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April 7, 2015

New Urban Institute report examines challenges posed by mentally ill offenders

The Urban Institute today released this significant new report titled "The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System: A Scan of Practice and Background Analysis." Here is an excerpt from the first few paragraphs of the report's executive summary (with few references omitted):

Mentally ill offenders possess a unique set of circumstances and needs. However, all too often, they cycle through the criminal justice system without appropriate care to address their mental health.  According to the Bureau of Justice Statistics, individuals with mental health needs make up a large proportion of the US correctional population.  An estimated 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates have a mental health problem.  These individuals often receive inadequate care, with only one in three state prisoners and one in six jail inmates having received mental health treatment since their admission.  Offenders with severe mental illness place even more strain on the criminal justice system as a whole, in terms of their unique case-processing requirements and treatment needs and their increased risk of recidivism. Housing mentally ill offenders in the criminal justice system is costly.  In addition to high health care costs, mentally ill inmates tend to have higher rates of prison misconduct and recidivism.

Despite the evidence that mental illness in the criminal justice system is a pressing concern, our comprehensive effort to identify cost-effective, evidence-based programs and policies for managing and treating mentally ill persons in the criminal justice system brought to light how limited current knowledge is on this topic.  There have been only a few rigorous evaluations of criminal justice programs and policies targeted at mentally ill offenders.  This limitation, in and of itself, is a notable finding, as it shows what more needs to be done to better understand how to effectively alleviate the costs and challenges of treating and processing offenders with mental illness in the criminal justice system. Given these challenges and their financial consequences for society and governments, it is important to understand how to identify and provide early intervention for those who suffer from mental illness in the criminal justice system.

This report focuses on the societal and economic costs of holding mentally ill offenders in jails and prisons.  It also presents a detailed discussion of how mentally ill offenders are processed in the criminal justice system, highlighting the diversity of protocols and practices outlined in state statutes to address these challenges.  Further, it discusses several promising criminal justice interventions and policies for mentally ill offenders....

April 7, 2015 at 11:26 AM | Permalink


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About a third of local jail beds contain straight state hospital patients. They made a nuisance on a bus, no one is posting their $1 bail because everyone is better off with their being in jail. They get cheap care, but it good enough. LA County is now the world's biggest state mental hospital.

Another third of is a bunch of intoxicated or mood problem people who are functioning on the outside, and would benefit from treatment. They have responsibilities, and are wasting time in jail. They can get treatment as a condition of probation or parole, on their own.

The remainder are stone cold predators. Meds would make them even stone colder.

If you think you are over regulated, try a shift as a prison guard. The lawyer has made it nearly impossible to run a prison, as it has almost all useful activities in the nation. If you do not like prison conditions, fire a judge. These nettlesome, know nothing, officious intermeddlers, have made it impossible to control prisoners, by their restrictions on prison guards.

In praise of jails and prisons and mental health. They accomplished the greatest achievement in the history of psychiatry, with no psychiatrist, no money, no additional staff, did I say, no money. Just an hour's training of supervisors a year.

They cut the suicide rate by 90%. No one has ever done that. How? Eyesight supervision. Period. No meds, no therapy. Had Robin Williams or the pilot of the Lufthansa flight been in jail, both would be alive today, along with 150 other innocent victims. They did the same with the rate of murders inside the prison, the same way.

I thought readers should get a more positive perspective than the relentless left wing propaganda bashing of jails and prison.

Posted by: Supremacy Claus | Apr 7, 2015 2:29:48 PM

"...left wing propaganda bashing of jails and prison" oh yes, your so right on, everyone knows what a vacation it is to be locked up and monitored 24/7. Everyone except those who have actually been there and done that. Posers and know nothings are just so unconvincing.

Posted by: Dee | Apr 7, 2015 6:33:38 PM

Dee: You do not understand the purpose of prison. It is not to serve the prisoner. It is to serve the crime victim. The conditions of prison therefore do not matter in the least for its primary purpose. Indeed, the higher the death rate, the better off everyone on the outside is.

I have advocated 123D. That may result in 10,000 executions, and the elimination of 15,000 murders and millions of violent crimes a year. It would end crime by attrition, and assumes no deterrent effect. That would add $trillion in value to the economy, in real estate value and the rest of the economy, as security costs drop to nearly zero. Children could go to school and think about education, and not about their safety. The first mass executions would be of the lawyer hierarchy, so that their clients could then be reached. These lawyers are saving, protecting, and privileging their criminal clients.

You also do not understand the real agenda of the awful left wing ideologue. The reason they bash jail is to increase the pace of release of prisoners. As the crime rate soars with each release, as each prisoner causes a major local catastrophe, they generate more government make jobs.

