Emptying the ‘new asylums’: A model for moving mentally ill inmates out of jail | LIVE STREAM
American Enterprise Institute・91 minutes read
A new report addresses the lack of forensic beds for mentally ill inmates, highlighting the risks of their prolonged stay in jails and prisons. The discussion emphasizes the importance of practical solutions to reduce mass incarceration and improve outcomes for individuals with mental illnesses.
Insights
- A critical shortage of forensic beds for mentally ill individuals too ill to stand trial leads to their prolonged stay in jails or prisons, exacerbating their conditions and increasing risks of harm.
- Data modeling and evidence-based approaches, such as the computer model developed by Dr. Lich, offer cost-effective solutions to reduce the incarceration of mentally ill individuals in America significantly.
- Collaborative efforts at the local level, like Miami's Crisis Intervention Team police program and post-arrest diversion programs, have proven effective in reducing mental health-related arrests, jail populations, and recidivism rates, emphasizing the importance of community-based solutions for mental health issues.
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Summary
00:00
Addressing Mental Illness Crisis in Jails
- Sally Satel, a resident scholar at AI, discusses the issue of mentally ill individuals in jails and prisons.
- An estimated 990,000 inmates were too mentally ill to stand trial last year, leading to a critical shortage of forensic beds for treatment.
- The lack of forensic beds results in mentally ill individuals staying in jail or prison, worsening their conditions and increasing risks of assault, suicide, and other harm.
- A new report titled "Emptying the New Asylums" offers an evidence-based approach to reduce mental illness in jails, providing hope for a solution.
- The report is based on a groundbreaking modeling approach and aims to address the crisis of mentally ill individuals in the nation's jails.
- Speakers at the discussion include Doris Fuller, Kristen Lich, Judge Steve Lifan, Matthew Chase, and Mike Rendes, each offering insights on the issue.
- The discussion highlights the alarming statistics of mentally ill individuals in jails and the need for practical solutions to reduce mass incarceration.
- A computer model developed by Dr. Lich and her team aims to reduce psychiatric boarding in emergency rooms and address the issue of mentally ill individuals waiting for beds in jails.
- The model's findings reveal that small, cost-effective changes could significantly decrease the incarceration of mentally ill individuals in America.
- The discussion emphasizes the importance of addressing the root causes of mental illness in jails, reducing costs, and improving outcomes for both inmates and taxpayers.
18:58
"Addressing Prolonged Hospital Stays Through Solutions"
- State hospitals face issues with extended stays due to lack of community discharge options.
- Forensic patients and NGI individuals contribute to prolonged hospital stays.
- Lack of community discharge options leads to bed shortages for shorter-stay patients.
- Administrative and bureaucratic reasons contribute to extended hospital stays.
- Increasing bed capacity is crucial to addressing the issue of prolonged hospital stays.
- Small changes in administrative practices can significantly reduce the human and economic toll of the problem.
- Data modeling from five states showed significant reductions in bed wait times with minor interventions.
- Reduction in hospital stay length by 2% in Texas led to a substantial decrease in bed wait times.
- Adding eight psychiatric beds in Wisconsin resulted in a significant drop in average bed wait times.
- Decision support models help simulate and analyze queuing systems to optimize service efficiency and reduce wait times.
36:18
"Mental Illness in Criminal Justice System"
- Individuals are 18 times more likely to find a bed in the criminal justice system than at any State Civil Hospital.
- Counties are spending $80 billion, impacting infrastructure like hospitals and schools due to high correctional costs.
- Treating people with primary health issues like mental illnesses is neglected, leading to homelessness and lack of services.
- Structural changes in communities are crucial for impactful changes, not just injecting more money into the existing system.
- A study in Florida identified 97 primarily homeless men with mental illnesses arrested 2,200 times, costing $13.7 million.
- Competency restoration for individuals with mental illnesses is a flawed system, costing states billions and leading to little treatment.
- Miami implemented a Crisis Intervention Team police program, reducing mental health-related arrests and jail population significantly.
- Post-arrest diversion programs for misdemeanors and felonies with mental illnesses in Miami have drastically reduced recidivism rates.
