By Rick Cagan, Executive Director, National Alliance on Mental Illness- NAMI Kansas

Another sad and disturbing population who find themselves in jail often for the wrong reasons are those with mental illness. Not unlike the disproportionate numbers of African-Americans incarcerated in this country, this trend has historical roots.

Incarceration of people with mental illness has come full circle.  From our country’s founding to the early 1800’s we incarcerated people with mental illness out of ignorance.  By 1900, a moment of enlightenment occurred and our nation determined that jailing someone for an illness was immoral. As a result, every state built psychiatric hospitals.  Still lacking effective treatment, individuals were segregated from the community and warehoused on a broad a scale.  It wasn’t until 1950 that the first psychotropic medication was developed. 

In 1963, President Kennedy signed a $3 billion authorization to create a network of community mental health facilities with the idea of returning them to their communities with support and newly developed medications.  After his assassination and the escalation of the Vietnam War, not one penny of the 3 billion dollars was ever appropriated.  By the late 1960’s several lawsuits triggered the movement of “deinstitutilaization” of state hospitals.   Ironically, the case initially had little to do with the conditions and treatment of patients. The primary motivation for closing state hospitals related to the costs to the taxpayer. 

Unfortunately, the national network of community mental health facilities with the financial resources to absorb these new patients was never fully created.  The rate of closure of state hospitals continued at an accelerated pace, and by the 1990’s the criminalization of mental illness began again for the second time in our nation’s history. 

Since 1955, the number of number of psychiatric hospital beds in the U.S. has decreased by 90 percent, while the number of people with mental illness incarcerated in our jails and prisons has grown by more than 400 percent. Given this historic process of continuously shifting the burden of responsibility without ever providing the necessary financial means to support recovery, it is no surprise that Douglas County is considering a bigger jail during a period of falling crime. We have failed to provide care to individuals with mental illness and systematically saddled police, judges, and jails with the burden.

The consequences of our policies are:  increased homelessness, increases in police injuries and police shootings of people with mental illness, and wasteful tax spending on systems that do not adequately address the problem. 

Significant numbers of individuals living with mental illness have encounters with law enforcement agencies and find themselves in the criminal justice system where the recognition and treatment of mental illness is not the primary mission.  Kansas Department of Corrections reported in 2014 a 13.8 percent increase among inmates diagnosed with a mental illness each year since 2009.

Other unintended consequences of incarceration of people with mental illness are the stress and hardship for the family as seen elsewhere in this report.  Inmates with mental illness are also likely to have longer sentences which affects stability of housing and employment. 

Judge Steven Leifman, who has extensive experience in Miami-Dade County, speaking at a Crisis Intervention Team Summit in Wichita in September 2016, reminds us:

• 1 in 104 adults in the U.S. are behind bars today.
• 1 in 33 adults in the U.S are under correctional supervision
• Since 1980 the number of people going to jail has tripled and time of sentences has increased by 166%

These increases are due in large part to untreated mental illness and substance use.  People with mental illnesses in the U.S. are nine times more likely to be incarcerated than hospitalized, eighteen times more likely  to find a bed in the criminal justice system than at a state civil hospital.  Annually, two million people with severe and persistent mental illness (SPMI) are arrested.  40% of all people with SPMI will come into contact with the criminal justice system at some point in their life.  Substance abuse accounts for a huge part of this problem.  Sixty-five percent of all inmates in jails and prisons have a diagnosable addiction disorder and eighty-five percent of all inmates meet criteria for substance abuse. 

So what can be done? The most important thing is to understand that jails are not therapeutic environments for people with mental illness. We need to do everything we can to divert those with mental illness out of the criminal justice system toward treatment, while also adequately funding the mental health continuum of care.

The good news is Douglas County has taken many important first steps:

Crisis Intervention Team (CIT)

CIT programs establish law enforcement protocols for crisis situations and provide training for law enforcement officers.  Douglas County is one of nine counties in Kansas where CIT training programs are established.  The decision by the Lawrence Police Department to provide every staff person and officer with CIT training is an amazing first step. Their decision recently to add mental health co-responders to ride with officers on mental health calls also displays great promise.

Crisis Stabilization and Treatment Centers

A regional network of stabilization treatment centers is needed as an alternative to jail or hospitalization for persons in crisis.  RSI in Wyandotte County is a role model. The plans for a Crisis Center in Douglas County are deeply supported in the mental health community.

Mental Health Diversion Programs

Diversion programs, such as one in Johnson County, help persons with severe mental illness to receive case management services and follow a treatment plan for a specified period.  Charges are dismissed upon completion of the plan.  Diversion is available for both violent (e.g., domestic battery, battery, etc.) and nonviolent charges when the underlying issue is the need for treatment. A nascent program in Douglas County to divert individuals out of jail began in March, 2016 with two assigned case workers from the Bert Nash Community Mental Health Center. The project has grant funding until October 2017.  We believe this project should be formalized to ensure charges are regularly dismissed when plans are completed. Also, eligibility for diversion treatment should not automatically rule out alleged violence but allow for discretion. These are critical items because the criminal justice system must put the necessary procedures in place to ensure no one is criminalized for having an illness. Also, long-term funding for the program should be provided by the county at a level that match the need.

Mental Health Courts

Mental health courts seek to prevent incarceration by making connections to mental health resources, then developing and assuring adherence to a treatment plan.  The City of Wichita has had a mental health court for several years; Topeka just recently established an Alternative Sentencing Court. The plans for such a court in Douglas County are encouraging. We would suggest expanding this court to include “substance abuse cases” as well.

The bad news is that our County leaders are inappropriately coupling the funding of a Crisis Center and the Jail as one project for the community to consider. This perpetuates the myth that people with illness are dangerous and need to be separated from the community (the opposite of best practice). This is a moral issue. We would never consider linking a Cancer Treatment Center with a Jail expansion. People must understand that mental illness is no different than cancer, a stroke, diabetes, and other illnesses of the body.  It is time we treated individuals with mental illness as people with a biologically based brain disorder. 

One practical way leaders in Douglas County can show respect for those with mental illness is to build the Crisis Center as soon as possible, invest in strengthening the continuum of care, and minimize contact and length of stay for anyone with mental illness in the criminal justice system.