Jails, prisons confront influx of mentally ill inmates

From The Oregonian, October 24, 1999

A survey this year by the U.S. Bureau of Justice Statistics found that more than 280,000 mentally ill inmates — 16 percent of the 1.75 million inmate population — live behind the bars of the nation’s correctional institutions.

And almost 20 percent of those incarcerated for violent crimes suffer some form of mental illness, the survey found. Inmates were identified as mentally ill if they reported a current mental or emotional condition or if they had spent the night in a mental hospital or treatment program.

The July survey was the Justice Department’s first comprehensive attempt to track a problem that grew out of a national movement in the 1960s to treat the mentally ill in their communities rather than in state-run hospitals.

Experts on mental health and the law agree that the push toward keeping patients out of institutions has left thousands to fall through the cracks.

“We dumped people back in the community but never provided adequate services for them,” said Linda Teplin, a psychiatrist at Northwestern University’s medical school in Chicago, who has studied mental illness in prison populations. “So the jail has become the poor person’s mental hospital.”

The problem is mirrored in Oregon’s adult and youth prisons.

Of the 9,173 inmates housed by the Oregon Department of Corrections, 1,479 — or 16 percent — have been diagnosed with severe and persistent mental illnesses or other severe mental problems.

“The corrections system has become the holding tank, the safety valve, for people with mental health issues, and that’s inappropriate,” said Pam Curtis, health policy adviser to Gov. John Kitzhaber. “The community mental health system . . . is not prepared to deal with seriously mentally ill people.”

Forty-five percent of the 1,109 youths incarcerated by the Oregon Youth Authority — the equivalent of adult state prison — have a mental disorder, records show.

Five percent to 7 percent have a serious, long-term mental illness such as major depression or schizophrenia. As many as 13 percent meet the diagnostic criteria for mental retardation. And 20 percent of youth authority inmates entering the system already take psychotropic drugs designed to control their moods, impulses and antisocial behaviors.

New medication triggered change

Before 1950, a state-run psychiatric hospital was the only place to care for people with serious mental illnesses.

These asylums were not pleasant places and often served simply as warehouses where the mentally ill were kept away from the unsympathetic eyes of a society that misunderstood them.

But the mental hospitals were better than what preceded them — which was nothing.

Advances in psychotropic medications in the 1950s allowed large numbers of patients to be released from confinement. This practice was called “deinstitutionalization,” and mental health experts characterize it as the largest government-sponsored liberation movement in U.S. history.

Today, only 2 percent of people with severe mental illness are in hospitals, and 93 percent are in the community, according to research by the Law and Psychiatry Center at George Mason University’s School of Law.

Oregon has closed all but one of its three state mental hospitals — the Oregon State Hospital in Salem. The state hospital is now a specialized, secure treatment center for the most severely disturbed people and the criminally insane.

Space there is limited. The hospital has 20 beds for children, 40 for teens and 582 for adults.

In 1962 in Oregon, 5,000 people lived in three state hospitals in Salem, Pendleton and Wilsonville.

“The problem is not the deinstitutionalization,” Teplin said. “Deinstitutionalization would work if we’d implemented it the way it was intended . . . to provide a breadth of community-based services,” including outpatient services, supervised housing and intensive case management.

Jails aren’t prepared for mental ills

Researchers for the National Institute of Justice found in 1997 that mental health and criminal justice workers increasingly use prisons and jails as alternatives to inadequate community-based mental health care, yet most of those facilities are not equipped to provide comprehensive treatment.

Fewer than one-tenth of mentally ill inmates got the treatment they needed while behind bars, the study found.

In Oregon, budget constraints and limited mental health staff members keep most inmates from accessing even basic mental health services, such as counseling, said Dr. Gary Fields, a clinical psychologist who heads the counseling and treatment services for the Corrections Department.

Only the most serious cases get attention. “We make no pretense about providing a broad range of services for the mentally ill,” Fields said. “We don’t do that.”

It’s no different for children and adolescents.

“We are not a mental health facility. We are a youth corrections facility,” said Robert Jester, area coordinator for the youth authority.

Teplin said law enforcement officials are left to deal with a problem that doesn’t belong to them.

“Jails were never meant to be mental hospitals; they do the best they can,” she said. “I’m sympathetic with jail directors and with police on the street because they have to clean up a problem that’s the result of the failures of the mental health system.”