Mental Health Resources in Jails

1 in 5 U.S. adults experience mental illness each year – of the 16 people in this room, that means about three of us probably dealt with some kind of mental illness in the past year and about half of us will struggle with mental illness over the course of our lifetimes. It’s frequently said that America is in a mental health crisis. And how has our country responded to this crisis? Mass incarceration. Jails and prisons are America’s largest mental health facilities. A recent report showed that two-thirds of people in jails had either current “serious psychological distress” or a history of mental health problems. Yet only about a third of those reporting serious psychological distress were currently receiving treatment. And despite positive progress to reduce Philadelphia’s incarceration rate, we still have the highest rate of any large jurisdiction in the country, and as of the end of August, 17% of the jail population in this city were defined as having a serious mental illness.

 

I’ve spent every Tuesday night this semester at a women’s jail in Philadelphia, getting to know a group of 25 inmates and helping to educate them on different health topics. What is obvious is that their mental health needs are not being met. They laughed when I asked if they had access to therapists and shared that mental health professionals are only available if an inmate has a full psychotic break or tries to kill themselves. They shared that doctors just try to give them medication to address their mental health challenges. They shared feeling helpless and powerless in their own mental health decisions. It is heartbreaking to hear their stories of need and learn that there is so little support for them. This is unacceptable. We need to invest in increased mental health professionals and training in Philadelphia’s jails because it will save people’s lives and futures, while also saving the city money.

 

Jails are where people are held when they are either awaiting trial or have a short sentence for a misdemeanor. Some will say that providing mental health services in jails is difficult and not worth the investment of resources because it is such a transient population, with people averaging stays of about 88 days in Philadelphia. But three months is a significant period of time and 3.5 times the national average of jail stays. And some inmates remain in jail for years. It’s an opportune time for intervention, as many people arrive in a state of distress or experiencing substance withdrawal. Plus, jail itself can be traumatic and triggering to inmates. Meanwhile, the mental health provided, as reinforced by the inmates I’ve interacted with, is almost entirely “self-injury prevention” and “psychopharmacology.” Denying inmates access to a therapist during what might be the most challenging time in their lives borders on unethical. In fact, denial of physical health and mental health care to inmates is considered “cruel and unusual punishment” under the Eighth Amendment. Medication and crisis response is not enough. Ironically, some of the only therapy provided in Philadelphia jails is for male inmates who end up in segregation, where they spend 23 hours a day alone in their cell. Seeing as solitary confinement has been known to lead to mental health challenges itself, the two hours of therapy a day can perhaps just offset the trauma we’re imposing on them.

 

The city has an immense opportunity to change lives through additional therapeutic interventions in its jails. While a full intervention may not be possible as inmates are sometimes unexpectedly released from jail, that is no reason to not have therapists easily accessible and more resources to help inmates get the support they need once they are released and reenter society. Inmates should not have to have a crisis to have access to psychotherapy - and sometimes even if they are in crisis, mental health professionals strapped for time and resources don’t always respond appropriately. A woman I met this semester arrived at jail in a dark place. She shared that she wasn’t sleeping as she kept reliving her past trauma. When she expressed to a professional that she didn’t feel like living anymore, she was told that that’s normal to feel in jail, given medication, and sent on her way. The woman has remarkably supported herself through a healing process, but the city is lucky this story didn’t end differently. In fact, suicide is the leading cause of death in local jails, especially in the first few weeks after someone arrives. Described as the “shock of confinement,” the loss of a sense of normalcy can be traumatic. A quarter of suicides in jail happen in the first 24 hours and half within two weeks. In the very city where it was professed that life, liberty, and the pursuit of happiness are unalienable rights and where we pride ourselves on brotherly love, no one should ever die at their own hands because we didn’t provide adequate resources when they were in our care. You do not want that blood on your hands.

 

And I know you’ll ask, “But don’t we screen for mental illness and suicidal thoughts before admitting someone to jail?” And yes, jails are required to screen for mental illness and suicide intention before admitting an individual. However, often these assessments are held in spaces that are loud and lack privacy. Would you want to disclose the most intimate details about your life in a space that isn’t private? In a space where there is one way in and no way out? In a space where you quickly learn to be hypervigilant about threats and fear appearing weak to those around you? Would you share your truth?

 

And while the human cost is what we should care most about, financial costs must also be considered. Philadelphia is spending about $50,000 per inmate in jail annually. Compare that to the $16,000 per student that the School District of Philadelphia spent in 2017-18, while community mental health services outside of jail are estimated to cost $10,000 per year - a fifth of the cost of incarcerating an inmate. Investing in mental health resources now can save the city significantly down the road because prisoners with mental health challenges are more likely to be rearrested. Imagine you receive a one-year sentence and are incarcerated in a Philadelphia jail. You experience depression and anxiety and are given medication to help you. When you are released a year later, you have of course lost your previous job and struggle to find a new one now that you have a record, so you can’t afford the medication you were receiving in jail. Your depression and anxiety resurface even more significantly and with no other coping mechanisms, you spiral downward, make some bad decisions, and end up back in jail, likely to receive a more significant sentence as a second offender. It’s not a very far-fetched scenario. By ignoring the needs of the population, we are feeding a vicious cycle of recidivism, which costs the city even more through additional incarceration costs.

 

Additionally, investing in more specialized mental health professionals in jail can not only reduce the risk of recidivism but also save medical costs. A jail in Louisiana found that adding one medical psychologist - who can provide more accurate diagnoses and targeted clinical care - led to a 67% reduction in pharmaceutical costs. Because inmates were getting more comprehensive treatment plans early on, the reliance on medication was reduced, resulting in savings of nearly $100,000 in just one year. Additionally, officials at the jail said that by prioritizing mental health, the inmates were more stable and had a better chance of success when they returned to their communities.

 

Of course we need to invest in mental health resources everywhere - in our neighborhoods, in our schools, on our college campuses. We need to help those with mental illness and ensure that they never end up in jail. That’s the tip of the iceberg - that’s what we know is happening every day when we see someone who is homeless and struggling or hear of another college student’s suicide - it’s what we know we need to change because it’s visible to us. But we can’t ignore what’s happening below the surface while we wait for change - we can’t ignore the people in jail just because they’re behind bars, invisible to us. If we only focus on the tip of the iceberg - on increasing mental health resources outside of jail - and wait for the impact to trickle down to the criminal justice system, we will never stop the cycle of recidivism that is all too common for those with mental illness.

 

If I have learned one thing from spending time with the 25 women I’ve gotten to know in jail over the past two months, it’s that they are the most resilient people I’ve ever met. Most have been through immense trauma, many are recovering addicts, and all of them never want to end up back in jail. We do a disservice to them, we do a disservice to their communities, and we do a disservice to the city of Philadelphia if we don’t give them the support they need to heal while in jail and successfully reenter society as healthier, more whole human beings. If we invest now in more mental health resources in our jails, then we can change the course of the lives of the people in our care and the economic future of this great city.