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Bedlam Revisited: Jails, Police, & Mental Health Courts as the
New Psychiatric Care System
E. Fuller Torrey, MD Treatment Advocacy Center
APA Annual Meeting, Philadelphia May 6, 2012
____________________________________
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My thesis is simple:
I. New psychiatric inpatient system: Jails & Prisons
II. New psychiatric outpatient system: Police & mental health courts
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Jails & Prisons New psychiatric inpatient system
• July 1969 – Lanterman-Petris-Short Act
took effect in CA
• 1972 – Dr. Marc Abramson reported an
increase in the number of mentally ill
persons in the San Mateo County, CA jail
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Jail & Prison Inmates with
Serious Mental Illness
3% 5%
10%
15%
20%
25%
0%
5%
10%
15%
20%
25%
30%
35%
1965 1975 1985 1995 2005 2015 2020
Est
imat
ed %
of
inm
ates
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SMI Jail & Prison Inmates:
Current Estimates
Year Location (State) Estimate %
2007 Roanoke County jail (VA) 25-30%
2009 Correction Center of NE Ohio (OH) 25%
2010 Broward County jail (FL) 23%
Harris County jail (TX) 25%
El Paso County jail (TX) 40%
2011 Tennessee prison system (TN) 32%
Rikers Island jail (NY) 33%
Stark County jail (OH) 30%
2012 Massachusetts jails (MA) 26%
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2010 Survey Results Treatment Advocacy Center
• 3x more SMI persons in jails & prisons
than hospitals
• 3 largest psychiatric inpatient facilities
are county jails in LA, Chicago, & NYC
• County jails hold more SMI persons than
public psychiatric inpatient facilities in
all US counties
Torrey EF et al, “More Mentally Ill Persons are in Jails & Prisons than Hospitals: A Survey of the States.” Treatment Advocacy Center, May 2010
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Problems Associated with Mentally Ill Prisoners
• Unable to
understand or
follow rules
• Costs of
antipsychotic
medications
• Costs of special
monitoring
• Longer stays
• Psychotic
behavior
• Suicides
• Lawsuits
• Victimized
• Assaults on staff
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Bricks & Mortar Evidence
Jails & Prisons increasingly use special
sections set aside for mentally ill
inmates
• 2007 (ME) – Proposed turning some
county jails into “special facilities for
people with mental illness”
• 2007 (Broward & Dade Counties, FL) –
Proposed building first ever county jails
built specifically for inmates with chronic
and severe mental illness
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• 2007 (MT) – Proposed opening special
prison for the mentally ill currently housed
in the regular prison
• 2012 (NC) – Currently opening a new
5-story hospital for mentally ill prisoners
– Directly across the street from closed
state hospital
Bricks & Mortar Evidence
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New York - Marcy State Psychiatric Hospital
1991: Closed & 2009: Prison opens
given to State special 100-bed
Corrections to be psychiatric unit used as a prison for prisoners
– Thus, some psychiatric patients originally
treated in state hospital were later treated
in state prison in the same building
– State officials proudly called this “an innovative approach”
Bricks & Mortar Evidence
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• 2011 (MS) – In process of emptying
psychiatric hospitals
– Issued mandates requiring jails to
become certified to hold the mentally ill
Bricks & Mortar Evidence
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Police & Mental Health Courts: The new outpatient system
• Police & sheriffs are frontline
community health outreach workers
and first responders
– Mental health calls now exceed calls
for robberies, etc.
• Training of police officers to become
mental health workers is widespread
– CIT program is an example
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Examples of Police &
Mental Health
• Seattle, WA - police departments
hire mental health professionals
• NC (2010) – sheriff deputies report
>32,000 trips to transport psychiatric
patients for involuntary
commitments
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Examples of Police &
Mental Health
• Ventura County, CA & Hillsborough
County, FL – police officers give
prisoners rides to first appointments
at treatment facilities upon release
from jail
• San Rafael, CA – police work with
local MH Center & drive prisoners to
doctor appointments
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Examples of Police &
Mental Health
• LA County – “Our local police forces
have become armed social
workers”
• Over 300 mental health courts exist
today & are essentially psychiatric
outpatient clinics under judicial
jurisdiction
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Examples of Police &
Mental Health
• Virginia Beach (2011) – city officials cut
$121,596 from mental health budget
– Sheriff offered to transfer $121,596 of his
department's funds to local mental health
program
– “This is money well spent, and it will decrease
the money I’d spend housing them [untreated
mentally ill individuals]”
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What is going on?
• Potential financial savings by mental
health departments
• Domino et al. reported increase in
the probability of jail use for persons
on Medicaid followed by a
decrease in expenditures in county
mental health system for outpatient
care.
Domino et al., “Cost shifting to jails.” Health Services Research . 2004; 39:1379-1401.
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Possible Next Steps
1. Status quo: Continuing increase of
mentally ill persons in jails & prisons
2. Abolition of state and local
departments of mental health
– Transfer their funds to Department of
Corrections
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Possible Next Steps
3. Mental health section does their job
– Assisted outpatient treatment (AOT)
shown to decrease incarceration rate
of SMI individuals
•87% reduction in NY (Kendra’s Law Final
report, 2005)
•91% reduction in CA (Nevada County,
unpublished, 2012)
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Possible Next Steps
4. Further crisis:
Summit County, OH - Sherriff Drew
Alexander announced his jail would no
longer accept violent mentally ill people
arrested by police (Feb 2012)
– First sheriff to take this step
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The number of persons distempered in
mind and deprived of their rational
faculties has increased greatly in this
province. Some of them going at
large are a terror to their neighbors,
who are daily apprehensive of the
violence they may commit.
Pennsylvania Assembly
Benjamin Franklin, 1751
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*This presentation is available on the website
Treatment
Advocacy
Center
www.treatmentadvocacycenter.org