Mentally Ill Offenders: An EpidemicCrystal E. Garrett

1773First Psychiatric Hospitals open and are designed to keep those with mental illness away from society-not treat them

Inhumane treatments were forced on patients

Dorothea Dix(1808-1887)• Schoolteacher• Discovered many people

with mental illness were in jails

• Crusaded for the establishment or enlargement of 32 mental hospitals, & transfer those with mental illness from almshouses and jails

• Influenced thought that people with mental illness should be treating with respect and compassion

President John F. Kennedy▪ Less than a month before his death signed the

Community Mental Health Centers Act of 1963, providing $150 million for new mental health center programs and treatment for the mentally ill

▪ Mental Illness affected his own personal life, he was on several medications for anxiety and his sister had a prefrontal lobotomy at age 23

▪ Because of new psychotropic medication he believed that the mentally ill could be treated in smaller community settings

▪ Led to “Deinstitutionalization”

Deinstitutionalization

▪ A socio-political movement for community mental health services and open hospitals;

▪ The advent of psychotropic drugs able to manage psychotic episodes;

▪ Financial imperatives (in the US specifically, to shift costs from state to federal budgets)

https://www.youtube.com/watch?v=hnUuyAlQDXc

Consequences▪ Homelessness linked as studies from the late 1980s indicated that one-

third to one-half of homeless people had severe psychiatric disorders▪ A process of indirect cost-shifting may have led to a form of "re-

institutionalization" through the increased use of jail detention for those with mental disorders deemed unmanageable and noncompliant.

▪  When laws were enacted requiring communities to take more responsibility for mental health care, necessary funding was often absent, and jail became the default option, being cheaper than psychiatric care.

One Step Forward, Two Steps BackPresident Jimmy Carter▪ Signed into law the most

important mental health legislation since Kennedy’s bill

▪ Mental Health Systems Act of 1980▪ Restructured community health

centers ▪ Required increase in grant

funding to treat the mentally ill

President Ronald Regan ▪ Administration supervised

massive budget cuts, especially to those serving the mentally ill

▪ Enacted Alcohol, Drug Abuse and Mental Health Block Grant▪ Decreased funding to community

health centers by 30%▪ Simply shifted burden on local

and state governments—jails and prisons were the only cheap option

Prisons: The New Asylums

The Reality

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Where do we go from here?Recommendations

Appropriate Treatment ▪ By law inmates are entitled to medical care, the same standard of care

needs to include mental illnesses▪ Specific guidelines and framework for treating mental illness within a

corrections environment▪ Appropriate State Laws need to be amended to be able to provide the

appropriate treatment▪ Availability of critical psychiatric prescription drugs must become easier

to access and less expensive

Diversion ProgramsMental Health Court

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Promote Assisted Outpatient Treatment▪ AOT assists with linking offenders to mental health resources available

within their community within 45 days of release▪ AOT is underutilized▪ AOT has been hugely successful, studies show:▪ In New York, the percentage of mentally ill individuals arrested decreased

from 30 percent prior to receiving AOT to 5 percent after and the percentage of those incarcerated decreased from 23 percent to 3 percent while on AOT

▪ Court ordered AOT accompanies a massive decrease in alcohol and substance abuse

Encourage Cost Studies▪ Main reason state mental hospitals were closed was to reduce costs▪ Misconception that jails and prisons cost less▪ Comparison is mischaracterized and does not take into account the

high costs of mentally ill offenders:▪ The longer the incarceration the more time it takes to restore them to sanity

in order to stand trial▪ Higher rate of recidivism among mentally ill offenders▪ Settlement and awards resulting from lawsuits of inmate suicides and self-

mutilation cases▪ Least expensive alternative is to treat them in the community so they don’t go

to jail!

