Nation's Jails Struggle With Mentally Ill Prisoners

More Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. The three largest inpatient psychiatric facilities in the country are jails. They include Rikers Island Jail in New York City. i i

hide captionMore Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. The three largest inpatient psychiatric facilities in the country are jails. They include Rikers Island Jail in New York City.

Bebeto Matthews/AP
More Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. The three largest inpatient psychiatric facilities in the country are jails. They include Rikers Island Jail in New York City.

More Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. The three largest inpatient psychiatric facilities in the country are jails. They include Rikers Island Jail in New York City.

Bebeto Matthews/AP

Three hundred and fifty thousand: That's a conservative estimate for the number of offenders with mental illness confined in America's prisons and jails.

More Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. In fact, the three largest inpatient psychiatric facilities in the country are jails: Los Angeles County Jail, Rikers Island Jail in New York City and Cook County Jail in Illinois.

"We have a criminal justice system which has a very clear purpose: You get arrested. We want justice. We try you, and justice hopefully prevails. It was never built to handle people that were very, very ill, at least with mental illness," Judge Steve Leifman tells Laura Sullivan, guest host of weekends on All Things Considered.

A failing system

When the government began closing state-run hospitals in the 1980s, people with mental illness had nowhere to turn; many ended up in jail. Leifman saw the problem first-hand decades ago in the courtroom. When individuals suffering from mental illness came before him accused of petty crimes, he didn't have many options.

See A Slideshow Of Mental Institutions At The Picture Show Blog

Photo of the Mead building lobby, Yankton State Hospital, S.D. Photographer Christopher Payne visited state mental institutions across the country, many of which were abandoned. His book, Asylum: Inside The Closed World of State Mental Hospitals, captures what he found. i i

hide captionPhoto of the Mead building lobby, Yankton State Hospital, S.D. Photographer Christopher Payne visited state mental institutions across the country, many of which were abandoned. His book, Asylum: Inside The Closed World of State Mental Hospitals, captures what he found.

Christopher Payne
Photo of the Mead building lobby, Yankton State Hospital, S.D. Photographer Christopher Payne visited state mental institutions across the country, many of which were abandoned. His book, Asylum: Inside The Closed World of State Mental Hospitals, captures what he found.

Photo of the Mead building lobby, Yankton State Hospital, S.D. Photographer Christopher Payne visited state mental institutions across the country, many of which were abandoned. His book, Asylum: Inside The Closed World of State Mental Hospitals, captures what he found.

Christopher Payne

"What we used to do, which I tell people was the definition of insanity [...] was they would commit an offense, the police would arrest them, they'd come to court, they'd be acting out so we would order two or three psychological evaluations at great expense, we would determine that they were incompetent to stand trial and we'd re-release them back to the community and kind of held our breath and crossed our fingers and hoped that somehow they'd get better and come back and we could try them," he says.

Instead, many disappeared and got re-arrested. Sometimes within minutes.

"They'd walk out the door, they were ill, they'd act out, because [the jail] is next to the courthouse there are several officers out there, and they'd get re-arrested," he says.

Not only was the system inefficient, it was costly as well. When Leifman asked the University of South Florida to look at who the highest users of criminal justice and mental health services in Miami-Dade County, researchers found the prime users were 97 people, individuals diagnosed primarily with schizophrenia.

"Over a five-year period, these 97 individuals were arrested almost 2,200 times and spent 27,000 days in the Miami-Dade Jail," Leifman says. "It cost the tax payers $13 million."

Sheriff Greg Hamilton runs the Travis County Jail in Austin, Texas. i i

hide captionSheriff Greg Hamilton runs the Travis County Jail in Austin, Texas.

Courtesy of the Travis County Sheriff's Office
Sheriff Greg Hamilton runs the Travis County Jail in Austin, Texas.

Sheriff Greg Hamilton runs the Travis County Jail in Austin, Texas.

Courtesy of the Travis County Sheriff's Office

A look Inside One Jail

Sheriff Greg Hamilton of Travis County in Austin, Texas, also sees the flaws in the system.

"It seems to me that we have criminalized being mentally ill," Hamilton tells Sullivan.

Hamilton has been the Sheriff of Travis County for seven years. In that time, he's seen more and more mentally ill people filter into his jail.

He says the lack of space at the local hospitals means his jail has become the default treatment center. He says the average stay of a mentally ill person in a Travis jail is about 50-100 days. But Hamilton says the longest term he's seen was 258 days.

Hamilton's jail only has a handful of counselors on staff to deal with the 400 inmates they house daily. The individuals who do get stabilized find it hard to get their medication replenished or see a psychiatrist once they leave the jail.

It's a broken system, but Hamilton notes that this was never the way the mentally ill were suppose to be treated.

"The jail was never meant to be a state hospital or a treatment facility," he says, "but we have been thrown out there and we've got to take the hand that we were dealt."

For the past decade, Miami-Dade County Judge Steve Leifman has fought to get treatment for people with mental illness and keep them from ending up in jail. i i

hide captionFor the past decade, Miami-Dade County Judge Steve Leifman has fought to get treatment for people with mental illness and keep them from ending up in jail.

Courtesy of Judge Leifman
For the past decade, Miami-Dade County Judge Steve Leifman has fought to get treatment for people with mental illness and keep them from ending up in jail.

For the past decade, Miami-Dade County Judge Steve Leifman has fought to get treatment for people with mental illness and keep them from ending up in jail.

Courtesy of Judge Leifman

Reforming the system

Judge Leifman is trying to prevent individuals with mental illnesses who have committed minor crimes from ending up in jail. He's creating a novel facility in Miami-Dade that will serve as what's known as a "forensic diversion facility." The program provides a sentencing alternative in cases where the offender has mental health issues. Those entering will begin in a higher-security area, more like a jail, and once stabilized move to a different part of the building for treatment.

"They'll continue to step down until they're actually ready to go back to the community," Leifman says.

The facility will be run on a "clubhouse model," meaning people with mental illnesses will take an active role in planning activities.

Leifman acknowledges the facility won't keep everyone with mental illness out of jails, but says "if we can keep 50 percent of the people who are coming into our jail out who have serious mental illness we've made a huge dent in the problem."

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