- A diversion program for competency restoration in Miami focuses on community reintegration, resulting in almost zero recidivism in five years.
- Small changes in communities can lead to significant cost savings and improved outcomes for individuals with mental illnesses.
51:27
Local Counties Address Mental Health in Justice System
- Bipartisan leadership and passion at the local level drive alignment on mental health issues.
- County governments in the U.S. have a total annual budget of $560 billion and employ 3.6 million people.
- Counties spend approximately $84 billion annually on healthcare for citizens and $20 billion for their own employees.
- Counties are responsible for indigent care, contributing to Medicaid costs in 26 states.
- County governments own hospitals, nursing homes, and manage public health and behavioral health services.
- County jails admit about 12 million individuals annually, with a significant population of 8.5 million daily.
- Los Angeles County, the largest, has 16,000 inmates daily, requiring a $2.5 to 3 billion replacement for their Central Jail.
- Counties act as middlemen, managing police, district attorneys, public defenders, judges, courthouses, and inmate healthcare.
- Policy issues include the suspension of benefits for veterans and Medicaid recipients upon arrest, affecting mental health treatment continuity.
- Collaboration among elected officials, nonprofits, and the private sector aims to reduce jail populations with mental illness, focusing on evidence-based practices for community safety and humane treatment.
01:07:24
"Guard Restraints Lead to Inmate Death"
- Joshua was restrained by guards in a way that led to his death, captured on prison video.
- State medical examiner ruled Joshua's death a homicide due to guard actions.
- Guards involved in Joshua's death were not charged or disciplined, with a cover-up by the department.
- Bridgewater State Hospital had a history of deaths due to restraints and solitary confinement.
- Guards at Bridgewater used restraints and solitary confinement excessively compared to other facilities.
- Civil lawsuits were filed, revealing routine use of restraints and solitary confinement.
- Governor Patrick took action after the cover-up, firing officials and appointing a special prosecutor.
- Guards were charged with manslaughter and civil rights violations, facing trial later.
- Mental health care system inadequacies were highlighted, impacting public safety and families.
- Recommendations included investing in mathematical models, expanding diversion programs, and increasing mental health workforce.
01:23:34
Health Plan Dominance in Northern Virginia Healthcare
- The second largest Health Plan in Northern Virginia operates on a county basis, despite the regional health economy.
- Kais, the second largest insurance carrier, has signed a long-term agreement with a hospital to take 70% of their patients.
- Patients from Arlington represent only a fraction of Northern Virginia, yet they are increasingly funneled into this hospital.
- State certificate of need authorities control access, but their data is considered too crude for accurate modeling.
- Internal consistency of data is crucial for models, as discrepancies can indicate issues in demand and capacity alignment.
- Closure of state psychiatric hospitals in the 50s led to unintended consequences, with a shift in responsibility to counties.
- The movement to close state hospitals was due to poor conditions and a lack of federal funding for community mental health services.
- The criminalization of mental illness was predicted, with a focus now on improving community mental health systems.
- Efforts are being made to divert acutely ill individuals to appropriate services, with a focus on collaboration and leadership.
- Initiatives like the Wellness Center in Leon County, Florida, demonstrate successful partnerships between nonprofits and jails for better outcomes.
01:37:56
Challenges in Mental Health Advocacy and Care
- The speaker highlights the challenge of releasing individuals from mental hospitals without considering the danger they may pose to families and others.
- In Maryland, individuals can be sent to a hospital against their will but cannot be forcibly medicated.
- Emphasizes the importance of reaching out to the research, academic, and treatment communities for mental health advocacy.
- A participant stresses the need to view mental health issues as illnesses and diseases, not choices, advocating for better education and research referrals.
- A student from a low-income community in Oakland, California, seeks ways for citizens to engage in mental health advocacy.
- A mother shares a personal story of her mentally ill son's struggles with non-compliance, aggression, and incarceration, highlighting systemic issues in mental health care.
- The discussion touches on challenges in Medicaid coverage for single males with mental illness, the need for more beds, and financial incentives affecting mental health care provision.
