The problem that will be discuss is how individual with mental issues are placed in jails and prison instead of giving them an alternative of helping them with their illness which has incidentally added to the many reasons why jails and prisons are over-populated. This analysis will examine mental health courts as a way to curb the entrance of jails to the mentally ill and reducing the overall percentage of those with mental illness in jails. In addition it well look to see if co-occurring drug and mental health courts or private programs work better to reduce recidivism and keep the mental ill out of jails more than the mental health courts. Operational cost, recidivism rates, and length of time between rearrests will be used to compare the effectiveness of each program.
Various stakeholders are involved in this problem. They are not all involved equally, but they all have a role to play to correct this problem and will be affected by the outcome. They are the mentally ill who commit non-violent crimes, government correctional agencies, politicians, legislators, judges, defense attorneys, prosecutors, probation officers and citizens.
The majority of the statistics that were used was obtained from the Bureau of Justice Assistance (BJA), RAND, and the National Institute of Justice. As well as other scholarly works that focus on the mentally ill and the criminal justice system.
2. Outcomes of Prior Efforts to Solve the Problem
Before mental health courts, there was not many policies that helped individuals with mental illnesses stay out of the criminal justice system or even get the help they need. The first Bill that was created was the Indigent Insane Bill. This bill would have provided a grant of land for "the relief and support of indigent, curable and incurable insane", if it was not vetoed by President Pierce in 1854. (Steven S. Sharfstein, 2000) Dorothea Dix, the writer and promoter of this bill believed there was a need for more humane treatment for those with mental illnesses based on compassion and care rather than assigning mentally ill persons to jails, poorhouses, or a life on the streets as was common in 19th century America. (Steven S. Sharfstein, 2000) A revision of this bill was signed into Public Law 88-164 by President Kennedy in 1963, but because of his assignation shortly after and the Vietnam War, this bill was ignored. In the 1980's the Mental Health Care Act was signed by President Carter and was meant to reinvigorate Public Law 88-164 by" giving additional dollars and redirect the community mental health center toward the tens of thousands of individuals who had been de-hospitalized during the 1970s" (Steven S. Sharfstein, 2000). This act proposed to increase funding for community health centers by federal funding but because this act was impeding on the goals of the Reagan administration, he repeal the act which " greatly limited a federal leadership role and left it up to states to reprogram institutional budgets as dehospitalization took place and patients were treated in community mental health programs". (Steven S. Sharfstein, 2000)
B. Scope and Severity of the Problem
1. Assessment of Past Policy Performance.
Past Policy implementations were not very successful. The three policies that I mentioned in the previous section all ended up not producing their attended affect. In fact since these policies intended to transfer patients from state hospitals and asylums to community mental health center, de-institutionalization occurred. However, since the policies where never implemented, those who were displaced from the asylums had nowhere to go. This resulted in trans-institutionalization, which is the transfer of institutional population form hospitals to jails, nursing homes, and shelters. (Deinstitutionalization) In 1970, the availability of inpatient beds for every 100,000 person was 200 in comparison to in 1992 where it decreased to less than 50. (Deinstitutionalization) In addition, the average number of patients in psychiatric hospitals decreased from over 2,000 in 1958 to about 500 in 1978, (Deinstitutionalization) while adjusted per-capita spending on mental health rose from $16.53 in 1969 to $19.33 in 1994, the portion of funds spent on state and county mental hospitals fell from $9.11 to $4.56. (Deinstitutionalization) These statistics give us an idea about how many mental institutions were closing but funding was still high, which gives us the idea that it was going to places like jails and prisons.
