Mental Health Warehousing in Jails: Breaking The Cycle

Stephanie Rosendorf, NLC Broward

Part twelve of The New Leader series The Arc of Justice: Examining the Failures of the Criminal Justice System and the Hope of Progressive Reforms

Introduction
The deinstitutionalization movement of the mid-to-late 20th century unfortunately brought forth many unintended consequences.[1] In my last piece[2]on the topic of specialty courts, I introduced some statistics about the high numbers of individuals that suffer from mental illness in our state and federal criminal justice systems. According to the Treatment Advocacy Center, anational non-profit organization dedicated to eliminating barriers to the timely and effective treatment for people with severe mental illness, “In 44 states, a jail or prison holds more mentally ill individuals than the largest remaining state psychiatric hospital,” and “individuals with psychiatric diseases like schizophrenia and bipolar disorder are ten times more likely to be in a jail or prison than a hospital bed.”[3]Fortunately, thousands upon thousands of individuals have been able to reclaim their lives and their futures by having access to mental health courts. Others have the resources to afford psychiatric/psychotropic medications and cognitive behavioral therapies that keeps them out of the system in the first place. However, what happens to those who aren’t so fortunate?

When it comes to treatment, the three largest institutions providing psychiatric care in the United States are actually jails in New York, Los Angeles, and Chicago.[4]Often, a mental health crisis serves as a catalyst for a spiral that leaves one bouncing around from the hospital, to the street, to the local jail, and so on, whereby the cycle keeps repeating itself. Individuals with mental illness not only remain in jail longer on average than the general inmate population, but they also require more resources.[5] For example, in Broward County, Florida in 2007, “it cost $80 a day to house a regular inmate but $130 a day for an inmate with mental illness.”[6]In addition, because of the lack of resources and proper treatment, jails and correctional institutions “may turn to brutal alternative options, including solitary confinement or restraining devices.”[7]

In order to end the vicious cycle of hospitalization and incarceration, individuals must have alternative options. But are these alternatives accessible and sustainable?

Assisted Outpatient Treatment
Assisted outpatient treatment is one way to help individuals stay out of jail or conditions of confinement by allowing courts to order certain individuals to accept treatment while living in the community.[8]Assisted outpatient treatment began in the early 1980’s as families of the severely mentally ill fought to keep them from incarceration or confinement.[9]Before assisted outpatient treatment, caregivers were often unable to assist their loved ones until a situation was already dangerous. The catch 22 is that once a person was considered dangerous to him/herself or others, police were required to involuntarily commit the individual to inpatient hospitalization. Overall, it is critical to note that assisted outpatient treatment is not meant to be an alternative to voluntary services. Rather, AOT is designed so that individuals who have severe mental illness who have objected to voluntary services can at least get the help they need to avoid the most serious consequences and potential tragedy.

Has AOT been effective? Studies in various states have shown positive results. For example, “compared to the three years prior to participation in the program, AOT recipients in New York were found to experience far less hospitalization, homelessness, arrest, and incarceration” with the following specific results:

● 74 percent fewer experienced homelessness

● 77 percent fewer experienced psychiatric hospitalization

● 83 percent fewer experienced arrest

● 87 percent fewer experienced incarceration.”[10]

National Solutions: The Stepping Up Initiative
The Stepping Up Initiative is a national campaign to help people with mental illness access treatment and remain out of jails. This effort is supported by many prominent national organizations,”including NAMI, the Council of State Governments Justice Center, the National Association of Counties, the American Psychiatric Foundation and numerous law enforcement associations, mental health organizations, and substance abuse organizations.” Just as there is no one-size-fits-all solution to most of our social problems, the Stepping Up Initiative focuses on efforts of cities and counties to best serve their communities and all of their unique needs.

However, given the fact that one in five people suffer from mental illness in the United States, we know that there are individuals across urban, suburban, and rural who can all identify with how it feels to suffer. To address this fact, part of the Stepping Up Initiative is a project called “31 Stories, 31 Days,” where individuals share their stories of how they overcame adversity, received treatment for their illnesses, and are now living fuller and more productive lives.

Local Solutions-The Lazarus Project in Miami-Dade County
When it comes to local progress, the Lazarus Project stands out as particularly innovative. This project, which started in 2014, consists of a small team of outreach workers, housing navigators, and psychiatric nurses who engage with and administer medical treatment, including psychotropic medications, to those who currently live on the street and agree to receive care.[11]This project enables those who are experiencing chronic homelessness to have access to much-needed medications, which may enable them to become mentally stable enough to proactively seek assistance. Accordingly, “By tracking them down every day to give them their pills, Trueba’s crew has shown they can draw some of Miami’s most vulnerable from out of the shadows and back into the light.”[12]

Conclusion
Until every individual has access to affordable mental health services, our jails will continue to serve as hosts for many individuals who are in need of medical treatment and therapy rather than incarceration and further isolation. I am grateful for the many local systems of care across the United States, including the coalitions of behavioral health providers, the law enforcement community, and passionate advocates, all of whom will continue working to implement creative and compassionate ways of treating those who are suffering.

Stephanie Rosendorf, Esq. currently works as a Commission Aide to Broward County Commissioner Nan Rich, a role that she has held since graduating from the University of Miami School of Law in 2016. She is also the Vice President of Broward Young Democrats, a volunteer Guardian Ad Litem for Florida’s 17th Judicial Circuit, NLC Broward Class of 2018 Fellow, and resident of Ft. Lauderdale, Florida.


[1]E. Fuller Torrey, M.D., “Out of the Shadows: Confronting America’s Mental Illness Crisis” New York: John Wiley & Sons, 1997, Retrieved fromhttps://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html.

[2]Stephanie Rosendorf, “History of Mental Health Specialty Courts: An Examination of Broward County’s Judicial Leadership on Serving Marginalized Populations,” The New Leader (2018), Retrieved from https://medium.com/the-new-leader/history-of-mental-health-specialty-courts-23c1f467c754

[3]“Serious Mental Illness Prevalence in Jails and Prisons,” Treatment Advocacy Center (2016), Retrieved from http://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/3695

[4]Ailsa Chang, “‘Insane’: America’s 3 Largest Psychiatric Facilities are Jails,” NPR (2018), Retrieved from https://www.npr.org/sections/health-shots/2018/04/25/605666107/insane-americas-3-largest-psychiatric-facilities-are-jails.

[5]“Serious Mental Illness Prevalence in Jails and Prisons,” Treatment Advocacy Center (2016), Retrieved from http://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/3695

[6]Ailsa Chang, “‘Insane’: America’s 3 Largest Psychiatric Facilities are Jails,” NPR (2018), Retrieved from https://www.npr.org/sections/health-shots/2018/04/25/605666107/insane-americas-3-largest-psychiatric-facilities-are-jails.

[7]Dahlia Lithwick, “Prisons Have Become America’s New Asylums” Slate (2016), http://www.slate.com/articles/news_and_politics/jurisprudence/2016/01/prisons_have_become_warehouses_for_the_mentally_ill.html