Posted by: Supremacy Claus | Apr 7, 2015 9:23:54 PM

Actually, the primary purpose of prison is punishment. The real story about the mentally ill in prisons is why they end up there in the first place. It has been observed for a couple of decades that elimination of state hospital beds (which were really long-term to permanent housing) and the negligence of states in failing to fund community treatment has been driving people with serious mental illness into the criminal justice system. The narrative about criminalization makes this direct connection: Lack of community services = increased criminalization. I make some different assertions. There is definitely a strong relationship, however, I blame lack of supported housing than lack of treatment. States have made supportive rather than supported housing their priority and there is not enough of what they have funded. Supported housing is what is really needed, but it provides onsite monitoring and a range of custodial care and states do not want to pay for it. They would rather pay for custodial care in jail and prison. Most people with severe schizophrenia (particularly those afflicted with anosognosia), schizoaffective disorder, and bipolar, are too sick and unstable to be living with family or alone with someone checking in on them.

Ultimately, what has every aspect of the "system" so criminally screwed up is the fundamental lack of understanding of psychosis and what it does to people. Human beings really do not understand what they are. They do not understand the human state of consciousness and what psychosis does to the human mind. Lack of comprehension is the root cause of everything that is massively wrong with the system and the law: Disability Rights Law, Fundamental fallacies in operants such as "competence to stand trial", Legal definition of insanity, mental health procedures acts under state codes, HIPAA laws...every single aspect of society is egregiously screwed up because everyone, Disability Rights advocates, Prosecutors, DAs, Judges, legislators do not comprehend psychotic diseases and disorders.

Ultimately, despite the horrible condition of lack of community services and hospital beds, what puts a person with a psychotic disorder in prison is the conviction by a potluck jury. The common juror has no clue as to what psychosis does and is not competent to analyze behaviors to try to devine mens rea. Juries make intuitive judgements in the case of violent crimes and generally only rarely find a defendant to be "insane" when violence is interfamilial. The greater the disconnect between medical science and the law, the greater the chance that a jury will convict. That seems to be the way the justice system wants it. What few jurors are informed of or contemplate is that a person who was "incompetent" when arrested was certainly out of touch with reality when the violence happened. M'Naughten's Rule, esp. the part that some states have retained after gutting the more protective test, is a fallacy in regard to psychosis. The thought disorder present in schizophrenia makes it dangerous for the accused to even testify on their own behalf because the brain is subject to random utterances that might be erroneously incriminating

M'Naughtens itself was a response to mob rule, societal ignorance, and an angry Queen Victoria. For ages now, people have been accusing defendants of trying to get off easy with the insanity defense. In fact, the mentally ill person (esp. where anosognosia is present) is the last person capable of raising such a defense. 40 to 50 percent or more of persons with a Sz subtype diagnosis has a neurological disorder (damage to or deficit of the brain) that prevents the person from knowing that they are ill. (web search Anosognosia in stroke patients to gain insight into this bizarre and confounding condition. Think you know what you are, that you are all about "character" and that your behavior is under the control of your good moral character...think again). Psychosis is not just the hallucinations, delusions, and altered perceptions? That is not enough to explain violence in psychosis. The fundamental feature of severe psychosis that the vast majority of society fails to understand is that it is a disorder of waking (and sleeping) consciousness. NO ONE in the throes of a psychotic episode when violence took place should be punished by the criminal justice system, yet so-called "forensic psychologists and psychiatrists" purport to be able to devine if someone was in what they want to call a transient state of psychosis. No one can do that! Trying to keep competency restoration separated from medical treatment in one's mind can be intellectually jarring. Competency restoration in its various forms, including administration of medication is a cruel and disgraceful abuse of human beings. The paradox is that Supreme Court puts limited restriction of the forced admin of medication, when in fact, in the presence of psychosis, is the very thing that the person needs to treat their medical condition - why?, because the justices fail to comprehend psychosis any more than the average lay person on the street. What is horrible disfigurement of logic and sanity.

As things stand, the aggression against the insanity defense (which poorly reconciles with psychosis) and the attendant legislative actions have created what almost amounts to a bill of retainder against defendants whose counsel dares to raise the insanity defense. We know that bills of retainder are unconstitutional. Moreover, people with criminal charges who have psychotic disorders (which is not sociopathy) are essentially operating under strict criminal liability. The same pharmaceuticals that are used to deliver life-saving and support medical health are used to force chemical sanity upon victims of the criminal justice system, so that constitutional I's are dotted, and T's crossed, so that people whose disease states that should confer inculpability upon them are cruelly punished. The insanity defense is not abused. In fact, it is rarely used and insanely applied. Society is steadily retreating into the dark ages in its understanding of psychosis as science is moving forward.

Posted by: Ginger | Jan 4, 2016 6:06:29 PM

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