2. Significance of the Problem Situation.
Torrey (1997) stated that between 1980 and 1995, the total number of individuals incarcerated in American jails increase from 501,886 to 1,587,791, an increase of 216 percent. (E. Fuller Torrey, 1997) In an published analysis by George Palermo and his colleagues on data of U.S. jails, mental hospitals and prisons for 83 years they found that the balloon theory (push in one part of the balloon and the other part will bulge) is valid to show that prison and psychiatric hospitals are inversely correlated. They concluded their data by saying there is an inverse relationship and the "statistical evidence derived from the national census data corroborates their clinical observations that jails have become a repository for pseudo-offendersÂ - the mentally ill." (E. Fuller Torrey, 1997)
One example of this can be seen in Fulton County Georgia. The national average of mentally ill detainees is 16 percent, but in Fulton County jails, the average is 24 percent, 50 percent above the national average. (Hope Hall Accountabilty Center) This makes Fulton County jail the largest de facto mental health facility in GA, with half of the 2,000 plus detainees receiving some type of mental services.
Jails are not to hold and give treatment for the mentally disabled, but to punish those who commit crimes because they have premeditated the outcomes that they will get, not because their medication has stopped working, or they are not taking theory medicine for whatever reasons. Attention needs to be given to this subject so we can find better ways of dealing with the mentally ill detainees or prisoner that does not pose a threat to the public. One way to do this is to divert these individuals to special programs before they go to jail. By doing this, we will have a reduction in overcrowded jails which will lead to less taxes for the community since it will cost less to run the jails and state prisons.
In addition, successful programs will help those with mental illnesses by reducing the recidivism rate, which will not only prevent them from going to jail on their first offense but help them to stay on the right track so they will not be arrested again.
II. Reasons for Attention
Prison and jail overcrowding, cost, which includes the price that it cost to hold inmates, and operational cost are a few reasons why more mental health courts should be used as a diversion technique from jail. While there are many advantages to using mental health courts, they are few disadvantages that could be found in the literature.
In 1999, the Los Angeles County Jail and New York's Rikers Island jail held more people with mental illnesses than the largest psychiatric inpatient facilities in the United States. (Bureau of Justice Assistance, 2008) If we were able to take these people out of the criminal justice system through diversion programs like mental health court, plenty money could be saved. During the first year that a Colorado's mental health court was open, it treated 30 people with different ranges of mental disorders. The amount they saved by diverting those 30 people through the mental health court was $600,000 which equals the amount it would cost to keep them in jail for a year. (Merchant, 2011) In addition, a U.S. Department of Justice study from 1999 found that half of the inmates with mental illnesses reported three or more prior sentences than an average offender. (Bureau of Justice Assistance, 2008) So if mentally ill offender recidivism rate is high, overall it cost much more to punish a mentally ill offender with jail time than an offender without a mental illness. Taxpayers in Miami-Dade County for example spend $100,000 each day to house the mentally ill in prison; furthermore, it has been shown that people with mental illness stay in jail eight times longer than other inmates, at seven times the cost. (Stephey, 2007)
There are many advantages of using mental health courts, some of which benefit the individual being helped and the community. Mental health courts have been linked to individuals receiving mental health treatment. In two Florida mental health courts 82% and 73% of its participants participated in mental health treatment, which is higher than the level of treatment received from those in misdemeanor court. It is also mentioned that they attended outpatient services more frequently than they had before they went to the mental health court.(Sarteschi, Vaughn, & Kim, 2011)
Another important advantage is it has been shown to reduce recidivism. Based on a study from individuals in a North Carolina mental health center, completers were 88% less likely to recidivate than those that did not participate. (Sarteschi, Vaughn, & Kim, 2011) Sarteschi also found that those that completed the program had longer periods before they were rearrested compared to those who were removed or did not complete the program. (2011)
It is also shown that mental health courts are cost effective. One estimate has a Pennsylvania mental health court saving its taxpayers approximately three and half million dollars over a two-year period. (Sarteschi, Vaughn, & Kim, 2011) . Moore and Hiday (2006) compare the rates of re-arrest with regulare court denfendent to see if there was a difference in recividism rates. During a 12-month follow up, the traditional court defendants were re-arrested significantly more often than the MHC participants were. Additionally, not only were mental health court participants arrested less than traditional court defendants, Moore and Hiday found that the rate of re-arrest was 47% less than those in the traditional court defendant group. (as cited in: Sarteschi, Vaughn, & Kim, 2011)
While the advantages of using mental health courts are good, the disadvantages also need to be considered. Sartechi noted that one disadvantage is "treatment is offered to mentally ill offender after they have been arrested and charged with a crime."(2011) A better approach would be proactive in nature so it would avoid involvement in the criminal justice system. (Sarteschi, Vaughn, & Kim, 2011) Also it has been noted that there are concerns involving if the mental health participants entered into the program voluntarily. There have been mixed reviews about if the participants were coerced into a mental health court. While the majority of participants said they agreed to participate, they stated that they were not informed that the program was voluntary. (Sarteschi, Vaughn, & Kim, 2011) Rediclich et al. found that a majority of participants did not understand how the court work fully but know the basic procedures.( as cited in: Sarteschi, Vaughn, & Kim, 2011)
Another legal disadvantage concern is pleading guilty
III. Groups or Institutions Towards Which Corrective Activity is Directed
The primary groups that the policy analysis targets are the inmates with mental health disorders, agencies in the criminal justice system that include the courts, prosecutors, and defense attorneys, and it targets the community and mental health advocates.
