Monday, August 13, 2007

TIME Gets One Right

I once read something I later discovered was true—“TIME magazine sounds really good until you read something you know about.” Well, for once I’ve read something I know about, and they get it right. This article on the mentally ill in prisons and under arrest and on the Crisis Intervention Teams adopted by some police departments should be a must-read for anyone interested in corrections sentencing policy and its future. Here are a couple of the many readable parts:

"If you think health care in America is bad, you should look at mental health care," says Florida state judge and criminal mental health expert Steve Leifman. More Americans receive mental health treatment in prisons and jails than hospitals or treatment centers. In fact, the country's largest psychiatric facility isn't even a hospital, it's a prison — New York City's Rikers Island, which holds an estimated 3,000 mentally ill inmates at any given time. Fifty years ago, the U.S. had nearly 600,000 state hospital beds for people suffering from mental illness. Today, because of federal and state funding cuts, that number has dwindled to 40,000. When the government began closing state-run hospitals in the 1980s, people suffering from mental illness had nowhere to go. Without proper treatment and care, many ended up in the last place anyone wants to be.
"The one institution that can never say no to anybody is jail," Leifman says. "And what's worse, now we've given [the mentally ill] a criminal record."
When it comes to mental health care in the U.S., Leifman says, history is repeating itself. During the 1800s, long before state-run agencies existed to treat mental illness, families would simply drop their loved ones off at jails or prisons, where their conditions remained untreated. Then came state-run hospitals that Leifman refers to as "horror houses" given that patients were usually either neglected or abused — experiments involving drugs and electroshock therapy inspired movies like One Flew Over the Cuckoo's Nest and finally drew the public's attention to the civil rights abuses of people with mental illness. There appeared a glimmer of hope in 1963, when President Kennedy, in what would be his last public bill-signing, authorized $3 billion to create the first national network of mental health facilities. But after Kennedy's assassination, the country turned its focus to Vietnam and not one penny went into the project.

"It's the one area in civil rights that we've gone backwards on," says Leifman, noting that nearly half of the nine floors in Miami-Dade's County Jail are mental health wards, even though the building is "more like a warehouse than a facility." He decries the conditions that these inmates face, including vermin-infested, decrepit buildings that lack adequate ventilation, lighting, and water supplies. Leifman also laments the amount of taxpayer dollars used to fund such an inadequate system. Florida taxpayers spend $100,000 each day to house the mentally ill in prison; moreover, studies show that people with mental illness stay in jail eight times longer than other inmates, at seven times the cost.

"We can't really build our way out of the problem. It's not just about state hospital beds or jails," Leifman says. "We need to really take a hard look at how we're dealing with the problem overall."

We’ve made the point here before that, if you look at “institutionalization” as a percentage of expenditure, rather than corrections and mental health separately, it’s a different picture than we normally emphasize. The problems clearly are the different populations that have been served and the ethics of treating the mentally ill with jail time. And not to be outdone, here comes an article from TN on the problems of handling an aging inmate population. Note how just two offenders ate up $1m. each in health care. You probably figure heart or Alzheimer’s, but, as this article shows, it’s the “staggering” renal care costs that will likely run up budgets just as high. That’s hard to get into a fiscal note, but it’s very real for every public and private prison and their calculations of future costs. As we’ve said before, if indeed you should count every offender as the equivalent of 2-3 for expenditure purposes, simply cutting prison populations won’t get rid of the budget problems as these guys keep piling up and piling up.

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