Better mental health treatment is key to reducing jail population, new study says

Providing medication and counseling for psychiatric patients after they are released from hospital stays could significantly reduce the number of mentally ill inmates in jail, a new study shows.

Researchers followed 4,056 people for seven years after hospital treatment and found that those who received government-subsidized medications or outpatient mental health services as a follow up were much less likely to get into legal trouble than those who did not.

“We often say we need to put public safety first and the notion of helping the individual second; what we found was that when we provide treatment, we actually achieve both those goals,” said Sarah L. Desmarais, assistant professor of psychology at N.C. State University.

The study also determined that previously hospitalized patients who received ongoing treatment for mental illness saved the government $25,000 each over the study period – $68,000 compared to $95,000 for those who were not given follow-up care. The savings averaged $10 per day.

“Someone may say that medication is very expensive, but it is less expensive than the cost of acute care or criminal justice services,” Desmarais said.

The study, published last month in the online journal Psychiatric Services, was conducted by Desmarais, Richard A. Van Dorn of the Research Triangle Institute, and faculty researchers at the University of South Florida. The study subjects who received treatment all were eligible for government-funded mental health services.


Improving access to mental health services, including case management to make sure that patients comply with their treatment plans, could make a big difference for court systems and jail facilities, according to police, judges and sheriff’s officials in the Triangle area.

About 60 percent of the 1,345 inmates in the Wake County Jail have some type of mental illness, said Obi Umesi, medical director for the Sheriff’s Department.

While inmates receive treatment while incarcerated, they often lack follow-up care, Umesi said.

“We send them out stabilized, but then they get destabilized and come back,” he said.

Up to 10 percent of inmates arrive at jail in the midst of acute psychiatric episodes, and another 10 percent are diagnosed as mentally ill for the first time after their arrest, the medical director said.

About 40 percent suffer from chronic mental illness.

“They may have been diagnosed and discharged from the hospital, so they are no longer acute, but they do require ongoing treatment and counseling,” Umesi said. “You can’t really expect mental health patients to manage their own medicines.”

Social service programs such as Cornerstone and the Helen Wright Center in Raleigh offer mental health services to low-income patients, but appointments often require a wait of several days or weeks, said Raleigh Police Officer Wendy Clark, who works in the downtown area.

Clark, who has crisis intervention training, said mental illness is common among the city’s homeless population – and so are arrests.

“We have our frequent flyers – people who have had a lot of arrests on nuisance charges, like begging and trespassing,” she said. “We try to get them connected to resources for mental health screenings, then get them stabilized and maybe even transitioned over to housing. The whole purpose of crisis intervention training is to try to prevent people with severe and persistent mental health issues from going to jail.

“But if the charge is something severe, like assault, there’s no way around it.”

Four judicial districts in the state – Brunswick, Guilford, Mecklenburg and Orange-Chatham counties – have set up special courtrooms to hear cases involving mentally ill defendants. These courts refer people to treatment and assign case managers as an alternative to jail.

In Orange and Chatham counties, case managers screen defendants to determine whether they are appropriate for Community Resource Court, as it is known in the district, said District Court Judge Joseph Buckner.

About 70 to 80 mentally ill offenders are involved in the program at any given time, Buckner said.

“These are people who were coming in to the court system, going away for short periods and coming back,” Buckner said.

‘Some relief’

He said CRC program has reduced the number of emergency psychiatric hospital admissions in the county and relieved some of the overcrowding at local jails. Chatham County has a 52-bed capacity at its jail, and Orange County houses 125.

“It has given us some relief in court, and also, hopefully, gotten more folks therapeutically compliant,” he added.

Wake County Chief District Court Judge Robert Rader said mentally ill defendants are a big issue for the court system in Raleigh, as well as for the jail.

But, Rader said, a lack of funding has been a stumbling block for creating a mental health court in Wake County.

“We need a system so that we can catch them on the front end and refer them to mental health programs for treatment,” Rader said.