Last week I entered a cell-block in Jailtown, USA. The facility was several decades old, a crumbling fortress of concrete and steel. It sorely needed new paint, air conditioning to alleviate the soaring humidity, and a good old-fashioned scrub down.
Yet that was not what shocked me. I have toured facilities on both coasts and in between; that is the state of affairs of 95% of the detention centers, jails and prisons in which I have consulted. What shocked me was what I found.
As I stepped into the Special Management Unit, I heard howling. This howling was not the cat-calls that are common to administrative segregation units when women enter the pod. This howling was hollow and low, followed by guttural growls.
I walked down the row of cells following the sounds. As I peered through a small, scratched Plexiglas window, I saw an emaciated man, rocking. He ran up to the cell door and smacked it loudly. He understood nothing of what I said. The deputy officer explained he had been like this since he was arrested for criminal trespassing, several months ago. This was confirmed by a review of the medical record.
Jails and prisons across the United States are allowing persons with severe mental illness to languish in custody, absent adequate medical and psychiatric care. Proper policies and procedures which could prevent these indignities are not routinely implemented. For example, many facilities have paid hundreds of thousands of dollars to inmates who have sued for negligent and improper care; Sheriff Arpaio of Arizona has reportedly paid out “$43 million and counting.”
In 1997, approximately 6 to 16% or between 70,000 to 190,000 of all incarcerated individuals were identified as being mentally ill, as compared with only 2% of the general U.S. population (Freeman, 2003; Lovell, et al., 2002). Data concerning specific mental illnesses is incomplete, but rough estimates seem to indicate that inmates with major depression constitute anywhere from 3.5 to 11.4 % of the national inmate population, while schizophrenia is found in about 1.5 to 4.4% of all inmates, and those suffering from bipolar disorder represent between 0.7 to 3.9% of incarcerated individuals (Lurigio, Rollins&Fallon, 2004). Follow up studies show that about 48% of these individuals were found to have been hospitalized in a psychiatric setting within 18 months of their release, while 64% were rearrested within the same time period (Lovell, et al., 2002).
As correctional facilities have increasingly become the primary care-givers to the mentally ill, it becomes imperative that medical, mental health and custodial entities work together to provide medical care that comports with generally accepted practice standards. This includes the provision of screening for suicidal thoughts, prior psychiatric or emotional problems, and access to ongoing psychiatric care.
Systems can benefit from the regular and critical process that continuous quality improvement brings. Recidivism cannot possibly be addressed until underlying causes are treated.
Who knows? Perhaps with collaboration and continuous quality improvement we can even make our streets safer.