Poor people are intentionally getting arrested to access mental health treatment

The title of this post actually refers to two different routes to jail. In one, people who need mental health care and can’t get it, for whatever reason, often wind up in jail. The other scenario is where people realize that they can get psychiatric care in jail and do whatever they can to get arrested.

Let’s look at the first case: someone who needs mental health care, can’t get it and ends up getting arrested.

Depending on the source, statistics show that anywhere from 30% to 50% of inmates in the New York City jail system have a psychiatric diagnosis.

Some of these people may have previously been treated as outpatients, but with years of decreased mental health budgets, there is less help available for them. Their diagnosis could be depression, bipolar disorder, schizophrenia, substance abuse or any one of a number of others, or even a combination of diagnoses. They may be arrested for crimes from misdemeanors to felonies. Some who can’t get their medications may self-medicate with alcohol. Others, homeless and destitute, may be arrested for shoplifting or prostitution. Some for assault or any of a number of other crimes.

When they get incarcerated, they may get no, or minimal, treatment even if their psychiatric problem is readily apparent or documented from a previous arrest. If they present as a “problem” to the jail personnel, they may be sent directly to solitary confinement. Some inmates with psychiatric problems may spend literally thousands of days in solitary because of the behaviors they display or threats that they make.

Therapist via Shutterstock

Therapist via Shutterstock

Even for those who may get some form of treatment, medications, therapy or both, the help may only be temporary. Upon release from jail, they may again be homeless, penniless, uninsured and destitute. They may be unable or unwilling to get help or help may not be available and they will return to jail to repeat the process again.

The Texas Observer points out that in Houston the problem is a little different. Mental health budgets have been cut in Texas, too. And, thanks to conservatives, the ACA Medicaid expansion has been stalled. Outpatient mental health services are hard to get, and harder to keep. Many spend months on a waiting list until a vacancy occurs. Unfortunately, some mentally ill patients can’t wait months without medications or other treatment. Those who couldn’t get treatment often got arrested, just as their NYC counterparts did.

The jails were faced with more and more psychiatric patients who, under other circumstances, wouldn’t be inmates. Sometimes upwards of 2,000 inmates in Houston were mentally ill. The city finally acted to deal with the problem. They instituted a psychiatric treatment area as part of the jail facility. Inmates with a psychiatric diagnosis could be housed here and receive medications and counseling.

This idea was successful. It helped the inmates deal with their mental health issues. But, again, it turned into a stopgap measure. It was effective while the inmates were jailed. But, upon release, they would go onto a waiting list to get outpatient mental health services. That meant, for many of them, they wouldn’t be able to afford their medications and couldn’t get therapy until they got accepted for outpatient services. Again, that might be months of waiting.

Some people got rearrested, some became homeless, some attempted suicide (some probably succeeded). But some realized that mental health treatment WAS available, back in jail. So they’d deliberately commit a crime just to get arrested and thus, get treated again. One man would break a window and then wait there, waiting for the police to take him to jail where he could get treated. Another, frustrated at this failing system, shouted that he wanted to be jailed for 20 years, so that he could get the medications and treatment that he needed.

Even if outpatient mental health care were available, there are still a number of problems that are present when trying to deal with this population. Upon release, some of these inmates will be homeless. The fortunate ones will get into shelters. But even those who get into a shelter face other problems. Getting a job (if they are able to maintain a job), signing up for health care, transportation to health care appointments, developing a support system and other problems. All of those are hard to do for someone who is mentally and physically healthy. Imagine how difficult it would be for someone who had a mental illness, physical illnesses, someone who is elderly, or disabled or has any one of a number of other problems to face.

There are no easy answers for these issues. This is a growing problem that has been getting worse for dozens of years as outpatient mental health budgets have been trimmed and trimmed again. And it’s not just confined to large cities. It’s found on all parts of the country to a greater or lesser degree. We and our lawmakers need to take a serious look at these problems and come up with some solutions. Group homes or halfway houses, job training programs, educational opportunities, counseling and therapy along with medications. These may be helpful to begin to address the problem, but address this problem we must.

Jail is not the appropriate place for people who need mental health treatment.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • AmericanPlutocracy

    So, a non-answer yet again? It’s unfortunate you cannot defend your position. But, entirely predictable. Sadly, individuals who argue as you do – do nothing to help those who could benefit from advocacy. I’d wait for data to support your claims but you’ve demonstrated no desire for the facts.
    Does the Hedges book talk about the % of Democrats responsible for ‘inflated’ housing prices? You imply that it does and yet I have the book in front of me and oddly it argues nothing of the sort. So your response is even further indicative of a lack of understanding of what you are attempting to rant about.

    Irrespective of your inability to support your nonsense (see argument without foundation)…you also do not address your lack of understanding with regard to supply and demand. Arguing that a ideological force can influence housing prices – that’s so laughably, forgive me, stupid, so as to defy consideration. It’s clear why you don’t respond to direct questions with answers…even if you’re unaware why.

  • dula

    Lol yeah there are overwhelming numbers of conservatives voting Republican in NYC, SF, and LA. You might want to pick up that Hedges book.

