Mentally Ill Jailed, Not Treated

I just came across an interesting article on the situation for prison inmates with mental illness in forth Wayne, IN. According to a study* cited in the article, people with severe mental illness are three times more likely to end up in jail rather than hospital, while of course a jail cannot provide appropriate treatment. It was not clear to me whether the reason people end up in jail is related to poor preventive care, leading ot increased crimes, or whether people end up in prisons without having committed a crime – a situation which used to be the case for juveniles in the Netherlands.

However, whether or not inmates have committed crimes, and which or how many, is irrelevant to the fact that people with serious mental illness need and deserve appropriate treatment. Prescription medications can be accessed, but a psychiatrist and counselor visit the Allen County jail discussed in this article only once a week, for quite a large number of inmates with severe problems. This is not enough to provide quality mental health services, which every inmate should have a right to.

There are a few improvements being made, including the introduction of a crisis intervention team, which has the authority to take people to a hospital instead of jail. Most people assessed by this team, were taken to a mental hospital, hence preventing unnecessary incarceration in prisons. Of course, it is assumed here that inpatient treatment is needed at all, which may not be the case.

As the article says, a Mental Health Court was not established in or near Fort Wayne. A Mental Health Court is a courr where people convicted of misdemeanor crimes can have their cases handled voluntarily to determine treatment as an alternative to punitive sentences. This treatment would, of course, be court-ordered. The advantage of such a court is that people with mental illness are more likely to get the care they need rather than being jailed and released back onto the streets to potentially commit more crime, without any mental health services. Mental Health Courts are pretty widespread in the United States, and seem to be quite a success. Since we do not have them in the Netherlands – treatment orders are made by regular criminal judges -, I am not totally sure whether they are necessary as an adjuvant to regular criminal justice, as is indeed questioned in the article.

The take home message from this article, however, is that people with mental illness, including prison inmates, deserve appropriate treatmetn. How this is achieved, may be up for debate, but it is in the best interest of the individual and, ultimately, the public, if mentally ill people are provided with mental health services rather than pure inprisonmnent.

* This study was funded in part by the Treatment Advocacy Center, which is a proponent of involuntary outpatient commitment laws countrywide in teh United States. I am a strong supporter of patient autonomy, and hence do not advocate involuntary treatment. This does create some problems with regard to criminal justice, which I was unable to get into in this post.