By Nicholas Turner
February 26, 2015
One reason annual jail admissions nearly doubled between 1983 and 2013 to 11.7 million, while crime dropped, is that jails have become the provider of last resort for people with mental health issues.
Nationally, about 14.5 percent of men and 31 percent of women in jails today have a serious mental illness, such as schizophrenia, major depression or bipolar disorder and 68 percent indicate problems with substance use. The rates are even higher in New York City. Most lack access to behavioral health care and social services in community settings.
The vast majority of people with mental health needs in jails face nonviolent charges but cannot afford even small amounts of bail. Their conditions are often exacerbated by pervasive abuse, medical neglect and overuse of solitary confinement. These conditions must improve, but we must also bolster efforts to prevent those with mental illness from ending up jailed in the first place. Health and justice systems can work together to identify people in need, get them to appropriate services in the community, reduce the chance of re-arrest and rebuilds lives.
Police departments nationwide employ crisis intervention teams made up of specially trained officers and often mental health professionals who can calm people in psychiatric crisis and help them get mental health care.
Seattle allows police officers to direct people charged with low-level drug crimes and prostitution into treatment services.
In San Antonio, the police department, county jail, mental health department, courts, hospitals and homeless programs have established centers to provide alternatives to arrest, including crisis intervention teams and short-term mental health care and social services. The city estimates that diversion saved them $50 million over the past five years.
In New York City, the Mayoral Task Force on Mental Health and Criminal Justice is enhancing early identification of treatment needs and expanding access to alternatives, like drop-off centers where police can bring people with behavioral health needs instead of jail or the emergency room. A pilot program of the city’s Department of Health and Mental Hygiene is focusing on identifying people with behavioral health needs who have been arrested and diverting them to treatment before arraignment.
The ultimate goal should be a robust community behavioral health system. The Affordable Care Act includes one of the largest expansions of behavioral health coverage in history and provides health insurance to many of those most likely to be involved in the criminal justice system. State and local health policy makers must take advantage of that.
This is a complex problem in dire need of solutions, but we will only see progress through interagency action and commitment.