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Mental Health in Texas Prisons and Jails

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Fall 2012 Mental Health in Texas prisons and jails October 13, 2012 University of Southern California A. Introduction: Issue, Policy, Problem: Texas has approximately 24. 3 million residents according to 2010 state statistics from the National Alliance on Mental Illness. Close to 833,000 adults live with a serious mental illness. Within these 24. 3 million residents of Texas in 2008, approximately 37,700 adults with a mental illness were incarcerated (NAMI. org).

Additionally, there is an estimated 31% of female and 14% of male jail inmates nationally live with serious mental illness. We see this because there are inadequate public mental health services to meet the needs of those suffering. Texas public mental health system provides services to only 21% of adults who live with a mental illness (NAMI. org). The objective of the 18th Edition Texas Laws for Mental Health are to provide a comprehensive range of services for persons with mental illness or mental retardation that need publicly supported care, treatment, or habilitation.

In providing those services, efforts will be made to coordinate services and programs with services and programs provided by other governmental entities to minimize duplication and to share with other governmental entities in financing those services and programs (TDSHS. us). Regardless of the objective by the Texas Laws, prisoners are not, however, a powerful public constituency, and legislative and executive branch officials typically ignore their rights absent litigation or the threat of litigation (UNHCR. org).

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With this being said, there is great failure within this objective. Many, even thousands of prisoners become incarcerated without receiving the major mental health services they require. Gazing within, many prison mental health services are woefully deficient, crippled by understanding, insufficient facilities, and limited programs. State budget cuts handed down during the recent legislative session left the Texas Department of Criminal Justice with a dangerously-low $6. 1 billion biennial budget, approximately $97 million less than last year’s funding levels.

As a result, the mental health care system suffered layoffs along with the rest of the prison health care services. In addition, although treatment and medications were left untouched, fewer medical workers are now left to treat mentally-ill inmates. Staffing cuts in turn increased the inmate-to-staff ratio from 58 to one upward to 65 inmates for every mental health care worker (Nix, 2011). The growing number of mentally ill persons who are incarcerated in the United States is an unintended consequence of two public policies adopted over the last thirty years.

The elected officials have failed to provide adequate funding, support, and direction for the community mental health systems that were supposed to replace the mental health hospitals shut down as part of the “deinstitutionalization” effort that began in the 1960’s (UNHCR,org). Following the deinstitutionalization process came the “war on drugs” campaign. This was to have embraced a punitive, anti-crime effort. What we saw was a considerable proportion of the prisons and jails population sore, more than quadrupling in the last thirty years. B.

History and Scope of Issue: Eighty-three years after the first American institution exclusively for the insane was opened in Williamsburg, Virginia, the first Texas facility for the mentally ill was established by the Sixth Legislature. Legislation signed by Governor Elisha M. Pease on August 28, 1856, called for the establishment of a state lunatic asylum (Creson). Fifty thousand dollars was appropriated for land and buildings. The State Lunatic Asylum (now Austin State Hospital) did not open until 1861, when Superintendent Dr. Beriah Graham admitted twelve patients.

Before 1861, individuals with a mental illness or mental retardation were kept at home, sent out of state for treatment or custodial care, or confined in almshouses or jails. Dr. David Wallace was the first physician in the state to limit his practice to psychiatry. During his tenure as superintendent of the two institutions, Wallace successfully resisted political patronage in the asylums, advocated removal of the "harmless mentally retarded" from them, did away with restraint, introduced occupational and recreation activities as treatment modalities, and utilized furloughing as a prominent part of institutional procedure.

Dr. David Wallace was a true advocate for the mentally ill, and fought for their right to be treated respectfully. Overcrowding became a major problem during the 1940s. Public pressure to reduce the lengthy waiting lists for admission to state hospitals and to remove mentally ill individuals from local jails increased occupancy in already overcrowded hospitals. In 1943, the legislature converted the Confederate Home for Men into a hospital for mentally ill male geriatric patients in order to provide beds in the larger hospitals.

In 100 years, the state system for caring for the mentally ill grew to nine state hospitals scattered about the state. Their population had, however, begun to decline as a result of new treatment techniques and changing social ideas about the role of state psychiatric hospitals in caring for afflicted individuals (Creson). Over the years, as the population continued to grow, so did crime, drug use, and violence. Research indicates that 72% of both male and female jail detainees with severe mental disorders also meet criteria for substance use disorders of alcohol or drug abuse (Abram & Teplin, 1991).

Within this negative growth, the punishment for the crimes also tightened. Soon we began to see an increase in arrest, and more offenders incarcerated. However, some of the increase was because those suffering with mental illnesses were the individuals committing the crimes. Subsequently, the mental institutions were closing, due to the changing social views of the way those suffering were treated, left those suffering with nowhere to go. As time moved forward, we can see a striking corresponding movement with the legislative funding for mental health care; it is spiraling downhill.

