The Decriminalization of Mental Illness in America

As a society, Americans have effectively criminalized mental illness. Our jails and prisons are filled with mentally ill individuals. 50% of prison and jail inmates in California have mental health impairments. But change may be approaching. More attention is being focused on this issue and Americans are starting to question the current criminal justice system. Some communities have begun taking action to remedy this societal catastrophe. There may be hope that soon we, as a country, may no longer be known as incarceration nation.

This post will discuss possible solutions to reduce the number of incarcerated mentally ill individuals. I will review new, pertinent legislation proposed in California and programs set up in other states that attempt to change the current status quo of the criminalization of mental illness. As discussed in my previous post, Santa Clara County is currently attempting to remedy the criminalization of mental illness in our community by spending $74 million on expanding its mental health unit in jail. But expanding the jail’s mental health unit does not provide a complete solution to the problem. Providing mental health treatment in jail is not as cost efficient or effective as outside treatment and may not be necessary. Many mentally ill individuals who are incarcerated commit low-level misdemeanor offenses such as trespassing, drug crimes, public urination, public intoxication, and aggressive manhandling. Research shows that if these individuals are provided support and treatment, they are much less likely to recidivate compared to when these individuals are incarcerated. We as a community must chose whether we want to lock up mentally ill offenders or care for them. The former perpetuates recidivism and chaos; the latter is more cost effective and humane. Continue reading “The Decriminalization of Mental Illness in America”

Will Dollars Bring the Right Change to Santa Clara Jail?

Main-Jail1-772x350-2Santa Clara County reports 50% of its jail inmates have mental health issues (see Augmentation of Behavioral Health Services to Inmates in County Jail, p. 2). The news reveals that Santa Clara County has a major problem effectively and humanely handling these individuals. This begs the question: how exactly are mentally ill individuals treated in the Santa Clara criminal justice system? This post attempts to point out specific areas during pretrial detention where the system in our county fails mentally ill inmates, effectively punishing them before conviction and thereby exacerbating their mental illnesses and increasing their chances of re-entering the criminal justice system after release. Continue reading “Will Dollars Bring the Right Change to Santa Clara Jail?”

Jail, America’s Psych Ward

In America, people with mental illness have a remarkably disproportionate involvement in the criminal justice system. Men in jail are four times more likely to suffer from serious mental illness than their non-incarcerated counterparts while women are almost six times more likely. There are ten times more people with a mental illness behind bars than in state funded psychiatric beds. Put another way, there is not a single county in the United States in which the psychiatric facility serving the community has as many individuals with severe psychiatric disorders as does the county jail. A serious mental illness is defined as persons over the age of 18, who currently or at any time during the past year have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration, resulting in a functional impairment that substantially interferes with or limits one or more major life activities.

The disparity between mentally ill individuals in society versus behind bars stems in part from the get-tough-on-crime policies that have permeated our criminal justice system for decades. These policies forced jails to morph into ill-equipped, large-scale, mental health facilities. If you follow the news, it is more apparent than ever that jail is not an appropriate place for the mentally ill. At the Los Angeles County Jail, a mentally ill inmate was beaten to death by his cellmates after they became irritated with him because he was “mumbling to himself.” In August 2015, a 31 year-old mentally ill detainee serving a five-day sentence for petty theft at Santa Clara County Jail was beaten to death by three correction deputies while he was waiting for a bed to free up in a mental health facility. He was allegedly beaten for pocketing his medication. These incidents illustrate that jail inmates with mental health issues are not getting the care they need and the results are devastating.

But are jails even required to provide mental health care to inmates? Absolutely. Jails are constitutionally required to provide adequate medical care to pretrial detainees under the Due Process Clause. In City of Revere v. Massachusetts General Hospital, the Supreme Court explicitly stated that pretrial detainees are entitled to be free of punishment, thus requiring the government to provide medical care to inmates and receive protections “at least as great as the Eight Amendment protections available to a convicted prisoner.” Under this obligation, the government must provide medical care necessary to maintain the health and safety of people they place behind bars. In Bowring v. Godwin, the Fourth Circuit concluded that the constitutional right to medical care extends to mental illness treatment, stating there is “no underlying distinction between the right to medical care for physical ills and its psychological or psychiatrist counterpart.” Because inmates are the only group of Americans with a constitutional right to health care it has been reported by some county officials that mentally ill individuals often commit crimes simply to receive treatment.

