Sunday, June 07, 2009

Jailing the mentally ill strains justice:

Every jailer in Florida knows the face of mental illness.

County jails throughout the state house thousands of people with serious mental conditions. Some of them can't maintain a life on the outside -- as soon as they are released, they commit a new, usually petty crime and end up back in jail. Counties pay staggering bills for psychiatric medications and treatment. They struggle to house inmates whose illnesses make them vulnerable (or in isolated cases, dangerous) in the jail's general population. And as community treatment centers close, the number of mentally ill people in prisons and jails increases, along with the burden on their families and the taxpayers who pay for fruitless rounds of arrest and incarceration.

Florida lawmakers had the opportunity this year to make a fundamental change in the way local jails and state prisons deal with people who have severe mental illness. But they fumbled, delaying action on a bill that would have created a new system for mentally ill offenders.

A study conducted by the Council of State Governments and published Monday in the journal Psychiatric Services illustrates how badly Florida leaders dropped the ball. Researchers administered psychiatric screenings to more than 20,000 inmates in five jails in Maryland and New York, concluding that 14.5 percent of men and 31 percent of women booked into county jails had at least one serious mental illness. The number includes only people with very serious afflictions such as bipolar disorder, schizophrenia and major depression -- excluding those with lesser (but often debilitating) diagnoses of anxiety disorders or other mental conditions.

The study didn't cover Florida, but the state's own numbers suggest similar concerns. According to a 2007 study, an estimated 15,000 inmates in Florida's jails on any given day have serious mental illnesses -- roughly one in four. And like the national study, the percentage of inmates with mental illness has climbed steadily in Florida.

The national study suggests several factors behind this increase. People with mental illness are more likely to be visible to police because they are less capable of controlling their behavior. They're also more likely to use illegal drugs, especially if they don't have access to treatment and psychiatric medication. The correlation between mental illness and homelessness is significant, and homeless people are far more likely to be arrested. Finally -- and this thread runs through the entire discussion -- the nation's mental-health treatment system is badly overburdened.

Many people believe the public is safer if people with mental illness are confined, even if that means imprisonment in an inappropriate setting like jail. The new study disputes that impression as well, pointing out the "weak correlation" between mental illness and violent behavior. In fact, many behavioral-health specialists believe that imprisonment increases the likelihood of violent crime, by further destabilizing people with certain mental disorders, and making them more likely perpetrators or victims of crime.

Counties are trying individually to confront the problems of mental illness in their jails. Volusia County, for example, recently hired Stewart-Marchman-Act Corp. to oversee treatment in its correctional facilities.

Still, it's not enough. The bill that failed to pass the Legislature this year would have sparked a comprehensive overhaul of Florida's criminal-justice system, setting up better community-diversion programs to keep people out of jail and creating transitions for people with mental illness who are about to be released from prison. But Gov. Charlie Crist shouldn't wait for the next legislative session -- many of the reforms the bill called for can be instituted by executive order instead, and the state Department of Children & Families can start planning others.

DCF Secretary George Sheldon says that the hundreds of millions of dollars Florida spends incarcerating people with mental illness is the "worst money we spend." It's time for a change, and Crist can help to bring it about.

Published in the Daytona News-Journal on June 7, 2009

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