Intake Screening▪ Establish careful intake screening▪ Identify potential problems at the time of entrance, more likely an

effective pro-active plan can be implemented ▪ APA has guidelines for serving mentally ill offenders

Mandate Release Planning▪ Detailed written plan should be created weeks ahead of release▪ Studies reports that inmates with mental illness who were released

from prison without follow-up treatment were almost four times more likely to commit another violent crime, compared with those that did have a release plan

Hopehttp://www.huffingtonpost.com/2015/05/19/mentally-ill-jail_n_7316246.html

References▪ (2016). Www-tc.pbs.org. Retrieved 12 April 2016, from

http://www-tc.pbs.org/wgbh/pages/frontline/shows/asylums/art/excerpt_chart.gif▪ (2016). Whatthefolly.com. Retrieved 12 April 2016, from http://www.whatthefolly.com/wp-

content/uploads/2014/06/WTF-Stanford-law-report-hp.png▪ (2016). S-media-cache-ak0.pinimg.com. Retrieved 12 April 2016, from https://s-media-cache-

ak0.pinimg.com/236x/45/74/60/45746028dbc26a5854695ac3a31fb2cc.jpg▪ (2016). Hrw.org. Retrieved 12 April 2016, from

https://www.hrw.org/sites/default/files/styles/node_embed/public/media/images/photographs/2015US_Mentally_ill_prisons.jpg?itok=NDRO680-

▪ (2016). Cdn2.newsok.biz. Retrieved 12 April 2016, from http://cdn2.newsok.biz/cache/w320-91b5911e8a931f93b1022fa16e11a86b.jpg

▪ (2016). Shq.lasdnews.net. Retrieved 12 April 2016, from http://shq.lasdnews.net/content/uoa/IRC/RELEASE%20AREA-INMATES.jpg

▪ (2016). Cdn.pastemagazine.com. Retrieved 12 April 2016, from http://cdn.pastemagazine.com/www/articles/STARREDUP-therapy-blackfilm.jpg

References (Cont.)▪ A History of Mental Institutions in the United States. (2016). Tiki-toki.com. Retrieved 12

April 2016, from http://www.tiki-toki.com/timeline/entry/37146/A-History-of-Mental-Institutions-in-the-United-States/#vars!panel=403814!

▪ Cox, R., Lenz, A., & James, R. (2015). A Pilot Evaluation of the ARRAY Program With Offenders With Mental Illness. Journal Of Counseling & Development, 93(4), 471-480. http://dx.doi.org/10.1002/jcad.12045

▪ Deinstitutionalization of State Mental Hospitals. (2016). YouTube. Retrieved 12 April 2016, from https://www.youtube.com/watch?v=hnUuyAlQDXc

▪ Eisenberg, L., & Guttmacher, L. (2010). Were we all asleep at the switch? A personal reminiscence of psychiatry from 1940 to 2010. Acta Psychiatrica Scandinavica, 122(2), 89-102. http://dx.doi.org/10.1111/j.1600-0447.2010.01544.x

▪ History of Insane Asylums and Psychological Treatments. (2016). YouTube. Retrieved 12 April 2016, from https://www.youtube.com/watch?v=bUE8PAjqZgY

▪ Inside A Mental Health Court | The Released | FRONTLINE | PBS. (2016). Pbs.org. Retrieved 12 April 2016, from http://www.pbs.org/wgbh/pages/frontline/released/inside/

References (Cont.)▪ Luciano, A., Belstock, J., Malmberg, P., McHugo, G., Drake, R., & Xie, H. et al. (2014). Predictors of

Incarceration Among Urban Adults With Co-Occurring Severe Mental Illness and a Substance Use Disorder. PS, 65(11), 1325-1331. http://dx.doi.org/10.1176/appi.ps.201300408

▪ McQuistion, H., Finnerty, M., Hirschowitz, J., & Susser, E. (2003). Challenges for Psychiatry in Serving Homeless People With Psychiatric Disorders. PS, 54(5), 669-676. http://dx.doi.org/10.1176/appi.ps.54.5.669

▪ mental illness and prisons - Google Search. (2016). Google.com. Retrieved 12 April 2016, from https://www.google.com/search?q=mental+illness+and+prisons&source=lnms&tbm=isch&sa=X&ved=0ahUKEwip-bupmofMAhVX3mMKHZ8ID2AQ_AUICCgC&biw=1366&bih=643#imgrc=nirw1mFPqiyknM%3A

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▪ Undone, T. (2016). The Last Bill JFK Signed — And The Mental Health Work Still Undone.commonhealth. Retrieved 12 April 2016, from http://commonhealth.wbur.org/2013/10/community-mental-health-kennedy

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