Hence, the beginning of overcrowding in Texas prisons and jails. Sadly, those suffering from mental illness will not receive quality, fair treatment during incarceration. Providing mental health services to incarcerated offenders is frustrated by lack of resources (UNHCR. org). Reflecting back to the early 1800’s, there is a mind blowing resemblance to what we see today; lack of treatment for those with mental illnesses. C. Perspectives and Analysis of Policy:

In Texas, legislators, mental health professionals, and advocates have recognized the need to reduce the prevalence of serious mental illness in jails and prisons by diverting minor offenders to community-based mental health services. In fact, House Bill 2292, passed in 2004, calls for the development of jail diversion strategies along with the implementation of Resiliency and Disease Management (RDM) by the Department of State Health Services (DSHS) for the treatment of severe mental illness (TDSHS).

Steps should be taken at the federal, state, and local level to reduce the unnecessary and counterproductive incarceration of non- offenders with mental illness. Mandatory minimum sentencing laws should be revised to endure prison is reserved for the most serious of offenders. Reducing the number of mentally ill offenders sent to prison will also free up prison resources to ensure appropriate mental health treatment for those men and women with mental illness who must, in fact, be incarcerated for reasons of public safety (UNHCR).

On any given day, between 2. 3 and 3. 9 percent of incarcerated offenders in State prisons are estimated to have schizophrenia or other psychotic disorder, between 13. 1 and 18. 6 percent major depression, and between 2. 1 and 4. 3 percent bipolar disorder (manic episode). In 1999, NAMI (formerly known as the National Alliance for the Mentally Ill) reported that the number of Americans with serious mental illnesses in prison was three times greater than the number hospitalized with such illnesses (UNHCR).

In the fiscal 1990 year, the average state hospital census was 3,475, and the number of clients served in community mental health-mental retardation centers was 125,277. The Harris County Psychiatric Center, a 240-bed hospital established in October 1986, jointly funded by the state and Harris County and under the direction of the University of Texas Health Science Center-Houston, served an additional 195 individuals. After federal block grants given to states in 1980 provided more state control in distributing federal funds, Texas (like other states) placed a high priority on severely and chronically ill patients in community programs.

This re-allocation of resources resulted in an exacerbation of conflicts caused by different local and state agendas, legislative concerns for cost effectiveness and advocacy groups' agendas for expanded services, as well as professional territorial battles and an expanded definition of what constitutes mental illness. Lawsuits have further complicated the matter of organizing, implementing, and administering the state system while compelling needed reforms. Significant in this regard in Texas was RAJ v.

Jones, filed in 1971. Major issues in the case included individualized treatment, patient rights, use of psychotropic medications, and adequate community aftercare services. Morales v. Turman, filed in 1971, resulted in increased quality and availability of mental-health services for juvenile offenders held by the Texas Youth Council. Ruiz v. Estelle did much the same for adults in state prisons and provided impetus for a new prison psychiatric hospital currently under construction in Sugar Land (THSA. org).

D. Impact of Policy and Analysis: During 2003 New Freedom Commission on Mental Health found that the mental health delivery system is fragmented and in disarray- leading to unnecessary and costly disability, homelessness, school failure and incarceration. In many communities, access to quality care is poor, resulting in wasted resources and lost opportunities for recovery. The likely-hood of failure for community mental health services to meet the needs of those suffering with mental illness is pronounced.

The Federal Substance Abuse and Mental Health Services Administration have estimated that 72 percent of mentally ill individuals entering the jail system have a drug-abuse or alcohol problem. Deinstitutionalization resulted in the release of hundred s of thousands of mentally ill offenders to communities who could not care for them. At about the same time, national attitudes toward those who committed street crime-who are overwhelming the country’s poorest -changed remarkably (UNHCR. rg). Prisoners with mental illness find it more difficult to adhere to prison rules and to cope with the stresses of confinement, as evidenced by the new BJS statistics that 58 percent of state prisoners with mental problems have been charged with violating prison rules, compared to 43 percent without mental problems. An estimated 24 percent with a mental health problem have been charged with a physical or verbal assault on prison staff, compared to 14 percent of those without.

One in five state prisoners with mental health problems has been injured in a fight in prison, compared to one in 10 of those without. Community health services, though good, are, due to lack of funding, inadequate to meet the needs of persons with mental illness. This results in those suffering to “fall between the cracks”, and into the world of criminal mishap. The lack of funding also affects the ability of law enforcement, courts and correction facilities to divert persons with mental illness away from the criminal justice system and into a more fitting arrangement.

Many persons with mental illness, prison can be counter-therapeutic or even "toxic. " Nevertheless, we recognize the tragic irony that, for many, prison may also offer significant advantages over liberty. For some mentally ill offenders, prison is the first place they have a chance for treatment. For those who are poor and homeless, given the problems they face in accessing mental health services in the community, prison may offer an opportunity for consistent access to medication and mental health services.

