Somewhere between 45 and 65% of all people in prison in the United States have a mental health problem. These include issues with depression, mania, delusions, hallucinations, anxiety, and mental health disorders like substance use disorder. In fact, some 75% of all inmates with a mental health problem also have a co-occurring mental health disorder.
The justice system fails people with mental illnesses in many ways, including by approaching mental illness in traditional court. The more recent switch to drug and mental health courts can work to remediate this problem – but often still are not enough.
Not Enough Experts in Mental Health
Today, the United States has some 300 mental health courts, spread across almost all 50 states. That seems like a lot, except most states have 200-450 state courts, and 87.7% of all people in prison were convicted in a state court. Individuals facing drug-related charges have more than 2,500 drug courts across the U.S. to turn to – meaning there are 733% more resources for people facing drug-related criminal charges than mental health related criminal charges.
That lack of support means that individuals moving into the criminal justice system are not being offered care by experts. Instead, judges and juries have to use evidence, must decide on their own if someone requires special treatment because of mental health problems, and do not use medical expertise to contribute to the case. That can dramatically change outcomes, with many shifting away from mental health treatment and towards incarceration.
Yet, data consistently shows that in situations where individuals with mental health problems go to mental health court instead of a traditional court, their outcomes are better. This includes a faster return to normal life, lower recidivism rates, and long-term reduced costs of treatment.
However, mental health courts are often argued against because they cost more in the short-term. In fact, it costs some $4,000 more per year for the first 6 years to move someone into an intensive mental health program rather than into jail. That’s because people with mental health problems need ongoing and consistent care – while jail typically only temporarily isolates that person from potentially engaging in criminal activities and which may offer light treatment in the facility.
Mental health problems result in more violent crimes, with persons with mental health problems almost 30% more likely to commit violent crimes and to engage in violence and fights in prison than those without. And, as a result, individuals with mental health problems face longer sentences, with a mean sentence of 45 months for someone with a diagnosed mental health problem versus 40 months for someone without.
And, individuals with a mental health disorder are 10 times more likely to end up in prison than in a treatment facility or hospital.
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Lack of Treatment
Despite these statistics, U.S. prisons and jails often do not treat their inmates for mental health problems or for substance use disorders. Instead, just 1 in 3 State prisoners with mental health problems receive treatment and 1 in 6 jail inmates. That’s despite the fact that some 24% of all prisoners in State penitentiaries show a history of mental health problems.
Many prisons do have mental health staff. However, with an estimated 5.5% of the total prison population of almost 2 million people qualifying as in crisis state of needing critical care, those facilities are not enough. The result is overworked mental health facilities without the capacity to effectively treat more than a tiny fraction of the people in its care.
In addition, prisons that do have resources to identify mental health problems in patients often have no way to add those health problems to the patient’s national record, to ensure that those health problems are taken into consideration, or to effectively assess and recommend treatment. This means that treatment in a state or federal prison is likely to consist of inadequate touchpoints with a therapist or counselor with no follow-up, no long-term care, and no care to help that person fit back into life, establish a job, and build a life for themselves outside of treatment.
The U.S. prison system does use a mental health rating system to categorize patients according to their mental health needs. However, with close to half of the prison population requiring some or significant care, those ratings aren’t enough.
In addition, the classification system doesn’t require enough care to be meaningful.
- Mental Health 1: No mental health history / is viewed as emotionally stable
- Mental Health 2: Mental health history is deemed not currently active/not requiring treatment
- Mental Health 3: Mild-moderate mental health disorder or good coping mechanisms
- Mental Health 4: Specialized treatment and medication required
- Mental Health 5: Crisis level mental health problems/ requires 24/7 care
In theory, that system seems good. In practice, it works out to the following requirements:
- Mental Health 1: Must be reassessed once per year or within 72 hours of requesting assessment
- Mental Health 2: Must be reassessed once per year or within 72 hours of requesting assessment
- Mental Health 3: Must meet a mental health professional every 30 days
- Mental Health 4: Must meet a mental health professional every 7 days
- Mental Health 5: Should receive continuous care
So, until the point where someone is in a crisis state, patients may have minimal exposure to mental health treatment at all – as the vast majority of individuals see a specialist every 30 days or less.
Mental health courts are becoming more common as the judicial system becomes more aware of its inability to properly handle people with mental health problems. Shifting mental health patients to hospitals and clinics rather than prisons also works to unburden prison care facilities, allowing them to offer better and more nuanced care to the people in their system. However, there’s still a long way to go and for many, there simply aren’t enough resources in place to offer adequate mental healthcare in prison.
This leads to high recidivism rates which currently hover at around 72%, high rates of violence, high rates of inmates with debilitating mental health problems, and a lack of improvement of quality of life for anyone in the system.
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