Mental health behind bars

By Michelle Chen Mar 12, 2009

Florida’s housing market may be imploding and residents may be losing houses at unprecedented rates, but lawmakers have apparently taken pains to give people with mental illness a place to call home… in the state’s prisons. Florida is on track to pour an estimated $3.6 billion into expanding the prison system to accommodate people with mental illness, who historically tend to be poor, uninsured and people of color. According to Steve Leifman, a Miami-Dade County judge and special adviser on criminal justice and mental health to the Florida Supreme Court, the criminal justice system has become a warehouse for people with mental health problems, while community-based services remain threadbare. Mental health advocates are pressing Florida lawmakers to promote diversion programs, which provide mental health or substance abuse treatment before people wind up behind bars or institutionalized. Florida recently scored a D on the National Alliance on Mentally Illness state report card on mental health. The organization reported:

Fourteen offices around the state contract with providers to deliver community mental health services, but typically people must be in crisis to secure services…. Many people who receive no or little mental health services enter the criminal justice system when they experience a crisis.

According to a 2007 Florida Supreme Court report, incarcerated people with mental illness—many of them imprisoned for low-level offenses related to their conditions—reflect the same racial disparities as the state’s general prison population:

On any given day in Florida, there are approximately 16,000 prison inmates, 15,000 local jail detainees, and 40,000 individuals under correctional supervision in the community who experience serious mental illness (SMI). Annually, as many as 125,000 people with mental illnesses requiring immediate treatment are arrested and booked into Florida jails. The vast majority of these individuals are charged with minor misdemeanor and low level felony offenses that are a direct result of their psychiatric illnesses. People with SMI who come in contact with the criminal justice system are typically poor, uninsured, homeless, members of minority groups, and experience co-occurring substance use disorders.

A study by the Consensus Project ties a lack of culturally competent mental health services in criminal justice to gross racial and ethnic divisions:

Among the many barriers to appropriate treatment that people with mental illness must negotiate, those arising from cultural differences can make a profound difference in the quality of care a person receives…. Cultural differences must be accounted for to ensure that minorities, like all Americans, receive mental healthcare tailored to their needs.” Failure to provide mental health services in a culturally sensitive context almost certainly results in higher numbers of people with mental illness from racial, cultural, and ethnic minorities in our nation’s jails and prisons.

Florida’s prisons encapsulate the many imbalances in the intersection of mental health and criminal justice across the country. The combination inadequate mental health care and structural racism has the dual impact of not only depriving people of physical freedom, but locking them in a prison of the mind. Image: A mental health worker at the Intensive Treatment Unit of Bridgewater State Hospital in Massachusetts. Boston Globe / Jonathan Wiggs.