The mentally ill should be treated, not locked up

May 6, 2013 

In an era that now seems long ago, a time when compassion and justice, not deficits and blame, were the concerns of those who led us, the liberal icon Hubert Humphrey said: “The moral test of government is how it treats people in the dawn of life, the children, in the twilight of life, the aged, and in the shadows of life, the sick, the needy and the handicapped.”

Applying that test today produces the greatest failure in regard to those in the deepest of shadows – the mentally ill locked in jails and prisons. As governments continue to cut funding for mental health care and close mental hospitals, the mentally ill are breaking laws and straining a criminal justice system that wasn’t meant to run de facto asylums.

Government hasn’t abandoned its obligations in all respects. Police are trying to learn how to deal nonviolently with someone who is mentally ill and agitated. Counties are staffing jails with therapists, and prisons are opening units for inmates whose mental conditions make them dangerous to themselves and others.

News & Observer reporter Craig Jarvis documented these efforts in two recent installments of “Mental Disorder,” an occasional series on the mental health care crisis (read the series at newobserver.com).

The stories leave the reader discouraged by the situation and inspired by those in the criminal justice system who are trying to care for people in settings designed for restraint.

An increase in cases

Studies estimate that between 15 percent and 20 percent of jail and prison inmates have serious mental illnesses. In North Carolina, that translates to roughly 5,500 in prison and an estimated 3,400 people in jails, many of them convicted of minor offenses and many awaiting trial. To compare, the state has 850 beds in its mental hospitals.

“Jail has become the largest mental institution in the state,” said Adam Adams, a psychotherapist who evaluates jail inmates in Wake County.

Three therapists and one caseworker at Wake’s two jails do what they can, but Adams said their caseload has doubled from 15 to 20 cases a day to more than 40 a day.

The legislature has acted to provide mental health training for law enforcement officers, attorneys and judges and taken several steps to lessen the time people have to spend in jail while their cases are unresolved. But much more needs to be done to keep the mentally ill out of the criminal justice system in the first place.

Prison treatment

At Central Prison in Raleigh, the population of mentally ill inmates is so large the prison opened a five-story mental health unit last year. The prison has a capacity for 1,000 inmates. The mental health unit holds 150 and can expand to house 216.

The new building is a vast improvement over prior conditions. It’s cleaner, quieter and safer for prison guards, workers and inmates. The emphasis is on treatment. Staff members are trained to defuse confrontations. Medication and counseling are provided.

It is to state government’s credit that that these improvements have been made, but it’s to society’s shame that the better care is delivered within a maximum security prison.

Peter Kuhns, head of the prison’s psychology staff, told Jarvis, “Prisons didn’t ask for this. Obviously, prisons are not very good places for people with severe mental illness.”

It shouldn’t be a crime to be mentally ill. And housing people with schizophrenia, bipolar disorder and other illnesses in jails and prisons isn’t fair to them, to other inmates or to guards and other staff. The criminal justice system is trying to cope with a task that shouldn’t belong to it.

State government should commit to providing more beds for the mentally ill. It should also hire more case workers to work with the mentally ill in the community. There should be court orders requiring chronic offenders to stay on their medications. These steps will require an investment up front but will save much more if nearly 1 in 5 inmates can get out from behind bars and into treatment.

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