A Summit on the Mentally Ill in U.S. Jails

April 20, 2016

By Ted Gest
The Crime Report

Amid growing recognition that large numbers of U.S. jail inmates suffer from mental health problems, three major organizations have gathered teams from 50 places in Washington, D.C., to plan a detailed attack on the problem.

At least one-fifth of jail inmates had a “serious mental illness” as of 2014, estimated the Virginia-based Treatment Advocacy Center. The organization said there were more mentally ill people in the Los Angeles County Jail, Chicago’s Cook County Jail, or New York’s Rikers Island jail complex than in any U.S. psychiatric hospital.

While the problem spans the criminal justice system, local jails have become a focus because their inmates tend to cycle in and out of the justice system with little or no treatment, costing taxpayers what the project’s sponsors call a “staggering” sum.

Last year, the American Psychiatric Association Foundation, the National Association of Counties, and the Council of State Governments Justice Center, with support from the U.S. Justice Department, began a program called “Stepping Up” to focus on reducing the numbers of jail inmates with mental problems.

Instead of what the groups call “a vague promise for reform,” they are assembling an “actionable plan” that will involve leaders in local government, the justice system, and public and private health providers to identify inmates who need help and find funding to deal with them.

At a Washington, D. C., hotel, a “national summit” that concludes today includes representatives of what the organizers say is “a cross-section of urban, suburban, and rural counties” from 37 states.

They are taking part in detailed discussions of such issues as how to screen inmates effectively, to take inventories of available services, and to seek increased funding to fill gaps in the system.

One major challenge is finding political support for necessary changes. Marilyn Brown, one of three commissioners of Franklin County in the Columbus, Ohio, area told conferees that “elected leadership is essential” to “get everyone around the table” to discuss how to handle mentally-ill suspects. That includes not only medical experts but every segment of the criminal justice system, such as sheriffs, prosecutors, and public defenders.

Brown gave an example of what may seem like a minor issue that actually could be a major one: a judge setting a bail figure of $150 for a suspect to be released pending disposition of a case. She said, “Some prosecutors say $150 shouldn’t keep someone in jail but it does,” sometimes for weeks or even months.

The conference also heard from two officials who must deal with the problem daily, Nneka Jones Tapia, a psychologist who runs the Cook County Jail in Chicago, and Sheriff Stacey Kincaid of Fairfax County, a large suburb of Washington, D.C. (population 1.1 million).

Kincaid said one of her worst days on the job happened last year, when a 37-year-old mentally ill mother died after she was shocked four times with a stun gun. The Washington Post said the woman was restrained with handcuffs behind her back, leg shackles and a mask at the time. Kincaid didn’t discuss the details yesterday, but said, “It’s too easy to bring someone to jail who is mentally ill.”

Kincaid, who has taken steps to insure that inmates can have access to psychiatrists on a 24/7 basis, said jailers must recognize that “if we can’t get someone stabilized, we need to get them to a hospital.”

Tapia, whose boss, Sheriff Tom Dart, has estimated that more than one-third of the county’s 8,600 inmates are mentally ill, said she immediately has inmates with mental problems enroll in Medicaid and plan for their eventual discharge from jail. She set up a “discharge lounge” so that “inmates know there is some place they can go” to get medical advice.

Another step Tapia took was to end solitary confinement for most inmates and allow them to take part in rehabilitation programs as long as they were shackled to a table. She believes that mental-health problems are reduced if prisoners are not required to spend 23 hours daily alone in a cell.

After solitary was eliminated, the number of disruptive incidents involving inmates in “administrative segregation” dropped from 600 per month to only 30, she said.

Too many inmates are placed in solitary, Kincaid agreed, but she said something still must be done about the small minority of prisoners who are both mentally ill and “seriously dangerous.” She said, “No one talks about them.”

Conferees agreed on the need to provide more “crisis intervention training” (CIT) to more employees throughout the justice system. Pioneered by Memphis in the 1980s, the training typically has involved 40 hours of instruction given to first responders.

Some police agencies have trained only 25 percent of their personnel, but there is increasing pressure to train not only entire police forces but corrections officers as well. Conferees praised training offered free to state and local officers by the National Institute of Corrections, an agency of the U. S. Justice Department.

This week’s summit was funded by the American Psychiatric Association Foundation, with support from Janssen Pharmaceutical Companies of Johnson and Johnson, the Elizabeth K. Dollard Charitable Trust, the Alkermes pharmaceutical firm, and Otsuka America Pharmaceutical Inc. The initiative is also supported by the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge.

Ted Gest is President of Criminal Justice Journalists and Washington bureau chief of The Crime Report. He welcomes readers’ comments.

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