  • AmericanPlutocracy

    So your answer is a non-answer. k. good story. Additionally, ‘passing the buck’ has no foundation. And as far as your ‘some of us have learned here that the blah blah split between true progressives and neoliberals’ – news flash that’s really not a secret. You could even pick up Chris Hedges book ‘Death of the Liberal Class’. So your data on liberals hoarding real-estate as compared with republicans – do you have that? Or shall you pass the buck and just adhere to your anecdotal observations…
    And, as if that were not enough. How would the ‘stopping of hoarding of real estate by wealthy liberals’ take place? Do you think that would help those referred to in the article? If you think that your knowledge of supply and demand within the housing market is quite, shall I say, ‘novel’…

  • http://www.americablog.com/ Naja pallida

    Mental health care in prison generally amounts to giving them whatever is necessary to prevent them from hurting themselves, or posing a threat to others. That doesn’t necessarily equate to proper therapy or treatment.

  • Bill_Perdue

    Socialists do it better.

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  • dula

    Oh quit passing the buck. Of course the GOP and their filthy neocon voters ushered in an oligarchy, with the help of neoliberals like Clinton and Obama and many congressional “liberal” frauds. We regularly trash the GOP here but some of us have learned that the Democratic Party has split between true progressives and neoliberals who have found a way to put a positive spin on Democrats spying on ordinary Americans, targeting children with drones, coddling the financial industry, creating pro-corporate policy like the current TPP, etc. We now know that many Democratic voters, like the Republican ones, have more loyalty to their political party than they have for their nation. So, I dare liberal cities like NY, SF, and LA to stop the hoarding of real estate by wealthy liberals by creating affordable housing, and by that I don’t mean simply adding a few units for the disabled or those on the poverty line of $12K/yr.

  • nicho

    The only problem with this is that it’s not working. These people may be getting treatment, but it’s apparently deficient care and shows very little in the way of results.

  • AmericanPlutocracy

    You think only liberals are engaged in hypocrisy? Your comment smells of partisanship and fully abdicates any consideration of the constituents at large. What party platform positions does the current GOP hold that address inequality? Pick one that is supported by historical evidence and/or economic data.

    Upon answering that (goodluck) which voting block is more likely to vote for policies and procedures that only deepen and entrench the inequality divide?

  • AmericanPlutocracy

    A subject that receives little attention because the voting block, in this instance, has little to no power and that is amplified by the stigmatism our society places upon those who might be struggling irrespective of the reason(s) why. We applaud social darwinism to a level of being pathological.

  • http://www.rebeccamorn.com/mind BeccaM

    This all started during the presidency of Ronald Reagan, when the conservatives argued that to save budgets, all the state-run mental hospitals should be shut down and the mentally ill treated as out-patients.

    Those of us who lived through that period remember what happened.

    First of all, the promised funding to help people suddenly discharged never materialized, nor were the out-patient programs developed at all. And there was an exponential increase in the number of mentally ill homeless people wandering the streets.

    And for the last three decades, nothing has changed despite the obvious abject failure of a deliberate political and economic strategy that simply abandons those who need help the most.

  • TheOriginalLiz

    I’m sure some GOPper will come out with a rant on how evil the poor are for gaming the system. After all, only the rich and the GOP should be allowed to do that with immunity.

  • LanceThruster

    Proof positive that our current approach is penny wise and pound foolish.

  • Whitewitch

    Thanks Bill…excellent video.

    I love when people call me a Socialist…they think they are calling me a dirty word, I think they are proving I am a sentient being who cares about my fellow traveler.

  • Whitewitch

    Well as the republican convention would say “Good then they better just die and get on with it. God will make it right in Heaven”. ::snark::

    Seriously, it is sickening that mental health is not a bigger issue in our country – clearly there are lots of people in our country that REALLY need help.

  • Whitewitch

    This is a horrible problem in our country, incarcerating the mentally ill is as barbaric as the asylums of old. And calling the police on a loved one that is “acting out” is inviting their death now a days.

  • dula

    Maybe the new supposedly “liberal” NYC mayor will do something about this. The glaring hypocrisies from liberal cities is getting harder to ignore. Our political and social ideologies aren’t matching the outer reality. For example, all the major liberal cities like NY, San Francisco, Seattle, and now the entire west side of Los Angeles are now unaffordable to most of the 99%. Santa Monica and Venice in LA is now referred to as Silicon Beach. Well-to-do liberals give lip service to income equality and then go ahead and hoard the real estate making it out of reach for others. That’s not progressive behavior. The working classes will have to get thrown in jail to access affordable housing if this keeps up.

  • therling

    Persons with a major mental health illness also face increased rates of physical illness. Having a severe mental health problem lowers one’s lifespan by anywhere from 10-20 years.

    http://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widens-between-those-mental-illness-and-general-popula

  • Bill_Perdue

    Awful. Desperate. Terrible. All these are inadequate terms to describe the violence perpetrated on working people by poverty, unemployment and a failed political and economic system. The medical care system in the US is backward and a failure because it’s run by for profit insurance and pharmaceutical companies that will do anything to increase profits, including murdering patients. Obama/Romney care continues and deepens the failures of the failed US healthcare system.

    http://www.youtube.com/watch?v=aUGep9nLU9k

    Everyone who works for a living, is unemployed, retired, training to work, is disabled or who is a single head of household deserves a good wage at high trade union levels, along with good, safe housing and socialized medicine. Democrats and Republicans won’t do that. Socialists will.

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