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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