KANSAS CITY — Myrna Trickey saw an increasing number of inmates with mental illnesses during her years working in the Missouri prison system.
It is criminalization of the mentally ill — and it's a huge problem, she said. At the same time, state funding has been cut to mental health, and the corrections system budget has grown.
"The traditional safety net of mental health care has not been well-funded in the last decade," said Trickey, who serves as president and chief executive officer of the Kansas City Community Center. "The responsibility for helping people with mental illness has, by default, gone to jails and prisons."
Frank Butler, a professor of criminal justice at La Salle University in Philadelphia, said nearly two-thirds of jail inmates suffer from some form of mental health problem. And with the closing of state hospitals due to deinstitutionalization, jails by default became inpatient mental-health centers.
"Mentally ill inmates are often 'frequent flyers,' ending up in jail time and again, commonly for minor offenses," Dr. Butler said. "Treatment resources for the mentally ill tend to be grossly inadequate in jail, in part because need far outstrips the resources allocated."
The National Sheriffs' Association and the Treatment Advocacy Center released a report last year that concluded mentally ill people are sent to jail more often than hospitals. The study suggested at least 16 percent of inmates in jails or prisons nationwide suffered from a serious mental illness. The study also pointed out 40 percent of individuals with serious mental illness had also either been in jail or prison at some point.
In 2007, 19.7 percent of inmates in Missouri prisons suffered from a mental illness. These people receive mental health care services while incarcerated, but the treatment comes at more of a cost to taxpayers and is less effective than what they would receive in a community health center setting, Trickey said.
"When they go to a jail or prison, they're going to get care, institutional care, instead of care that can be had more cost-effectively in the community," she said. "Instead of providing support to these individuals in a community settling, where they have their own housing and have assistance, instead in the prison system, they're getting room and board and 24-hour supervision and care being managed at a much higher cost."
The Missouri Coalition of Community Mental Health Centers claims total spending by states for the treatment of the mentally ill is one-third less now than it was in the 1950s. From 1992 to 2000, the state spending on corrections increased by 129 percent.
The Missouri Coalition also referenced a 1997 study that reported for every dollar invested in drug treatment, the state could save as much as $7.46 in crime-related and health spending. It put the annual cost to place someone in Missouri Drug Court at $5,042, compared to the cost of housing one inmate for a year at $12,998.
"Obviously, the best way to receive treatment is for someone who's in the criminal justice system through some sort of treatment court — whether it's a drug court, DWI court, mental health court or whatever," said Dan Kellogg, Buchanan County circuit judge.
He added addiction and mental health treatment is pretty limited at the county jail level. In a prison setting, there are more opportunities for services. However, the problem of mental health treatment is more of a community issue that's tied to a lack of funding, Kellogg added.
"I think the magic wand is adequate funding for programs to address those needs," he said.
"That's not because money cures all, but certainly, if we can provide services to more people, then that's great. But it is unrealistic in this budgetary and economic climate. We've got to do what we can with the dollars that we do have. I think we try and do a good job of that."
Chris Cline, spokesman for the Missouri Department of Corrections, said inmates have access to psychiatrists, psychologists and counselors while incarcerated. They also have access to group therapy and psycho-educational programs and may be treated with medication while in prison.
"The mentally ill receive treatment while incarcerated," he said.
A former mental health provider who worked in the Missouri prison system, and asked not to be identified, said the prison system didn't really offer counseling. The counseling sessions that took place were mostly responses to requests for services from the prisoners, who sometimes wanted medications that they sold or traded in the underground economy.
"A typical 'session' lasts less than five minutes, and they are scheduled four to 10 per hour," he said. "When prisoners come into prison already on medication, those medications are provided, assuming they are cheap enough to be on the pharmaceutical list recognized by the prison."
The person added many mentally ill prisoners who are "warehoused" in the prison system are sent there by well-intentioned judges who labor under the illusion that they will get proper treatment. "Unless they are unruly or unmanageable, they are left alone by the system," he said.
Buchanan County Prosecuting Attorney Dwight Scroggins said the vast majority of the time, the mental health issues people have aren't enough to prevent them from being prosecuted. He said the larger problem is that services are not readily available in the community.
"What happens is they continue to offend, and instead of dealing with them once they're within the mental health system, law enforcement ends up dealing with them repeatedly within the criminal system," Scroggins said. "It would be much more effective if they could have their mental health issues addressed and not then break the law."
He said people who have addiction problems and are not convicted of violent crimes often go to drug court before being sent to prison. The emphasis in the Department of Correction is on treatment outside the system; probation is more common than any other sentence.
"There are a lot more people who are out early on parole, or are placed on probation and shouldn't be," he said.