So what kind of mental health care are pretrial detainees (remember, these are individuals who have yet to be found guilty of any crime) actually receiving while incarcerated? Despite the large number of mentally ill people involved in the criminal justice system, police officers and jail staff receive very little training about interacting and managing inmates with mental disabilities. This lack of training can have deadly effects in the field and in jail. Mentally ill inmates are often locked in solitary confinement because jail staff doesn’t know how to manage them. Solitary confinement is thought to be the most severe and cruel punishment for anyone suffering from mental illness and is known to lead to suicide. Jails are often understaffed and thus many mentally ill inmates go untreated. Until recently, the Santa Clara County Main Jail had a grand total of three psychiatrists for the approximately 1,500 mentally ill inmates behind bars. This lack of staff has irreversible effects for Santa Clara jail inmates. For example, inmates experiencing adverse side effects from prescribed medication often go unnoticed. Inmates are often forced to stop taking their medication in preparation for a doctor’s appointment resulting in extreme drug withdrawal that leads to psychosis. This inadequate treatment results in a vastly higher number of mentally ill individuals re-entering the criminal justice system. In sum, “[t]he lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society.” – Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center.

There are a number of additional factors contributing to the insufficient mental health care that inmates receive in jail. First, inmates with serious mental illnesses are four times more likely to be incarcerated for less serious charges such as disorderly conduct and threats than non-ill inmates. Second, jail exacerbates psychiatric symptoms because inmates are often placed in solitary confinement, and can be subjected to violence and sexual abuse from fellow inmates or jail staff. Third, people suffering from mental health disorders that don’t cause a radical change in behavior, like depression or PTSD, may go untreated because unless recognized by staff, an inmate’s mental health is self-reported. Fourth, pretrial detainees who were in therapy or comprehensive treatment before an arrest do not continue to receive these services while incarcerated, making mental health issues significantly worse. And remember, all these devastating affects of incarceration on mentally ill pretrial detainees occur before the individual is even found guilty.

Not only can the results of jails becoming de facto mental hospitals be detrimental to mentally ill inmates, but we actually spend more money by investing in incarceration instead of preventative care. Frequent flyers in the criminal justice system cost taxpayers twice as much as assertive community treatment programs because inmates tend to continually cycle in and out of jails and hospitals. According to a special report published in 2016 by USA Today, a community can pay for an entire year of intensive treatment for the cost of one incarceration (94 days) or one hospital stay (19 days) for a person with mental illness. The numbers prove that investing upfront in preventative mental healthcare actually reduces costs in the aggregate. A jail diversion program for the mentally ill in Massachusetts saved $1.3 million in emergency health services and jail costs. Georgia found that providing comprehensive mental health services to mentally ill people involved in the criminal justice system cut the number of days these people spent in the hospital by 89%, and the number of days spent in jail by 78%. In all, the program saved Georgians $1 million in its first year.

Mentally ill people are much more likely to be arrested and charged for minor offenses. These individuals are then placed in jail, an environment that exacerbates mental health issues, even before being convicted. They receive less than adequate mental health care for two times the cost of community treatment programs and when eventually released are significantly more likely to recidivate then their non-ill counterparts. My next post will be about the specific challenges mentally ill inmates are faced with right here in Santa Clara County, followed by a discussion of possible solutions to this great economic and social catastrophe.

Propagating Mental Illness in the California Jail System

Approximately 71% of jail inmates in California are pretrial detainees. Pretrial detention is supposed to be limited to individuals who pose a risk to public safety or are unlikely to return for their court date. About 17% of people entering the nation’s local jails for pretrial detention meet the criteria for serious mental illness. In many communities, people with mental illnesses remain in jail for considerably longer than those without mental illnesses, despite facing similar charges and posing no more of a flight risk or danger to society. Pretrial incarceration of the mentally ill results in a reduced chance of recovery and stability in the community and is a large cost on taxpayers. In some areas, pretrial inmates wait months for court-ordered mental health services, which can be detrimental to their recovery. As of 2015, Santa Clara County Jail reported having six full-time psychiatrists for the approximately 1,300 inmates with mental disabilities. There are about 139 beds for inmates with severe mental disabilities. What happens to the other 1,161 inmates in need of mental health treatment? What impact does pretrial incarceration have on their mental health? What can we do to save taxpayers money and avoid propagating mental illness in the criminal justice system? These are the questions I will be attempting to answer this semester in Criminal Law and Policy.

My name is Arielle Hostetler and I am a Bay Area native. At the University of California-Santa Cruz, I studied the intersection of psychology and law. There I learned that the justice system had the ability to create a more equal society because it came into contact with the people who needed the most help. But, instead, the justice system has failed on its promise to control crime, reduce suffering, and rehabilitate. Before law school I worked at the Santa Cruz Public Defender’s Office, the International Rescue Committee, the Peace Corps in China, and the Atlanta office of the American Civil Liberties Union. I am currently a 2L at Santa Clara University School of Law, where I hope to use my real-world experience and academic background to effect change in the criminal justice system.