Our Mentally Ill Should be in Treatment not Prison

Some of you may have been the recent PBS program on the Mentally ill in Prison.
Please lobby your State and Federal legislators for mental health funding and volunteer with the group homes in your community.

The only way to break this cycle is for our communities to embrace our mentally ill brothers and sisters with love and compassion. Prisons should not be the new asylums.

The stigma and fear still keeps many of us from reaching out to the least among us.
On medications, the mentally ill are not dangerous. Sometimes, the media focus can skew reality. I'm grateful for PBS and Frontline coverage of this issue.

http://www.pbs.org/wgbh/pages/frontline/released/
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Frontline: The New Asylums (1995)


Once released from prison, mentally ill ex-offenders are faced with the challenges of reintegrating into their communities. Those who do not make a successful transition relapse and return to prison. But across the country, community groups and prison and mental health officials are working together to break this cycle.


In 1999, New York City was routinely releasing its mentally ill ex-offenders into impoverished neighborhoods between 2 and 6 in the morning with only $1.50 in cash and two subway tokens. In a class-action suit against the city, several inmates claim that without provisions for continuing treatment of their mental illnesses or help finding housing, psychiatric care and government services, they were more likely to psychologically decompensate, become homeless, relapse into criminal activity, and return to jail. Though this case was settled out of court with the city pledging to provide services for its inmates after their release, variations of this story are being played out across the country.

In 2004, some 630,000 prisoners were released back into their communities, many of them with mental illness and co-occurring disorders such as substance abuse. Studies have shown that 60 percent of released offenders are likely to be rearrested within 18 months, and that mentally ill offenders are likely to be rearrested at an even higher rate. Experts claim that a major cause for recidivism among the mentally ill is the "epidemic" shortfall in community-based mental health services. "While offenders have a constitutional right to receive mental health treatment when they are incarcerated, they do not enjoy a similar right to treatment in the community," writes Lance Courturier, chief psychiatrist of the Pennsylvania Department of Corrections.

Experts and corrections officials like Courturier believe that the solution is to directly link prison mental health services to services in the community. The Consensus Project, a coordinated effort by the Council of State Governments to improve services for mentally ill offenders, recently released a report that recommends planning for post-release services almost from the day they arrive in the justice system. A successful system for reentry would coordinate efforts among specialists in a range of services, integrate treatment for mental illness and substance abuse, combine primary healthcare with mental healthcare, create and improve housing resources for the mentally ill, involve families and the community with the offender's treatment, and ensure that people with mental illness are accessing the full range of government entitlements for which they are eligible, such as Social Security Disability Insurance.

Across the country, communities and organizations are taking up this call, in some cases beginning services a year before an inmate's release and continuing them for as long as those services are needed. One such program, operated by the Allegheny County Department of Human Services in Pittsburgh, has reduced recidivism to less than 10 percent. It helps mentally ill offenders apply for social services, arranges for their temporary housing, supplies them with bus passes, and sets up appointments with community doctors so they can continue to receive their medications. In addition, the program also provides more personal services, such as arranging for someone to pick up offenders at the time of their release and take them shopping for $200 worth of clothing and toiletries.

Compassion, Compulsion and the Mentally Ill

By E. FULLER TORREY
The debacle of deinstitutionalization continues to worsen with each passing year. In 1955, there were 559,000 individuals in America's state mental hospitals. By 2005, there were only 47,000 state hospital beds left in the country, a number that continues to fall. Numerous studies have documented the tragic effects of releasing hundreds of thousands of seriously mentally ill individuals from state hospitals while failing to ensure that they receive treatment.

The latest, carried out by Jason Matejkowski and colleagues at the University of Pennsylvania, found that individuals with serious mental illnesses are responsible for 10% of all homicides in Indiana. That translates into approximately 1,700 out of 17,034 total homicides in the U.S. in 2006. Over the past 20 years – during which time the public mental-health system has progressively deteriorated – that would mean 38,000 of 388,311 total homicides.

The University of Pennsylvania study examined the records of 723 individuals convicted of homicide between 1990 and 2002 in the Hoosier state. The results were published in the Journal of the American Academy of Psychiatry and the Law.

Examples of such homicides include Joseph Corcoran, diagnosed with paranoid schizophrenia, who shot four people in Fort Wayne because he thought they were talking about him. And Frank Salyers, also diagnosed with paranoid schizophrenia, who killed a policeman in Goshen after his parents tried unsuccessfully to get treatment for him at a local mental-health facility.

Although the Indiana study is the largest research of its kind in the U.S., two earlier but smaller studies reported that seriously mentally ill individuals were responsible for 10% of homicides in Contra Costa County, Calif., and 29% of homicides in Albany County, N.Y.

Most of these homicides were preventable, since the perpetrators in most cases were not being treated. Nontreatment, a past history of violent behavior and substance abuse are strong predictors of potential dangerousness in this population. We have proven options for decreasing such violence, including outpatient commitment. These programs require mentally ill individuals at high risk for violence to continue taking medication as a condition for living in the community.

Kendra's Law, passed in New York state in 1999, established one such program. A 2005 study by the New York State Office of Mental Health showed that physical acts of violence – as well as suicide attempts and arrests – by patients compelled to undergo treatment under Kendra's Law dropped dramatically in just six months; a similar reduction in violent behavior was shown in a North Carolina study.

Despite such data, assisted outpatient treatment is seldom used in the 42 states in which it is available and does not even exist in the other eight states. Even in New York, only a few counties use Kendra's Law widely. Why not? One reason is the reluctance of mental-health professionals to mandate treatment, even for patients with a history of violence and noncompliance with treatment.

Another is the misconception that such programs are expensive. In fact, it is our failure to use such laws that is expensive. Repeated hospital readmissions, incarceration costs, and the costs of homicides and other associated violence take a far greater toll on local, state and federal coffers.

The societal cost of not treating the seriously mentally ill is staggering. They constitute at least one-third of the homeless population. Unable to defend themselves because of their disabilities, they are often exploited and victimized. Approximately 5,000 commit suicide each year – one-sixth of all suicides. An estimated 230,000 are in jails and prisons, 10% of all incarcerations.

According to a 2006 study by the U.S. Justice Department, 56% of state prisoners, 45% of federal prisoners and 64% of local jail inmates suffer from mental illnesses. In fact, there are now more individuals with a serious mental illness in state prisons than in state mental hospitals.

In the end, involuntarily treating people with serious mental illnesses – who, because of their illnesses, are not aware they are sick – does not infringe on their civil rights. The fears of civil libertarians notwithstanding, the paramount civil right of someone who is severely mentally ill should be adequate treatment.

As Supreme Court Justice Anthony Kennedy wrote in 1999: "It must be remembered that for the person with severe mental illness who has no treatment, the most dreaded of confinements can be the imprisonment inflicted by his own mind, which shuts reality out and subjects him to the torment of voices and images beyond our powers to describe."

Dr. Torrey is the author, most recently, of "The Insanity Offense: How America's Failure to Treat the Seriously Mentally Ill Endangers Its Citizens," out this month by W. W. Norton.