Friday, December 15, 2006

Mental health treatment and the CJ system

One of the issues raised by the previous post, Hip-hop in the holler (Up the Ridge documentary) is the issue of our criminal justice system’s handling of the mentally ill, specifically in super-max prisons. Of course, that’s only part of a broader picture.

This is one of those occasions when it helps to consider the criminal justice system as a system. Mentally ill people disproportionately come in contact with the CJ system, from arrest to incarceration. Our jails and prisons contain a disproportionate and growing number, as documented by BJS here:

At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 78,800 in Federal prisons, and 479,900 in local jails. These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates.

Further, the mentally ill prisoners are at least somewhat more dangerous to citizens, other inmates, and staff - both based on prior record and current infractions. The BJS study notes that State prisoners who had a mental health problem (61%) were more likely than State prisoners without (56%) to have a current or past violent offense. The BJS study also notes that State prisoners who had a mental health problem were twice as likely as State prisoners without to have been injured in a fight since admission (20% compared to 10%). This means staff will be under pressure to respond professionally to a particularly troublesome clientele. One of the issues raised in the documentary is that employee training is vital to appropriate response.

Jurisdictions such as my own are grappling with ideas for better procedures. For example, one of the earliest points of contact with the CJ system is at arrest. Police departments are attempting to build interdisciplinary crisis response teams to link police with mental health services – which may mean diversion from the criminal justice system to treatment in an inpatient or outpatient setting. Whether diversion occurs or not, police need to be trained in detection and treatment to identify the problem early and deliver the appropriate response, and that may mean calling on other professionals. And of course we all know that inter-agency and inter-discipline teams are complicated and require skillful coordination to work.

Later on down the line, after arrest, specialized courts are also appearing to address the problems raised by the mentally ill in the CJ system (here). For pre-trial/probation/parole departments, timely linkage of mental health professionals for pre-trial releasees, probationers and parolees can avoid costly incarceration in some cases and trouble later (e.g., here and here). If incarcerated, prisons and jails need resources devoted to mental health treatment, and staff trained in emergency response. Federal prisons and most State prisons and jail jurisdictions, as a matter of policy, provide mental health services to inmates. However, staff training, or lack of it I should say, appears to have been a major problem documented in Up the Ridge.

No comments: