Incarceration of Mentally Ill Preventable, APA Says

A radical new approach to the way people with mental illness are treated before, during, and after they come in contact with the justice system is a social, economic, and moral necessity.

That's the conclusion of a report produced by APA's Committee on Jails and Prisons and the Division of Healthcare Systems and Financing, titled,“ Mental Illness and the Criminal Justice System: Redirecting Resources Toward Treatment, Not Containment.”

The report, to be used as an advocacy resource, has been a priority of APA President Marcia Goin, M.D., and was unveiled during the Association's annual business meeting at last month's annual meeting in New York City.

The report outlines an agenda for change that relies on collaboration between the justice system and the mental health system, and all the stakeholders involved in those two systems. The report also lays out a legislative, research, and communications or public relations strategy.

The report calls for a comprehensive approach to a far-reaching problem.“ Launching a new approach to the way we treat people with mental illness before and after they come into contact with the criminal justice system can have great value for our nation,” according to the report. “The necessary foundation is a viable mental health treatment structure. The value is not just economic, but more moral, contributing to the overall quality of life for all of us. The costs of inaction are significant.

“Providing access to treatment and necessary human services will produce better outcomes and improve quality of life and public safety in the community,” according to the report. “It will also lead to a more judicious use of precious public fiscal resources. It is the right thing to do.”

Deinstitutionalization Partly to Blame

In her address to members at the Opening Session at APA's annual meeting (see Original article: page 1), Goin explained that her interest in the subject derives from personal visits to the Los Angeles County Jail. There she witnessed firsthand the suffering of patients in what has come to be regarded as the largest psychiatric hospital in the country.

She outlined how the problem of mental illness in jails and prisons has historical roots that go back to deinstitutionalization, exacerbated today by severe budget cuts at the state and local levels.

“Following deinstitutionalization, the number of state hospital beds decreased from 339 per 100,000 population to fewer than 20,” Goin said.“ Meanwhile, the number of mentally ill persons in jail has increased geometrically. Untreated and without access to long-term care, many mentally ill patients ended up with symptoms and behavior that led to their incarceration.”

Today, Goin said, hospital closures, reduced services in outpatient clinics, and crowded emergency rooms have contributed to the erosion of resources available for public psychiatry and the care of people with severe mental illness.

“Too often the body politic has been willing to abdicate responsibility for the health consequences of impoverishment and violence,” she said.

Incarceration More Expensive

In 2002 the Corresponding Committee on Jails and Prisons was created. Its members began working with APA's Office of Healthcare Systems and Financing, and this past February a meeting was held with prominent stakeholders to gather data and brainstorm ideas on how to reverse the criminalization of people with mental illness (Psychiatric News, March 19).

Goin said the group modeled its work on the APA Business Initiative, focusing its efforts on the fiscal implications of the problem. The report, for instance, cites data showing cost savings associated with treatment versus confinement.

“The reality is that money often drives the engines of change,” Goin said at the annual meeting. “In this age of severe budget constraints, attention must be paid to fiscal projects in order to redirect resources to achieve the needed results.”

Members of the group that helped draft the report included, in addition to the Corresponding Committee on Jails and Prisons and APA staff, representatives of the federal Center for Mental Health Services, National Association of Counties, National Association of State Mental Health Program Directors, National Alliance for the Mentally Ill, research economists, and leaders in public and private hospital psychiatry, among others.

“I consider this report a first step,” Goin stated in an introduction to the report, “the beginning of our work—not the end.”

The report will be posted soon on APA's Web site at<www.psych.org/public_info/libr_publ/resource.cfm>.▪