James M. Cummings, BridgeTower Media Newswires
Much has been written lately about criminal justice reform. Such a public dialogue can be productive to ensure justice is being best served. Unfortunately, though, many of the media accounts and political agendas are overly simplistic and shortsighted without an understanding or appreciation of what our nation's correctional facilities have become.
In addition to rehabilitating criminals, our jails, houses of corrections and prisons are now the place where many of our addicts and mentally ill people end up.
Today, it is a daily occurrence that, among the new inmates "booked" into the facility, is a significant number detoxing from narcotics and alcohol. In fact, in Barnstable County, Massachusetts where I am sheriff, about 40 percent of newly arriving inmates require some level of medical detox intervention. In addition to the drug- and alcohol-addicted inmates, correctional officers also are faced with people suffering from serious mental illnesses.
Many of the inmates have co-occurring disorders resulting in both an active addiction and a diagnosed mental illness. According to reports published in the Journal of the American Medical Association, approximately 50 percent of those with severe mental disorders are also affected by substance abuse. We must further acknowledge that there are more than a few incarcerated individuals who have not yet been diagnosed and are not included in the statistics.
There is near total agreement from those on both the far right and extreme left of the political spectrum that jail is not the ideal place for individuals with mental health issues.
So, how did correctional facilities become the dumping ground for the nation's mentally ill and addicted? Mentally ill people were at one time treated in "mental hospitals." While not a perfect system, marked by occasional reports of overcrowding and neglect, citizens with serious mental health challenges were generally provided a safe place to reside where they received appropriate care.
The deinstitutionalization of state mental hospitals was arguably a well-intentioned plan following a federal court decision regarding the overcrowding in some state hospitals. Between 1973 and 2010, the Department of Mental Health closed 10 public psychiatric hospitals across Massachusetts, with the patients returning to the community.
The logic at the time was that the use of new psychiatric medications and community-based homes would provide a new and progressive mental health system and rescue the patients from the "evils" of institutionalization.
The mass closure of mental health hospitals with nothing more than a new community care concept for the discharged patients has been a disaster on many levels, including the impact on correctional facilities and the increases in homelessness and addiction. Jails are now the default answer for those who cannot follow the rules of society due to a mental illness.
Correctional facilities were never physically designed to house the mentally ill, and in the past, correctional staff was not trained to deal with those with serious mental health issues. That has led to countless problems for the correctional system, including increased danger to the safety of correctional officers and other inmates and significant financial costs to provide mental health services.
People suffering from serious mental health issues often are unable to follow the rules of a jail and often are dangerous to correctional officers, other inmates and themselves. Because of security requirements of correctional facilities, mentally ill inmates who cannot follow the basic safety rules often find themselves in some form of segregation. Such violations frequently lead to the loss of parole and early release opportunities, resulting in mentally ill inmates serving longer than expected sentences.
For many reasons, suicide risks for inmates are significantly higher than the general public. According to several published studies, as many as 50 percent of suicides in jails across the country are committed by inmates who have underlying serious mental health issues.
Mentally ill inmates also cost significantly more to house in a jail setting, including additional spending for increased staffing requirements, suicide monitoring, specialized training for security staff, psychiatric medications, and psychiatric examinations with mental health providers.
In Barnstable County, to respond to the growing need for mental health services, we have contracted with Correctional Psychiatric Services to ensure we are identifying and providing appropriate treatment. These additional services are expensive, but the financial, societal and individual cost of simply "warehousing" inmates with mental health issues is far greater.
Not only are correctional officials required to keep the public safe from our most dangerous criminals, we are also expected to be de facto mental health hospitals and addiction treatment centers. Until the state and federal governments come up with real options to incarceration for those suffering from serious mental illnesses and addiction, the revolving and expensive door of using correctional facilities as treatment centers will likely continue.
-----
James M. Cummings is sheriff for Barnstable County.
Published: Fri, Jun 16, 2017
