Monday, July 21, 2008

Going to prison for mental health services

The Houston Chronicle reports that jails are becoming the new psychiatric hospitals of America:

At the Harris County Jail, deputies and health care workers have a name for them — frequent fliers.

They are mentally ill homeless people who return to jail so often, sometimes on minor charges, that they become familiar to the psychiatric staff.

During a recent survey, county officials found that more than 400 of the jail's 11,000 inmates were homeless and suffered from a major mental illness: schizophrenia, bipolar disorder or a chronic depressive-psychotic disorder. They were among 1,900 inmates on psychotropic medications.

When the mentally ill homeless leave jail — and leave behind its mental health care staff — many stop taking medication and end up on the street again. Treatment resumes only when they commit a crime and return to jail or their dementia overwhelms them and they are brought to an emergency psychiatric center.

Treating the mentally ill as they cycle through jail and emergency psychiatric wards is expensive. A county budget analyst estimates that it costs $80,000 a year, per person.

At the jail, spending on mental health care has risen to $24 million annually, and the combined cost of incarcerating and treating the mentally ill is $87 million annually.

"The jails have become the psychiatric hospitals of the United States," said Clarissa Stephens, an assistant director of the county's budget and management services office who has been studying the jail's mental health costs.

The Commissioners Court is so concerned about the rising costs that it has retained a consultant — psychiatrist Avrim Fishkind — to study whether providing outpatient services and supervised housing would reduce the numbers of mentally ill revolving through the jail.

"The costs of reincarcerating and court costs far outweigh what the costs would be if you housed, clothed and supervised the mentally ill," Fishkind said.

A June survey of more than 11,000 inmates revealed:

  • About one-quarter suffer from mental illness or once suffered from
  • Of those on medication, 978 suffered from schizophrenia, bipolar disorder
    or a severe depressive-psychotic disorder.
  • Of the 978 with a major mental health disorder, 423 likely were
  • Of the 423 homeless with a major mental health disorder, 97 percent had
    been arrested at least once before during their lifetimes; 43 percent had a
    prior arrest during the last 10 years.