Treating the Incarcerated Mentally Ill– What Should Be Done?

This article is a continuation of a mini-series on the costs of behavioral health care in corrections.

The lack of stability and consistency concerning treatment options for inmates often works toward the detriment of the inmates, especially because many facilities resort to over-medicating inmates because it is the most convenient and cheapest option. The standards for medicating inmates vary among states but are typically loose. Most only require the that the inmate pose a harmful threat toward others or him- or herself—which contradicts the fact that most mentally ill inmates are incarcerated for non-violent offenses—and is “incapable of proper functioning.” The overuse of medication for treating inmates only increases their dependency on these drugs and makes it more difficult for them to deal with their illnesses through less invasive behavioral therapies if and when they are released and are potentially cut off from these medications. Another detrimental treatment option corrections officers often resort to is solitary confinement. Not only is this long-term internment costly, but it also fails to rehabilitate prisoners and can often worsen the mental illness and sometimes cause it in previously healthy inmates.

The two most blaring problems facing recently released ex-prisoners are housing and employment. Without these fundamental sources of income and shelter, seeking any kind of treatment, let alone mental health treatment, is extremely difficult and nearly impossible. It is, therefore, no surprise that one in five people who leave prisons become homeless soon after. Furthermore, a 2011 report published by the Mental Illness Policy Organization stated that approximately one-third of the estimated homeless population at that time had untreated psychiatric illnesses.

 Recidivism rates are substantially higher for homeless released prisoners than those with housing, and the deficits in the public mental health system due to lack of funding and necessary reforms only further contribute to the recidivism of mentally ill ex-convicts.

As recently as April 2014, the National Sherriff’s Association called for public officials to execute various reforms, including mental illness treatment laws and practices in the community to eliminate barriers to treatment for individuals too ill to recognize they need care. The idea is to ensure more mentally ill individuals receive help before they are so disordered they commit acts that result in their arrest. The National Sherriff’s Association also called for the reworking of jail and prison treatment laws so inmates with mental illness can receive the same kinds of treatments that those with medical conditions are entitled to. Jail diversion programs, such as mental health courts, as well as court-ordered outpatient treatment to provide the support for at-risk individuals reintegrating into society, are also in high demand.

Apart from these and other reform movements, a shift toward telepsychiatry as a possible approach toward treating mentally ill inmates has occurred. A literature review conducted by researchers in Charleston, West Virginia used five electronic databases, the National Bureau of Justice and the American Psychiatric Association websites to investigate the implementation of telepsychiatry in Arizona, California, Georgia, West Virginia, Kansas, Ohio and Texas. The review found that telepsychiatry improved and increased the access of inmates to mental health services across the mental health continuum and reduced costs for correctional facilities from $12,000 to $1 million.

A multifaceted approach toward improving mental health options both within and outside of correctional facilities might help reduce the incarceration of mentally ill individuals and the options for those seeking help in the general population.

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