The main group of people that is the target of this policy are those who have a mental disorder that is listed in the Diagnostic and Statistical Manuel of Metal Disorders (DSM-IV). This includes 705,600 inmates in state prisons, 78,800 in Federal prisons and 479,900 in local jails that can account for more than half of all prison and jail inmates. (James, Glaze, & BJS Statisticians, 2006) According to the Bureau of Justice Statistics (BJS), female inmates have more mental illness problems than men in state and federal prisons and local jails with 73.1%, 61.2% and 75.4 % respectively, compared to men inmates in state and federal prisons and local jails with 55%, 43.6%, and 62.8% respectively. (James, Glaze, & BJS Statisticians, 2006) White inmates have the highest percentage of inmates with mental illness with 62.2% in state prisons, 49.6% in Federal prisons, and 71.2% in local jails. Blacks and Hispanics followed with 54.7% and 46% in state prisons, 45.9% and 36.8% in federal prison and 63.4% and 50.7% in local jails. (James, Glaze, & BJS Statisticians, 2006). With such a high population of inmates with mental health issues, the criminal justice system has to find alternative ways to deal with them that would be both fair and helpful for the inmate and cost efficient for the system.
The criminal justice system encounters a high number of people with mental health issues as stated in the ladder paragraph. The policy will target all facets of the criminal justice system. Defense attorneys are the first individuals that can determine if an inmate has mental health problems and how to proceed with the case. Defense attorneys expressed reluctance to employ these traditional judicial solutions out of concern over the intense negative stigma placed upon criminal defendants with mental illness. (as cited in: Denckla & Berman, 2001) Defense alternatives feel that the court system has to find alternatives to deal with the inmates that truly will help the inmates and while maintainâ€¦.
Prosecutors are affected by the policy because they have to determine if sending an individual to the mental health courts is in the best interest of both the public and individual. As stated in ____prosecutors want mental health courts to ensure the accountability of defendants linked to treatment. (Denckla & Berman, 2001) They want to make sure that the inmate who is sentence in the mental health courts will not commit any violent crimes. Prosecutors have to assess each case thoroughly and make a sound decision on who to refer to the mental health courts.
Judges are impacted by the policy because they are the ones who determine whether or not an individual is suffering from a mental illness and if so how to help that individual. They have to determine a person's sentence and if the sentence is suitable for the individual in regards to his mental health needs. Judges want to be fair to those individuals with mental health problems. Judge Ginger Lerner-Wren of the Broward County Mental Health Court has described her experience this way: "We view the Mental Health Court as a 'strategy' to bring fairness to the administration of justice for persons being arrested on minor offenses who suffer from major mental disability. (Denckla & Berman, 2001)
IV. Beneficiaries and Losers
V. Related Programs and Activities
Pre-booking and post-booking diversions and probation are related programs that is can keep the mentally ill out of jail and prisons.
VI. Goals and Objectives
VII. Criteria and Effectiveness
VIII. Policy Alternatives
IX. Policy Recommendations
Criteria for Recommending Alternatives
Description of the Preferred Alternative
Limitations and Unanticipated Consequences