing mental health care;
• Implementation of Assisted Outpatient Treatment (mandated treatment) for mentally ill offenders;
• Increased training for police officers in Crisis Intervention Team (CIT) training (https://www.nami.org/Get-Involved/Law-Enforcement-and-Mental-Health), a specialized training to assist police to intervene safely with mentally ill to prevent violence while providing assistance and referral to appropriate healthcare and social service programs;
• Legislation that prohibits solitary confinement of mental ill in jails and prisons;
• Legislation that outlaws the execution of mentally ill offenders (Ohio S.B. 162).

At the national level, NAMI is currently advocating to pass legislation in Congress that would provide support for state and local law enforcement and correctional officers.  Ronald Honberg, J.D, the Senior Policy Advisor, Advocacy & Public Policy at NAMI, writes about a comprehensive approach to services that emphasizes interventions at various stages of the criminal justice system. The bill titled The Comprehensive Justice and Mental Health Act of 2015 would authorize funding to provide:

• Law enforcement training and partnerships such as Crisis Intervention Team (CIT) programs;
• Specialty Courts such as Veterans Treatment Courts and Mental Health Courts;
• Treatment and services in correctional settings, including alternatives to solitary confinement;
• Programs to assist people transitioning out of corrections and reentering communities, including mental health and substance use treatment, housing, and employment

This bill and several other recent initiatives provide reasons for hope and optimism. Proposed federal legislation such as The Helping Families in Mental Health Crisis, championed by Congressman Tim Ryan address additional overarching system wide issues in caring for the mentally ill which have now become part of the broader healthcare reform topics. Advocates like Congressman Ryan and others, like Pete Earley,  inspire hope and are helping to bring these issues to the forefront, to cast a light on the shadow. I hope you’ll join us in our advocacy efforts. Each of you brings a unique perspective of experience that is needed to raise the voice of those many that go unheard.