THE DILEMMA OF JAILS AND PRISONS SERVING AS MENTAL HEALTH TREATMENT FACILITIES
A new Wall Street Journal article draws attention to the mental illness crisis in US prisons and jails. The story hits close to home—Los Angeles County Twin Towers Jail serves as the nation’s largest mental health facility—and points toward the need for lasting solutions to the revolving detention door, like adequate treatment programs and rehabilitative help on the outside.
WSJ requested information from every state on mental health issues within their prisons. Twenty-two states gave detailed responses. States on the lower end of the mental health patient ratio reported one in ten inmates suffered from mental illness, while Oregon and Iowa on the other end of the scale said that a whopping 50% or more of their their state inmates battled mental health problems. (California landed somewhere in the middle with about 27%.)
The WSJ article by Gary Fields and Erica E. Phillips is behind a paywall. Here are some of the relevant clips for those of you that don’t subscribe:
America’s lockups are its new asylums. After scores of state mental institutions were closed beginning in the 1970s, few alternatives materialized. Many of the afflicted wound up on the streets, where, untreated, they became more vulnerable to joblessness, drug abuse and crime.
The country’s three biggest jail systems—Cook County, in Illinois; Los Angeles County; and New York City—are on the front lines. With more than 11,000 prisoners under treatment on any given day, they represent by far the largest mental-health treatment facilities in the country. By comparison, the three largest state-run mental hospitals have a combined 4,000 beds.
Put another way, the number of mentally ill prisoners the three facilities handle daily is equal to 28% of all beds in the nation’s 213 state psychiatric hospitals, according to the National Association of State Mental Health Program Directors Research Institute Inc.
“In every city and state I have visited, the jails have become the de facto mental institutions,” says Esteban Gonzalez, president of the American Jail Association, an organization for jail employees.
To get a snapshot of how the U.S. is grappling with such an explosive societal issue, The Wall Street Journal surveyed all 50 states about issues of mental health within their prison populations. Of the 22 states that provided detailed responses, their mental-health patient ratios ranged from one in 10 inmates to one in two. Inmates in all 23 responding states account for 55% of the prisoners in the U.S. under state jurisdiction.
In Oregon, the trend is particularly acute. Officials there estimate that half the state’s 14,000 prison inmates suffer from some type of mental-health issue.
Several states with large inmate populations, like Michigan and Illinois, reported to the Journal that about 8% to 10% of their inmates suffered from serious mental illnesses, such as schizophrenia. Smaller states, like Montana, said as many as 15% of their inmates suffered from serious mental illness.
Caring for such distressed inmates is costly. National Alliance on Mental Illness, one of the leading advocacy research groups, estimates that prisoners with mental illness cost the nation $9 billion annually.
Other challenges are evident. In Los Angeles, for example, the U.S. Department of Justice found in 1997 that mentally ill inmates were abused and endured conditions that violated their federal civil rights.
Earlier this month the DOJ sent a letter to L.A. officials saying that despite some apparent progress, there is “a growing number” of mentally ill inmates housed in general population quarters at Men’s Central Jail, as well as a “recent increase in suicides.”
Assistant Los Angeles County Sheriff Terri McDonald said the growing population of mentally ill inmates “certainly strains the system.” She said they would continue to work with DOJ officials “and we welcome their thoughts.”
LA COUNTY PROBATION CAMPS COME UP SHORT ON ONE OF THE MOST IMPORTANT DOJ REFORM REQUIREMENTS
On Wednesday, the Department of Justice released its most recent report detailing the progress being made through its oversight of LA County’s juvenile probation camps. According to the report, while the county has come into compliance on 38 monitored areas for reform, four provisions—staffing ratios, rehabilitation and behavior management, access to community alternatives, and the auditing process—are still not in full compliance.
While this shows improvements from this time last year when Probation appeared to have slid out of compliance in several disturbing areas, it’s especially concerning that rehabilitation and behavior management (arguably the most important reform area) is still out of compliance.
The 141-page report comes after about five years of DOJ-monitoring of the probation camps, and re-assesses compliance reports from 2011 and 2012 on the Feds’ original 2008 reform demands.
(We’ll have more on this next week, but here’s the short form.)
Here are a few clips from what the report had to say about rehabilitation and behavior management:
With regard to the programming provisions of Paragraph 17, the County has increased the range of programs available to youth. The capacities of these programs were determined in part by the results of the youth “Needs Assessment” discussed in a previous Monitoring Report. After an intensive period of staff training, the County now has sufficient capacity in the major rehabilitative programming components, with the exception of a small number of camps with limited ART capacity. For the most part, and despite some weaknesses in the process, youth at all camps now have access to enriched programming services. With the increased capacity, once the County is certain that youth are accessing needed programs, their impact on the youth’s behavior must be evaluated.
