Budget cuts force jail time for mentally ill

Saturday, March 12, 2011 | 6:00 a.m. CST

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.

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Christopher Cross March 12, 2011 | 10:52 a.m.

The 2010 Report to the Governor speaks about a steering committee, that is largely comprised of government officials.

The report cites a 14.8% recidivism rate for the year 2010 among offenders with mental and other like disabilities, which is slightly up from 2006, as the Department reported a 14.2% recidivism rate existing among offenders with mental and other like disabilities.

It seems to me, and logically so, that if there were any sincerity in wanting to “identify recommended system, policy, and practice reforms needing to occur” and “the need to identify needed best practices and to promote them at local and state levels” then there would not be the overt refusal to ensure existing rules and regulaitons comply with state and federal laws relevant to guardianship's.

The Missouri Department of Corrections uses rules and regulations to disenfranchise people with disabilities by inflicting discriminatory practices. A non-disabled offender, probationer, and parolee has far more rights than does an offender, probationer, and parolee whose disabilities necessitate their having a Guardian.

State law [Article IV ¶ (i) of Mo. Rev. Stat. § 217.535] is implicitly clear that a Guardian “shall not be deprived of or restricted in his exercise of any power in respect of any inmate.” Therefore, there is absolutely no excuse for Department rules and regulations not already being in line this state law.

Moreover, federal law [42 U.S.C. § 12203(b)] also makes it illegal to “coerce, intimidate, threaten, or interfere” with an offender, probationer and parolee in the exercise of any right guaranteed under the Americans with Disabilities Act by the aid of their Guardian and yet, Department rules and regulations are not in line with this law either.

Every year taxpayers of Missouri shell out upwards of $80 million to private corporations to deliver health care services inside Missouri prisons and yet, even the 2010 report to the Governor [see “Challenges” at ¶ 2] questions the effectiveness of existing mental health services being provide by the current contract vendor, as this is one area identified in the report needing to be improved.

So, again stating the obvious here: We are spending all this tax revenue going around and around in circles and not accomplishing much of anything. The system is broke and all the band-aid solutions being applied is not fixing the system, and it is human beings who are paying the price for your ongoing ineffectiveness and routine failures.

(Report Comment)
Yves Montclear March 12, 2011 | 1:50 p.m.

Christopher, your typing, makes too much sense to be posted here.

I actually learned something today, that is a good day.

While you point out the problems, can you formulate a better solution? I didn't see a solution to the problems in your post.

(Report Comment)
Christopher Cross March 13, 2011 | 9:22 a.m.

Yves: Thank you for your compliment and more importantly, you question.

The first solution I would recommend is that Department rules and regulations must be in line with existing laws relevant to legal guardianship's. If there is any class of offender, probationer, and parolee that stands the best chance at not re-offending it is those who have a legal Guardian. However, at the present time Department officials, correctional employees, probation/parole officers, politicians, and mental health staff all maintain a steady course that works against a legal Guardian and not with them.

The second solution I would recommend is that if we are going to contract with a private corporation to provide mental health and psychiatric services, then we must also mandate a specified percentage of dollars that must be spent on mental health and psychiatric services, programs, and activities and not some meaningless percentage either.

From 2007 to 2011 the taxpayers of Missouri have paid $86,963,449.17 to the current contract provider, Mental Health Management Correctional Services. However, when clients are only receiving less than five minutes of counseling for, which is only [scheduled] to occur once a month, we are not helping those who need these services, rather we are just lining the pockets of corporate executives instead.

Third, studies show that family members play a significant role in the success of offenders leaving prisons and not re-offending. As such, we need to incorporate family members, spouses, and those who are a Guardian, into the pre-release mechanisms and programs / services. By doing this we increase the support system for the offender and when you increase the support systems you increase the likelihood they will succeed.

Forth, we need to institute a mentoring case management program that helps offenders with disabilities in the critical transition stages of parole. The role of the case manager would be to work with both the parolee and his / her family, spouse, or the Guardian if they have one and help them navigate the system and services, and serve as an advocate in a broad spectrum of areas. This was actually done in the 1980's and had some very good successes.

Fifth, there is not one county in this state that should not have a mental health court. This diversion program has shown promising successes in helping those charged with crimes gain the services they need and achieve success in developing the skills they need to live a life that is crime free.

Finely, the status quo is not working. Our system is broke and it is costing taxpayers too much money and not giving us a positive return for our financial investment. As such, the general public needs to stand up and help fix our system, just as politicians need to help and bureaucrats need to do the same. This mindset that its not my problem and “lock em up” needs to change. Its everyone’s problem and existing solutions are not working.

(Report Comment)
Christopher Cross March 13, 2011 | 10:03 a.m.

According to the Bureau of Justice Statistics, by the end of 1990 there were 771, 243 people in state and federal prisons. Today it is estimated that there are 2 million people incarcerated in state prisons throughout the United States.

In the 2006 report from the Human Rights Watch the number of people in jails and prison with mental illness nearly quadrupled to 1.25 million from 1999.

Interestingly enough, in 1999, the U.S. Supreme Court issued its ruling in Olmstead v. L.C. 527 U.S. 581, which held that people with disabilities have a protected right under the Americans with Disabilities Act, not to be forcibly confined in state institutions.

So, from 1999 to 2006, the states responded by simply locking these people up in herds, in state prisons, instead and in contast to what exists today, it is not all that different.

The 2009 report from the Human Rights Index estimates that in 2009, there were 350.000 people with mental and other like disabilities in jails and prisons for, which was higher if you include anxiety disorders.

In terms of managed health care services, Valitás Health Services which owns Correctional Medical Services, holds the contract to provide medical and dental servies in Missouri prisons. And according to the March 4, 2011 report by St. Louis Today website, Valitas will have an estimated $1.4 billion in revenue received this year.

Mental Health Management Services, Inc., which owns Mental Health Management Correctional Services holds the contract to provide mental health & psychiatric, services in Missouri prisons. And from 2007 to 2011 it has received $86,963,449.17.

Suffice to say, crime is a major money maker for private corporations, and because it is premised on a flat-fee payment, the objective for them is to produce financial profits. This begs the question of what incentive is there for these corporations to help offenders, when doing so will likely mean lower corporate profits?

According to the March 2011 report from the National Alliance on Mental Illness, states, across the board, are making serious budget cuts to mental health care and treatment services. The natural cause and effect when we decrease services is to increase crime rates and with this, increase the prison population of offenders with mental and other like disabilities.

As pointed out in the Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act of 2008, “In addition, mentally ill offenders can be affected psychologically by incarceration differently than general population offenders.”

People with disabilities are NOT second class citizens but are routinely treated as such, and when we cut funding for mental health / developmental services and programs, and for community housing providers, we disenfranchise this class of citizens and inflict irreparable harms.

(Report Comment)

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