Mental illnesses among prison inmates growing in Maryland

From The Gazette in Maryland:

Victoria Shaffer (pictured) never sees her work when it is successful, but she often does when it is not.

As a therapist at the Montgomery County Correctional Facility, she deals with a steadily growing stream of inmates with mental health issues.

In some cases, the facility is like a revolving door. When inmates with mental illnesses are released back into the community, there often is not a strong support system of family or public programs to help them, and they revert to their prior behavior, she said.

The ones where treatment works are not likely to return.

"This is not the most cost-effective way to treat mental illness, and it also is not the most humane," Shaffer said. "This is a jail environment and not a mental hospital."

A new study released earlier this month showed that a growing number of inmates in jails nationwide have serious mental health problems. The study of more than 20,000 men and women inmates by the nonpartisan Council of State Governments' Justice Center and Policy Research Associates found that 14.5 percent of men and 31 percent of the women in jails suffered from serious mental illnesses such as schizophrenia.

"I don't feel overwhelmed, but it saddens me," Shaffer said. "It's not the way we want to treat those with an illness."

The study showed that people in jail were more than three to six times likely than people in general society to have a serious mental illness.

Corrections officials said the percentage of inmates with mental health issues has grown dramatically in recent years, as the federal and state governments — and more recently, strapped counties — have cut funding for mental health services.

For example, in Montgomery County, the county's outpatient mental health clinics served 1,583 clients in fiscal 2009, but the number is expected to decline to 1,403 in fiscal 2010 because of program cuts.

At least 19 states have enacted public health cuts this year, according to the Center on Budget and Policy Priorities, which works at the federal and state levels on fiscal policy and public programs that affect low- and moderate-income families and individuals.

Mental health grows

as a jail issue

Washington County Sheriff Douglas Mullendore, who oversees his county's jail as well as the patrols by deputies, said that police encounter more people than in the past with mental health issues that cause them to commit crimes. The crimes often are minor, such as disturbing the peace by shouting or trespassing, Mullendore said.

"It's the same old thing," he said. "When money gets tight for public services, one of the first things cut is mental health. They don't get their medications or services, the police get called, and they get locked up."

In some cases, the mentally ill inmates are more dangerous than the inmates in the general population because of their erratic behavior, he said.

But the correctional deputies are not trained in psychiatric counseling, which makes working with the mentally ill more stressful, said Maj. Van Evans, warden of the Washington County Detention Center.

Because the police do not have anywhere else to take the seriously mentally ill after they commit even minor crimes, they end up in jail, Shaffer said.

Services at jails across Maryland vary considerably. While Montgomery County has its own staff of therapists to provide mental health services, jails such as in Washington County contract them out. Montgomery County has a mental health wing called the Critical Incident Unit with full-time staff, while Washington County's incarcerated mentally ill can see a therapist twice a week.

"Jails at the county and municipal level were never intended to replace the need for a strong, community-based mental health system," said Art Wallenstein, director of the Montgomery County Department of Correction and Rehabilitation. "Better alternatives exist, and they must be encouraged and supported. Jail is not the answer for addressing mental illness in this country."

The Montgomery County mental health wing holds 40 inmates and generally is at or near capacity all the time, Wallenstein said.

"This is a public policy issue of growing importance because the jails have become the major mental health provider in the country," Wallenstein said. "That's totally wrong. The goal is to use incarceration in appropriate cases and use community-based mental health treatment when appropriate."

The Montgomery County budget for psychotropic medications exceeds $300,000 a year to meet the needs of inmates, he said. The drugs help treat people with mental illnesses by altering their behavior and stabilizing their moods.

A jail setting is not the best for providing the counseling services the mentally ill need, Shaffer said.

"If you have an inmate who is paranoid and is already locked up, he is going to be more of a challenge to treat because of the environment," she said.

When they are released into the community, the support system isn't in place to make certain they are obtaining their medications or taking them when they do get them, she said.

"The reality is many of them are homeless," she said.

That often results in the mentally ill returning to jail when they commit new offenses.

"If they're doing better, we usually don't hear about them," she said.

Del. Galen Clagett (D-Dist. 3A) of Frederick, who worked in prisons in the 1960s and is chairman of a House appropriations subcommittee on prisons, said some of the problem can be traced to the movement to get the seriously mentally ill out of a residential setting and back into the community.

"When they deinstitutionalized these facilities, all of these people were dumped back into the communities," Clagett said. "It's a really complicated issue and is a real sticky wicket."

At the federal level, Senate Judiciary Committee Chairman Patrick Leahy (D-Vermont) has sponsored the Mentally Ill Offender Treatment and Reduction Act to authorize federal grants to help state and county governments offer treatment to mentally ill inmates and to train police to react to situations involving the mentally ill.
But Shaffer said the needs of the mentally ill often are not on the radar.

"You very seldom hear a politician run on the issue of what they'll do in office for the mentally ill," she said.