With regard to the behavior management requirement of Paragraph 17, the County has now had more experience with the enhanced Merit Ladder program. By design, it includes a range of short-term, mid-range and long-term rewards to incentivize pro-social behavior. Problems with the mechanics of the point system and delivery of some of the rewards persist in several camps. Significant work remains to shore up the implementation of the Merit Ladder.
…only recently (July 2013) have staff been trained to implement the new policy on the use of the SHU. Its implementation has not yet been assessed by the County nor witnessed by the Monitor.
…and community-based alternatives:
Paragraph 73 was added to the MOA to ensure that alternatives to incarceration are properly considered for youth who come into contact with the juvenile justice system, and that youth receive treatment and services in the least restrictive setting consistent with public safety, the youth’s needs, and the goal of rehabilitation. Because the provision deals with many of the processes and programs already in place in the County system and facilities, Monitors were frequently told that the existing policies, procedures and practices needed either no change or only minor adjustments for full compliance with the Paragraph. However, during this monitoring period the County and the Monitors have found many of the policies and procedures lacking in the specific requirements of the provision. Even where, in some instances, the policies and procedures may have been adequate, the practices and implementation of those policies may not have been.
TENNESSEE WOMAN REDIRECTS AT-RISK KIDS WITH “TOUGH LOVE”
In a suburb of Nashville, Carolyn McFall runs the community-based Evening Diversion Program where at-risk youths are referred as a final opportunity to turn their lives in the right direction before they end up in state custody.
Seventy-year-old McFall takes on a grandmotherly role with the kids, who often have issues at home and substance abuse problems, and equips the kids healthy coping mechanisms and teaches them how to “rescue themselves.”
The Juvenile Justice Information Exchange’s James Swift has the story. Here’s a clip:
The program operates out of a small, one-story home in a quiet, residential neighborhood close to the Franklin city limits. It stands side-by-side with My Friend’s House boys’ home, which is one of the last remaining standalone group homes in Middle Tennessee.
The EDP site, which she refers to as “her cottage,” does not feel like just another building, McFall said. Its quaintness gives it a certain intimacy, she said, which is something that’s often lacking in larger facilities.
“The Evening Diversion Program is a program for small groups of at-risk youth,” she said. “The court wanted us to start a program that would be the last program before these kids went into state custody.”
For McFall, 12-hour days are not unusual. EDP pre-planning usually begins at noon, she said, but frequently, her workday begins even earlier. If one of her youths has a court appearance in the morning, McFall said she’s more than willing to show up beside them, even though her position doesn’t necessitate it.
“I go to court with them, every time,” she said.
Routinely, she said she visits the Williamson County Juvenile Court, not only to see if any of her former youths have re-offended, but also to scout potential EDP participants. “If I see a kid who comes through there that sounds like they’re just perfect for the program,” she said, “I’ll just go to the YSO and say, ‘hey, what about so-and-so?’”
One of the favored approaches McFall employs is what she called a “backdoor treatment plan.” She sits down with youth in the program, and allows them to chart their own plans, based on what they believe would be the best way to achieve rehabilitation. In one example, she said she asked what one youth felt he needed to do to become sober; his responses, McFall stated, ended up becoming his own blueprint for treatments.
McFall’s program seeks to instill in young offenders specific life skills, such as coping mechanisms and how to work with others to solve problems. Instead of being punitive, she said EDP is designed to educate youths on how to make better decisions and “rescue themselves.”
The goal of EDP, she said, was to “normalize” its participants. “You’re just making mistakes and you don’t know how to get out of them,” she said. “Every one of them is worth saving.”
For McFall, social skills development is a pivotal aspect of rehabilitation. To help youths better empathize with others, McFall said one of her groups once prepared dishes for a get-together with several agency members. “They see DCS, Youth Service Officers and the court officers, they’re here to punish you,” she said. By having regular social interaction with probation officers and YSOs, however, she said her kids were able to better relate to and understand systems employees. Learning how to discuss contentious issues civilly, she said, was another major component of the program.
The most difficult part of her job, McFall said, weren’t the kids, but working with their parents and custodians.
“So many of these families have given up on these kids,” McFall said. She recalled several incidents involving LGBT youths enrolled in the program.
“This is a very religious area,” she said. “And I have had any number of parents who come in here, who wants me to explain to [their children] that God doesn’t love them.”
Consider your first article in today’s posting when evaluating the second. A significant number of juveniles with mental health issues have been branded “delinquent” and fill up detention centers and camps. As with their adult counterparts, treatment is provided in the least likely therapeutic setting. Merit ladders and systems of reward are meaningless concepts to the most disturbed. We are warehousing mentally ill adults and children as criminals and ignoring the resulting chaos in our detention centers.