FOR IMMEDIATE RELEASE
July 14, 2016
Jamie Mondics
Treatment Advocacy Center
(215) 439-8512

First Comprehensive National Survey in More Than 20 Years Shows County Jails Unequipped, Overwhelmed With Inmates Who Suffer From Mental Illnesses
Incarceration Has Replaced Psychiatric Hospitalization for Thousands of Inmates With Serious Mental Illness
ARLINGTON, VIRGINIA  -- A new comprehensive national survey of county sheriffs and detention officers released today by the Treatment Advocacy Center and Public Citizen shows challenges faced by county jails, almost all of which reported housing inmates with serious mental illnesses.
 
The survey, which focused on county jails, sought to understand the point of view of front line workers at county jails, including sheriffs, deputies and other staff who have to care for mentally ill inmates during their incarceration. The report describes the numerous challenges faced by county jail staff, as well as the limited training they are given, to address the needs of inmates with serious mental illnesses.

The incarceration rate for Americans with serious mental illnesses has reached a critical stage because many of these individuals are predisposed by their illnesses to committing minor crimes (such as trespassing or shoplifting), landing in jails and racking up prolonged time in jail awaiting a state psychiatric bed. Many of them receive no or inadequate mental health treatment during their incarceration, which worsens their conditions. 

The survey obtained responses from 230 sheriffs' departments in 39 states that operate jail facilities or detention centers. These survey data constitute the most thorough national feedback on the perspective of county jail staff in more than two decades.

"The problems faced by county jail staff in housing, treating and safely overseeing the well-being of inmates with serious mental illnesses is pervasive and unyielding and spans the entire country. The problems are particularly acute in large jails and those with high numbers of these inmates," said Dr. Azza AbuDagga, health services researcher of Public Citizen's Health Research Group and the report's lead author. "This growing problem is not solely a criminal justice problem. At its heart is the unacceptable failure of our public mental health system, which began when the country embarked on the deinstitutionalization movement more than half a century ago, resulting in disastrous downsizing and closures of state psychiatric hospitals without providing the necessary levels of community-based treatment alternatives."

Added John Snook, executive director of the Treatment Advocacy Center, "The horror stories from family members and law enforcement alike should galvanize the country to make substantial reforms to our mental health system that would allow necessary and appropriate treatment before people become entangled in the criminal justice system."

The majority of our county jail respondents were located in the Midwest (39 percent) and South (38 percent), while the remaining jails were located in the West and Northeast (18 percent and 5 percent, respectively).

"The devolution of jails into the largest American mental health providers is morally reprehensible and fiscally irresponsible," said Cook County Sheriff Tom Dart. "This data makes abundantly clear that the most vulnerable among us belong in community-based care, not behind bars."

The survey also showed that:
  • The vast majority (96 percent) of the jails reported having some inmates with serious mental illnesses. A fifth (21 percent) of all jails reported that 16 percent or more of their inmate population were seriously mentally ill. The problem is worse in large jails, with 31 percent of those jails reporting that 16 percent or more of their inmates were seriously mentally ill;
     
  • Three-quarters of the jails reported seeing more or far more numbers of seriously mentally ill inmates compared to five to 10 years ago;
     
  • A third of the jails described the recidivism rate for these inmates as higher or much higher than that of the general inmate population;
     
  • Most jails reported major problems with the seriously mentally ill inmates, including the necessity of watching them more closely for suicide, their need for additional attention, their disruption of normal jail activities and their being abusive of, or abused by, other inmates;
     
  • Almost half of the jails reported that only 2 percent or less of the initial training provided to sheriff's deputies and staff was allotted to issues dealing with seriously mentally ill inmates, and 60 percent reported that staff were allotted on average two hours or less for training on such issues annually;
     
  • Half of the jails had implemented housing or staffing changes to accommodate the seriously mentally ill inmates;
     
  • In their efforts to accommodate inmates with serious mental illnesses, only 4 percent of the jails reported hiring deputies with experience in dealing with these individuals. Less than a third reported hiring full- or part-time non-law-enforcement staff members (including nurses, social workers and psychiatrists) to accommodate these inmates;
     
  • In terms of their structural changes to accommodate these inmates, only about a third of the jails reported diverting these inmates to facilities other than jails; and
     
  • Even though psychiatric medications are central to stabilizing people with serious mental illnesses, only 42 percent of the jails reported offering such medications to these inmates. Even lower percentages of the jails reported offering psychotherapy services for these inmates.
Jennifer Hoff, a California resident whose mentally ill son has been incarcerated, said the report resonated with her. "The nightmare began when our son turned 18 and he was able to make his own medical decisions, including discontinuing treatment for his bipolar disorder," Hoff said. "It was like watching my own child drown slowly."

While the ultimate solution is providing more state psychiatric hospital beds and community-based mental health treatment services, the report recommends interim evidence-based solutions for this problem.

These include diversion programs to prevent the mentally ill from entering the criminal justice system in the first place; extensive training for police officers about how to recognize offenders with mental illnesses and help them find treatment programs; a functional intake system that screens individuals with serious mental illnesses in jails and channels them for mental health treatment; and the provision of proper mental health treatment for seriously mentally ill inmates in jails.

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The Treatment Advocacy Center is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illness. The organization promotes laws, policies and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.

The organization does not accept funding from the pharmaceutical industry. The American Psychiatric Association awarded the Treatment Advocacy Center its 2006 presidential commendation for "sustained extraordinary advocacy on behalf of the most vulnerable mentally ill patients who lack the insight to seek and continue effective care and benefit from assisted outpatient treatment."