On March 27, 2023, a mass shooting occurred at The Covenant School, an elementary school in Nashville, Tennessee when a transgender man killed three nine year old children and three adults. On October 25, 2023, a mass shooting occurred in the State of Maine when a mentally ill man killed eighteen people. Mass shootings imperil the peace, safety and dignity of our citizens. Thousands of innocent citizens in the United States have been fearful for their lives and their children’s lives because of the perceived lack of addiction and mental health services for mentally ill and drug-addicted citizens. While the services do exist, the funding for those services does not.
The first psychiatric hospital in the U.S. was founded in 1773 in Virginia. Nearly 200 years later, the FDA approved the antipsychotic drug haloperidol, which everybody hoped would cure mental illness. As a result, and because nobody wanted to adequately fund psychiatric facilities anyway, the states began shuttering their psychiatric facilities.
“Deinstitutionalization doesn’t work. We just switched places. Instead of being in hospitals the people are in jail. The whole system is topsy-turvy and the last person served is the mentally ill person. - Jail official, Ohio.” (Torrey, et. al, 1992).
The loss of these facilities has led to today’s mental health crisis. Instead of being miraculously cured by this wonder drug, the majority of those patients wound up homeless and, in most cases, self-medicating with drugs. Today, this population makes up the majority of the people we see in correctional facilities. Correctional facilities have become de facto mental health institutions. Correctional facilities were built for security purposes, not therapeutic purposes. As a result, correctional facilities are not adequately equipped to care for this difficult-to-treat and often noncompliant population – yet they’re being tasked with doing so, without the necessary additional funding for additional services. Still, nobody wants to adequately fund the “de facto” psychiatric facilities – correctional facilities.
“Police frequently use disorderly conduct charges to arrest a mentally ill person when no other charge is available. The mother of a son with schizophrenia in Texas said that her son was frequently arrested for “just wanting to talk to normal (his word) people in the malls or street. … He would follow them and just keep talking. … [He] would not go away when they asked him to and they were afraid. … His looks were very unkempt, which added to their fear.”… A man with schizophrenia in Illinois was arrested for throwing a television set out the window, probably because he believed it was talking to him.” (Deinstitutionalization, 2005).
Correctional facility leadership have spent years requesting their boards and local leaders to authorize their budgets to appropriately fund robust behavioral health programs in their facilities – addiction specialists, individual and group counseling, community discharge planning, MAT (methadone-assisted treatment) programs, substance use disorder screeners, suicide watch release and rounding, etc. Suicide is the number one cause of death in jail, and yet in most cases, sheriffs can barely get two hours per week of counseling approved for the entire facility.
Community mental health is touted as the “free” solution to the problem, but community workers are generally inexperienced in the specialty of corrections, and frequently found to be unlicensed, untrained, or prefer to work-from-home (never entering the correctional facility walls). When acute incidents occur, hospitals will only hold people for around 72 hours before they return them to the correctional facility. Even if they are accepted into the emergency department or state hospital, all it takes is one outburst (a symptom of mental illness) for the hospital to file criminal charges and demand the patient be transported back to the correctional facility. There aren’t enough psychiatric beds to care for them, so these patients continue to languish in the correctional facility without appropriate behavioral health services (Geringer-Sameth, 2022). Again, these services are available – but the funding isn’t being approved.
- In Washington, “quite unintentionally, the jail has become King County’s largest institution for the mentally ill.” (Keene, 1993).
- In Texas, “the Travis County Jail has admitted so many prisoners with mental disabilities that its psychiatric population rivals that of Austin State Hospital.” (Gamino,1993).
- In New York, the estimated population of 10,000 mentally ill inmates in the state’s prisons "now surpasses [that of] the state’s psychiatric hospitals.” (Foderaro,1994).
- In California, approximately 3,300 of the 21,000 detainees in the Los Angeles County Jail “require mental health services on a daily basis,” making it “the largest mental institution in the country.” (Grinfeld, 1993).
The need for building correctional psychiatric facilities has become increasingly important due to the closure of state hospitals. Correctional psychiatric facilities could provide a continuum of safe, therapeutic care that ranges from outpatient care and transitional-type housing situations to inpatient care. How would correctional psychiatric facilities be different from correctional facilities? Properly designed, there would be more areas for group and individual classification (as appropriate for peer support and faster intervention in case of an emergency); inaccessible lighting fixtures and sprinkler heads; ligature-resistant sinks and toilets; no ligature or tie-off points conducive to hanging or asphyxiation; non-breakable and flush-mounted mirrors; padded cells as opposed to concrete; plexiglass for a clear line of sight (instead of opaque walls); privacy doors with the ability to see people’s heads and feet for safety; and solid platform beds. Supervision would also be critical, with patients ideally under continuous observation.
Additional funds must be allocated for the construction of state-owned inpatient correctional psychiatric facilities in all state capitols across the country. Should citizens balk at this admittedly insanely expensive solution, then they must move forward with the alternative: funds must be allocated to correctional addiction, counseling, discharge planning, mental health, psychiatric, psychological, and substance use disorder services for detainees and inmates in correctional facilities throughout the country. The public welfare requires it.
With today’s addiction, mental health, and suicide crises reaching startling new heights, are we finally ready to adequately fund behavioral health programs in the jails, or support the construction of therapeutic correctional psychiatric facilities? Time will tell what future generations will say about us as they look back at history and see how we handled this public safety crisis. Until then, correctional facilities will remain our modern-day state hospitals, doing the best they can with shrinking budgets.
References
Deinstitutionalization - Special reports. (2005, May 10). PBS: Public Broadcasting Service. Deinstitutionalization - Special Reports | The New Asylums | FRONTLINE | PBS
Foderaro, L. W. (1994, October 6). For mentally ill inmates, punishment is
treatment. New York Times, p. AI.
Gamino, D. (1993, April 17). Jail rivals state hospital in mentally ill population. Austin American-Statesman.
Geringer-Sameth, E. (2022, November 28). Despite state budget funding, little progress bringing psychiatric beds back into service. Gotham Gazette: The Place for New York Policy and Politics. You are being redirected...
Grinfeld, M. J. (1993, July). Report focuses on jailed mentally ill. Psychiatric Times. pp.1-3.
Keene, L. (1993, July 6). A helping hand keeps mentally ill out of jail. Seattle Times, pp. A1, A7.
Torrey, E. F., Stieber, J., Ezekiel, J., Wolfe, S. M., Sharfstein, J., Noble, J. H., " Flynn, L. M. (1992). Criminalizing the seriously mentally ill. Washington, DC National Alliance for the Mentally Ill and Public Citizen Health Research Group, p. 43.
