Guest Comment: Locking up people with mental health conditions doesn’t make anyone safer

By Sam McCann

Dashawn Carter, a 25-year-old from Staten Island, missed nearly 100 doctor visits while detained on Rikers Island, mainly because prison officers didn’t escort him to the clinic. He struggled to access the mental health drugs he needed and was effectively left to fend for himself. Carter committed suicide in his cell on May 7, 2022. He had been detained in the general population despite an extensive history of mental illness and a stay in a psychiatric hospital just two days before his death.

“It didn’t have a support system,” Carter’s high school friend Ray Robinson told The City. “He just had to really rely on himself and the people close to him.”

This type of neglect is all too common and is a direct consequence of the criminal justice system which often serves as the primary intervention point for people’s mental health needs. In the United States, people with severe mental health conditions are more likely to have contact with law enforcement than to receive any form of treatment. In addition, ten times more people are detained in prisons and prisons than in state hospitals: a number is partly rooted in divestment, with the number of beds in state hospitals falling by 94% since the 1950s. State hospitals themselves were often punitive, and in the 1960s Congress passed legislation to replace them with community mental health centers. But few of these centers have ever been built, and governments have failed to invest money in programs such as crisis response teams or treatment options. Instead, the funds flowed into prisons and prison systems, which are now the largest mental health care providers in the country.

But prisons and prisons are fundamentally not therapeutic settings and are ill-equipped to provide these services. About three in five people with a history of mental health problems do not receive treatment while in detention. They are also more likely to face discipline and spend three times as long in isolation. The trauma of incarceration, compounded by a lack of adequate care and re-entry resources, creates a revolving door in which people with mental health problems are unable to stabilize their lives.

This is bad policy: mental health services that are accessed outside of prisons and prisons are not only more effective, but also more cost-effective than incarceration. Failure to invest in care has a direct cost to people’s ability to live their lives, but officials continue to pour more money into prisons and prison systems that are totally unable to address underlying mental health needs. People with mental health needs do not pose a threat to public safety at all, in fact, they are more likely to be victims of a crime than an executioner. Jailing people in need of care is both unfair and destabilizing, subjecting them to the trauma of incarceration without adequate services. This is the real public safety risk.

In Los Angeles and New York City, Vera is working to address acute mental health crises in local prisons. In both cities, significant investments in mental health services can create security and reduce the prison population.

Los Angeles: A successful program requires investment

41% of the people in the Los Angeles County prison system have mental health needs. That number has increased by 21% since 2020, part of a 10-year increase in the number of people with severe mental health conditions in county jails. The Los Angeles prison system is the only largest mental health institution in the United States, and the county spends $ 548 per day to incarcerate people in mental health units despite a cost of only $ 207 per day to put them in housing and community care.

“By default, we have become the largest treatment facility in the country. And we are a prison, “Tim Belavich, the director of mental health care for the Los Angeles County prison system, told WWLP.” I would say a prison facility is not the proper place to treat someone’s mental illness. ” .

But according to a study by the RAND Corporation, 61% of incarcerated people with mental health problems could be safely diverted to existing alternatives to incarceration, such as the Office of Diversion and Reentry (ODR) Housing Program. Prison actually increases the likelihood of recidivism by trapping people with mental health needs in a vicious cycle of incarceration without ever providing them with treatment. Community-based diversion programs, on the other hand, strengthen public safety and reduce re-arrest rates by meeting underlying needs. There is no public safety reason to continue to keep people in prison instead of making sure they get the care they need.

The ODR Housing program is extraordinarily effective. It offers permanent supportive housing and intensive clinical support to people with severe mental health needs accused of crime instead of incarceration. The program model recognizes that the path to stability is not linear and considers housing as a fundamental pillar of success. Even if a client has another interaction with the criminal justice system, the ODR works to get him back into the program with the agreement of the prosecutor and the judge. Some of the program’s most successful clients needed more chances to reactivate. This ongoing support ultimately addresses two of the most pressing issues in the county: homelessness and the revolving door of the criminal legal system. One study found that 86% of participants had no new felony convictions after 12 months and 74% had stable housing after 12 months.

These promising results require support. However, the ODR is underfunded. Investing in 3,600 new mental health treatment beds, including for ODR Housing clients, would reduce the county’s reliance on jail and further its goal of closing Men’s Central. ODR’s success to date indicates that those new beds and services would reduce recidivism in Los Angeles by providing people with options that help stabilize their lives rather than jail them when they need treatment. The Los Angeles County Board of Supervisors will issue an additional budget this September, a key opportunity to invest in a program that can serve as a national model.

New York City: Reduced prison budget could build more favorable housing

Rikers Island is facing a mental health crisis. 53% of the people detained in the prison complex had a mental health diagnosis in fiscal 2021, up from 46% the year before. Cases of self-harm have skyrocketed as a result of the ongoing humanitarian crisis in New York prisons, which killed 16 people in 2021 and has already claimed 11 more lives this year.

As in Los Angeles, treatment in New York prisons is absolutely inadequate or non-existent. Despite a $ 2.7 billion budget, the city’s Department of Correction (DOC) constantly fails to provide the necessary medical care for the people in his custody, with thousands of missed appointments each month leading directly to death. Earlier this month, a judge ruled that the city must pay more than $ 200,000 to people who missed appointments while in DOC custody.

People with mental health problems are also subject to punitive treatment and longer stays in New York City prisons. The average length of stay for the general population on Rikers Island is 222 days. People in OCD custody for 24 hours or more who receive mental health care, however, are held for an average of 357 days, or 61% more.

The city pushed to create new safe mental health units on Rikers. This solution is fundamentally inadequate, as prison facilities are incompatible with the treatment required to meet mental health needs. And despite a bloated budget, DOC has delayed bringing even this deeply compromised solution online.

Instead of pouring money into programs that will continue to disappoint New Yorkers with mental health problems, the city should invest in housing instead. New York spends an average of $ 556,539 per person per year to keep people locked up. In contrast, providing supportive housing costs only $ 41,833 per person per year.

The city can and should invest in therapeutic services that enable people and communities to succeed and thrive at a fraction of the cost of incarceration. Mobile crisis response teams and crisis stabilization centers can provide alternatives to arrest. Controlled release, safe hospital beds, and semi-safe treatment programs can provide alternatives to detaining people on Rikers Island. And supportive housing can provide stability for people with mental health needs to avoid involvement of the criminal legal system and hospitalization in the first place.

Dashawn Carter should still be alive today. A common sense investment that meets mental health needs in the community, rather than in prison, will build safer neighborhoods across the country and reduce our failed addiction to incarceration.

Originally published by Vera Institute of Justice

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