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Prisons have become the defacto asylum
for Idaho's mentally ill
Passage of the Mentally Ill Offender Treatment and Crime Reduction Act of 2004 supports collaboration through intervention, appropriate treatment options, graduated sanctions, adequate training and communication. The goal is to reduce the number of those with mental illness in adult and juvenile correctional facilities, while enhancing public safety.
Idaho is pioneering an effort to bridge gaps in mental health care for offenders and is the first state in the nation to create a broad-based coalition consisting of public agencies and private citizens. The Idaho Mental Health Coalition strives to: “Create a continuum of care between communities and the criminal justice system to manage mental health treatment for offenders to positively impact community safety.”
Research confirms the rate of mental illness for the adult incarcerated population is three to four times that of the general population (5 percent). Idaho mirrors that trend — 9 percent of all adult inmates have a diagnosed mental illness that is treated with psychotropic medication and the Idaho Department of Juvenile Corrections reports that 44 percent of juveniles committed to IDJC exhibit mental health problems. Nearly all of these offenders will eventually return to our communities.
Prisons became de facto mental health hospitals as public policy shifted over the past 35 years. Mental health patients were pushed from institutional care to communities. Even as the nation’s general population grew by 65 percent, state mental health hospital populations decreased 86 percent, from 559,000 in 1955 to fewer than 80,000 in 1999. The community-based support worked for some, but others fell through the cracks and into the criminal justice system.
Recognizing the need to remedy the mental health/criminal justice issue, Congress recently passed the Mentally Ill Offender Treatment and Crime Reduction Act of 2004. A key Congressional finding states that “collaborative programs between mental health, substance abuse, and criminal or juvenile justice systems that ensure the provision of services for those with mental illness can reduce the number of such individuals in adult and juvenile corrections facilities, while providing improved public safety.”
The Data
Mental Health patients are more likely to come into contact with the criminal justice system.
40 percent of adults who suffer from serious mental illness will come into contact with the American criminal justice system at some point in their lives.
Idaho’s prisons house more mental health patients than the state’s mental health hospitals
Adults
16 percent of adults incarcerated in jails and prisons have a mental illness (N=700,000)
That rate is at least three times the 5 percent rate of mental illness in the general population
Juveniles
More than 150,000 juveniles involved in the juvenile justice system each year have at least one emotional disorder.
5 to 9 percent of all children have a serious emotional disturbance
Adults
26 percent of the inmates housed in Idaho’s adult prisons have a mental illness (N=1,564 inmates)
5.4 percent of Idaho adults have an identified serious mental illness (N=50,000)
Juveniles
44 percent of all Idaho juvenile offenders managed by IDJC have a mental health issue
5 percent of Idaho children, 17 and under, have a serious emotional disturbance (N=18,452)
The Data
Additional Costs
Mental health has an indirect cost estimated at $79 billion each year in the United States
$4 billion is lost in productivity for incarcerated individuals and for the time of those who provide family care
In Los Angeles, 90 percent of all jail inmates with mental illness are repeat offenders and one third have been incarcerated 10 or more times
Additional Costs
Mental health care costs the Department of Correction $1.34 million each year
It cost half a million dollars to provide psychotropic medicine to incarcerated Idaho offenders last year
In Canyon County’s juvenile facility, 50 percent of all incidents with restraints involved the 27 percent of offenders with mental health issues
Fiscal Impact
The fiscal impact of the mental health population on all criminal justice and state systems is well documented. 97 percent of all inmates return to communities. A review of national facts reveals more than 70 percent of all offenders with mental health issues recidivate.
The New Freedom Commission report ordered by President Bush states: “Cost studies suggest that taxpayers can save money by placing people into mental health and substance abuse treatment programs instead of in jails and prisons.”
Illinois
The Cook County Thresholds Jail Program in Illinois illustrates how providing appropriate community services can prove cost effective. Prior to entering the program, 30 participants with mental illness spent 2,741 days in jail. After a year of intensive community-based services, the same 30 participants spent 489 days in jail. Calculated at $70 per day this reduction in jail time represents a savings of $157,640.
Idaho
An Idaho collaboration that is making a difference is the District 7 Mental Health Court. Three years is needed before a program can be measured, but preliminary results indicate the base is being built. The Mental Health Court in District 7 has had seven graduates. Since participating, the number of jail days used by all participants has declined by 85 percent and the number of psychiatric hospital days has declined by 97 percent. The first three graduates had a combined 324 jail days and 10 arrests in the year prior to mental health court participation. The first graduates completed court in April 2004.
The Congressional passage of the Mentally Ill Offender Treatment and Crime Reduction Act of 2004 supports collaboration through intervention, appropriate treatment options, graduated sanctions, adequate training and communication. The stated goal is to reduce the number of those with mental illness in adult and juvenile correctional facilities, while enhancing public safety.
The Idaho Mental Health Coalition mission is essentially the same:“We will create a continuum of care between communities and the criminal justice system to manage mental health treatment for offenders to positively impact community safety.”
Opportunities for Making a Difference
Dr. Tom Fagan, a national expert who reviewed Idaho’s correctional mental health system, challenged coalition members to begin building connections to maximize the impact of existing services. Dr. Fagan identified the following areas where partnership could enhance services for adult and juvenile offenders identified as having a mental health issue:
(1) A need to improve information sharing among agencies;
(2) A need for more cross-training among agencies regarding available services, programs, and unique problems;
(3) A need to identify and/or develop more community resources to meet the pre- and post-confinement needs of offenders with significant mental health problems; and
(4) A need to engage in more partnerships among agencies aimed at designing cooperative demonstration projects, conducting program evaluation on existing and new mental health programs, and engaging in research activities.
