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First Comprehensive National Survey in More Than 20 Years Shows County Jails Unequipped, Overwhelmed With Inmates Who Suffer From Mental Illnesses

July 14, 2016

First Comprehensive National Survey in More Than 20 Years Shows County Jails Unequipped, Overwhelmed With Inmates Who Suffer From Mental Illnesses

Incarceration Has Replaced Psychiatric Hospitalization for Thousands of Inmates
With Serious Mental Illness

WASHINGTON, D.C. – A new comprehensive national survey of staff in county jails released today by Public Citizen and the Treatment Advocacy Center shows challenges faced by county jails, almost all of which reported housing inmates with serious mental illnesses.

The survey, sought to understand the point of view of front line workers at county jails, including sheriffs, deputies and other staff who have to care for seriously mentally ill inmates during their incarceration. The report describes the numerous challenges faced by county jail staff, as well as the limited training they are given, to address the needs of inmates with serious mental illnesses.

The incarceration rate for Americans with serious mental illnesses has reached a critical stage because many of these individuals are predisposed by their illnesses to committing minor crimes (such as trespassing or shoplifting), landing in jails and racking up prolonged incarceration time awaiting a state psychiatric bed. Many of them receive no or inadequate mental health treatment during their incarceration, which worsens their conditions.  

The survey obtained responses from 230 sheriffs’ departments in 39 states that operate jail facilities or detention centers. These survey data constitute the most thorough national feedback on the perspective of county jail staff in more than two decades.

“The problem of increasing numbers of seriously mentally ill individuals in county jails is pervasive and unyielding, and spans the entire country. It is particularly acute in large jails,” said Dr. Azza AbuDagga, health services researcher of Public Citizen’s Health Research Group and the report’s lead author. “This growing problem is not solely a criminal justice problem. At its heart is the unacceptable failure of our public mental health system, which began when the country embarked on the deinstitutionalization movement more than half a century ago, resulting in disastrous downsizing and closures of state psychiatric hospitals without providing the necessary levels of community-based treatment alternatives.”
John Snook, executive director of the Treatment Advocacy Center added, “The horror stories from family members and law enforcement alike should galvanize the country to make substantial reforms to our mental health system that would allow necessary and appropriate treatment before people become entangled in the criminal justice system.”

The majority of the county jail respondents were located in the Midwest (39 percent) and the South (38 percent), while the remaining jails were located in the West and the Northeast (18 percent and 5 percent, respectively).

“The devolution of jails into the largest American mental health providers is morally reprehensible and fiscally irresponsible,” said Cook County Sheriff Tom Dart. “These new data make it abundantly clear that the most vulnerable among us belong in community-based care, not behind bars.”

The survey also showed that:

•    The vast majority (96 percent) of the jails reported having some inmates with serious mental illnesses. One in five jails (21 percent) reported that 16 percent or more of their inmates were seriously mentally ill. The problem is worse in large jails, with 31 percent of those jails reporting that 16 percent or more of their inmates were seriously mentally ill.
•    Three-quarters of the jails reported seeing more or far more numbers of seriously mentally ill inmates compared to five to 10 years ago;
•    A third of the jails described the recidivism rate for these inmates as higher or much higher than that of the general inmate population;
•    Most jails reported major problems with the seriously mentally ill inmates, including the necessity of watching them more closely for suicide, their need for additional attention, their disruption of normal jail activities and their being abusive of, or abused by, other inmates;
•    Almost half of the jails reported that only 2 percent or less of the initial training provided to sheriff’s deputies and staff was allotted to issues dealing with seriously mentally ill inmates, and 60 percent reported that staff were allotted on average two hours or less for training on such issues annually;
•    Half of the jails had implemented housing or staffing changes to accommodate the seriously mentally ill inmates;
•    In their efforts to accommodate inmates with serious mental illnesses, only 4 percent of the jails reported hiring deputies with experience in dealing with these individuals. Less than a third reported hiring full- or part-time non-law-enforcement staff members (including nurses, social workers and psychiatrists) to accommodate these inmates;
•    In terms of the structural changes to accommodate these inmates, only about a third of the jails reported diverting these inmates to facilities other than jails; and
•    Although psychiatric medications are central to stabilizing people with serious mental illnesses, only 42 percent of the jails reported offering such medications to these inmates. Even lower percentages of the jails reported offering psychotherapy services for these inmates.

Jennifer Hoff, an Orange County, Calif., resident whose mentally ill son has been incarcerated, said the report resonated with her. “The nightmare really began when our son turned 18 and he was able to make his own medical decisions, including discontinuing treatment for his bipolar disorder,” Hoff said. “It was like watching my own child drown slowly.”

While the ultimate solution is providing more state psychiatric hospital beds and community-based mental health treatment services, the report recommends interim evidence-based solutions for this problem.

These include diversion programs to prevent the mentally ill from entering the criminal justice system in the first place; extensive training for police officers about how to recognize offenders with mental illnesses and help them find treatment programs; a functional intake system that screens individuals with serious mental illnesses in jails and channels them for mental health treatment; the provision of proper mental health treatment for seriously mentally ill inmates in jails; and jail pre-release care planning to end the “revolving door in and out of the justice system” for these inmates.