Realizing this opportunity depends, of course, on whether the prisons provide the necessary services. In 2008, 1,900 out of 11,000 inmates, or 17. 3 percent in the Harris County jail were on psychotropic medication. Spending on mental health care in the prison has risen to $24 million per year, and the combined cost of incarcerating and treating the mentally ill is $87 million annually. A county official noted: the jails have become the psychiatric hospitals of the United States.

Class action lawsuits have led to improvements in prison mental health care in a number of states, including Alabama, Arizona, California, Florida, Indiana, Iowa, Louisiana, Michigan, New Mexico, New Jersey, New York, Ohio, Texas, Vermont, Washington, and Wisconsin. Lawsuits have led to consent decrees and court orders instituting reforms and the court appointment of masters and monitors to oversee compliance. Considering the needs of today's mentally ill prisoners, the progress to date is far from enough. Viewed from the perspective of where prison mental health was two decades ago, the progress has been momentous.

Both the state system and the private sector are in a period of major transition. The Texas Department of Mental Health and Mental Retardation was placed by House Bill 7 under the auspices of the Commission on Health and Human Services, a new umbrella agency established by the legislature in July 1991. How this new structuring of the administration of state mental health care will ultimately affect the delivery of mental health services remains to be seen (TSHA). E. Judgement: There are nine state mental hospitals in Texas with a total of 2,477 beds to reat civil and criminal patients. About a third of the beds are reserved for criminal commitments, and in 2006, the Department of State Health Services started a waiting list for the beds, because the demand exceeded availability. The shortage of state hospital beds is a problem that local law enforcement officials have been grappling with for years as sheriffs cope with overflowing jails, in which many of the inmates are mentally ill. Harris County officials have seen the number of mentally ill inmates explode since 2003, the last time Texas had a budget crisis and made major cuts.

Then, there were fewer than three full-time psychiatrists on duty at the jail. Now, there are more than 15. Often they see the same mentally ill inmates repeatedly. State lawmakers are considering budget proposals that would reduce community-based health care services for adults and children and for community mental hospitals by about $152 million in 2012 and 2013. It is about a 20 percent reduction in financing from the previous two-year budget. For community mental hospitals, financing would fall about 3 percent, but the money would be split among five facilities instead of three (Grissom, 2011).

Several problems associated with housing mentally ill persons in jails and prisons rather than hospitals: - The rate of recidivism. Since mentally ill inmates generally receive little care for their illness while in jail or prison, they return to jail or prison at a greater rate than the general prison population. - Mentally ill inmates cost more than other prisoners to house. The average Texas inmate costs the state approximately $22,000 per year. While an inmate with a mental illness costs the state approximately $30,000 to $50,000 per year. Other issues the study cites include the fact that mentally ill inmates commit suicide at a greater rate than the general prison population, and mentally ill inmates are easier targets for abuse by other prisoners and prison staff. Texas ranks 49th in the nation in per capita spending on mental health services. Only 25 percent of children and 18 percent of adults with severe mental illness and in need of services from the public mental health system in Harris County are able to receive them. Now, Texas lawmakers are looking to cut funding to the already overburdened public mental health system by $134 million for 2012-13.

A prime example of cost shifting has occurred within the Harris County Jail, now the largest mental health facility in Texas. The Harris County Jail treats more individuals with mental health issues on a daily basis than our state’s 10 psychiatric hospitals combined. This is especially worrisome given that the United States Department of Justice reports that it costs 60 percent more to incarcerate inmates with serious mental illnesses than it costs to house typical inmates. It is clear that imprisonment of the mentally ill will not help the situation at hand, only add to the severity of it.

Incarceration of the mentally ill can be devastating and costly. While, those suffering from mental illness need help, confinement in federal, state, and local prisons is not the answer. Local leaders and government officials need to advocate for the mentally ill, and push for more funding to insure proper treatment is available to those in need. References Abram, K. M. , & Teplin, L. A. (1991). Co-occurring disorders among mentally ill jail detainees. American Psychologist, 46, 1036-1045. Dan L. Creson, "MENTAL HEALTH," Handbook of Texas Online (http://www. shaonline. org/handbook/online/articles/smmun), accessed October 14, 2012. Published by the Texas State Historical Association. Janice C. May, "GOVERNMENT," Handbook of Texas Online (http://www. tshaonline. org/handbook/online/articles/mzgfq), accessed October 14, 2012. Published by the Texas State Historical Association. Undefined. (May 15, 2012). Texas Department of State Health Services. In 18th Edition Texas Laws for Mental Health. Retrieved October 14, 2012, from http://www. dshs. state. tx. us/mhrules/Texas_Laws. shtm.

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