During its first meetings, the Idaho Mental Health Coalition created action plans and has since made strides toward building a mental health care delivery system for offenders that shares resources more effectively.
Action Plan: Information sharing
Two deputy attorneys general have drafted a statute which would facilitate the flow of mental health records between jails, the IDOC and other government agencies and providers.
Information technology representatives have reviewed the compatibility of technology systems for this transfer of information.
Action Plan: Available community resources
A comprehensive resource inventory has been created to avoid duplication of efforts and enhance available resources for offenders returning to communities.
Action Plan: Training
Cross training and education: Coalition members will set up e-mail notification of training opportunities for coordination and sharing of those opportunities.
Action Plan: Education effort
A work group created this white paper to educate stakeholders on the problem, its fiscal and safety impact on communities and the goals of the coalition. The education effort includes a video, Web site and continued updates.
Action Plan: Program development
A work group is comparing programs for mental health offenders that are provided in the community with those provided through the criminal justice system. The synergy of this effort will create research-based programs that bridge between prisons and communities.
In addition to the Governor’s office, partners currently include representatives from the Legislature, The Idaho Department of Correction, The Idaho Department of Juvenile Corrections, The Commission for Pardons and Parole, The Idaho Department of Health and Welfare, Vocational Rehabilitation, Boise State University and the Attorney General’s Office. Judiciary representatives include; District 7 Judge Brent Moss and The Idaho Supreme Court. Also included are county representatives, mental health care providers, National Alliance for the Mentally Ill, Comprehensive Advocacy, Friends and Families of Inmates and other community members.
Appendix
White Paper Committee Members
Dr. Michael Graham, Division of Vocational Rehabilitation
Nancy Cladis, Ada County Misdemeanor Probation
Tammy Payne, Healthy Families-Nampa Project
Renee Smith, Division of Vocational Rehabilitation
Ginger Wright, Department of Correction
Ray Millar, Health and Welfare
Dr. Michael Blankenship, Boise State University
David Haas, Department of Correction
Doug Call, National Alliance for the Mentally Ill
Patty Tobias, Supreme Court
Teresa Jones, Department of Correction
Jean Weber, Department of Correction
References
Nationally, several efforts are underway to design a mental health support system that is more effective. These documents are the main resources for the national statistics in this paper.
1. The Consensus Project
The Council of State Governments in partnership with police, corrections and mental health program directors recently completed the two-year Criminal Justice/Mental Health Consensus Project. The resulting recommendations will guide improvements in the criminal justice system’s response to people with mental illness.
2. The President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America, Final Report July 2003
President Bush created the New Freedom Commission on Mental Health to review what he called “…our fragmented mental health service delivery system.” He asked his commission to study the problems and make concrete recommendations to improve mental health care in America.
Other information used in creating this document was provided by:
3. Idaho Department of Correction
4. Prison Health Services
5. Idaho Department of Juvenile Corrections
6. Idaho Department of Health and Welfare
7. Fagan Report, National Institute of Corrections
8. District 7 Court
9. Mentally Ill Offender Treatment and Crime Reduction
Action of 2004
10. U.S. Census
Appendix
Definitions
Co-occurring disorder—Refers to two or more disorders occurring simultaneously. Generally refers to mental health and substance abuse disorders but can refer to mental health, physical health, developmental or other disorders.
Offender—The target population for this effort is adults or juveniles who have been adjudicated/convicted of a crime, either misdemeanor or felony, who have been identified as having a mental health issue.
appendix definitions continued
Psychotropic medication—Prescription drugs that address psychiatric symptoms, usually given to reduce anxiety, depression or other consequences of mental illness such as hallucinations, delusions or bizarre thinking.
Serious emotional disturbance—(SED) Child or adolescent birth to age 18; currently or anytime in the past year has a diagnosable mental, behavioral or emotional disorder to meet DSM-IV diagnostic criteria; functional impairment substantially interferes with family, school or community activities; excludes DSM-IV V codes, substance abuse and developmental disorders unless they occur with another diagnostic DSM-IV disorder.
Serious mental illness—(SMI) adults with a serious mental illness are persons age 18 and over, who currently, or at any time during the past year, have had a diagnosable mental, behavioral or emotional disorder of sufficient duration to meet diagnostic criteria specified within DSM-IV-TR (Diagnostic and Statistical Manual for Mental Disorders), that has resulted in functional impairment which substantially interferes with or limits one or more major life activities. (President’s New Freedom Commission on Mental Health)
Nationwide in prisons and jails:
Nearly half of all inmates with a mental illness in state or federal prison in the U.S are incarcerated for committing a non-violent crime.
Offenders with mental health issues stay in prison longer.
Nearly three-quarters of all inmates with mental illness have a co-occurring substance abuse problem.
Nationwide in communities:
Inmates with mental illness were 2.5 times more likely to have been homeless in the year prior to their incarceration than inmates without mental illness.
97 percent of all inmates return to communities after serving their time.
Mental health offenders are more likely to re-offend. Nationally, some jurisdictions report up to a 70 percent recidivism rate for these offenders.
According to a 1994 study, jail releasees who received fewer of the services than they reportedly needed were more likely to return to a jail or prison.
One in 12 individuals who come in contact with a patrol officer is suffering from a severe mental illness.
In Idaho Communities:
Approximately 325 adult Idaho offenders currently receiving mental health treatment will be released from Idaho prisons this year.
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