Tuesday, January 13, 2009

Back to the Future or: How I Learned to Stop Worrying and Love The Penal System

Here we go again!

From the News Leader in the Shenandoah Valley:

Children's center to close; 200 mental-health workers to lose jobs

This is part of a wave of cuts including closing a children’s unit at a state mental hospital and a proposed closing of a state training center and residential facility for the mentally retarded. We’re talking hundreds of beds, including some that have been homes for individuals for decades. Virginia is not a leader in trying a second (or third or fourth, depending on how you count) wave of deinstitutionalization. Florida, North Carolina, and Pennsylvania are years ahead of Virginia on this. Those states are also years ahead in crowding their jails with the mentally ill, and seeing the fallout:


From the Pittsburgh Post Gazette in 2001 regarding the high number of teen suicides in correctional custody (over 100 between 1995 and 2001):

"Now," he said, "you can find more mentally ill juveniles in jail than you can in hospitals."
When states like Pennsylvania closed their state hospital adolescent units, "we lost the capacity to provide appropriate treatment, pharmacologically and otherwise, and to hold these kids long enough to be able to turn them around," Torrey said. Unlike mental hospital patients, Pennsylvania teens 14 and older who are in custody can and do refuse to take their medications.
Ultimately, he said, even the best-managed lockup with the best-trained staff cannot replace structured, long-term psychiatric care in a safe setting. The percentage of jailed teens who commit suicide while confined to their rooms is one stark example of that.


How prevalent are mental health problems in prisons? In an epidemiological study done in 2006, 25,000 prisoners across the country were studied. More than half were noted to have reported mental health problems, 56 percent, specifically. Yet only one in four in prison, and one and six in jail actually received treatment—usually just medications. It has been shown in many studies that since at least 1997, there are significantly more persons with serious mental illness (schizophrenia, and the lot) in prison than in mental health facilities.

Furthermore, the quality of treatment in the correctional centers has a very high degree of variability. Specialists may be hard to come by (in many rural areas especially), formularies can be very limiting, and ancillary services are often non-existent. I worked at a local county jail for a time providing specialist services a few hours a week. Sadly, counseling services were not available for inmates; furthermore, I was astounded to learn that there were not even supportive services such as Alcoholics Anonymous or Narcotics Anonymous meetings.

Insufficient funding is usually the scapegoat. While states are encouraged at the idea of trimming the budget with the closure of a mental health facility, the thought of sending monies earmarked for mental health to the correctional system either eludes them, or perhaps just doesn’t make for good political fodder.


Geoffrey Kruse-Safford said...

Perhaps we could begin by educating people that mental illness is just that - an illness, very often treatable, and no different in kind from various physical ailments. We still think of the mentally ill as "different", rather than just people who are ill and in need of a doctor.

Doc said...

That would be time and money well spent. It, unfortunately cannot be bought or taught without some serious societal assistance at the level of the individual.

The stigma of mental illness is particularly tough, I believe, because it is one area in which we do not want to put ourselves (mentally) into the shoes of the ill. To empathize requires looking at our own psyche, and it is difficult to maintain a sense of mental manifest destiny (read: ego) when we consider that it can be stripped away so easily.