Treating the ill

An important story in this week’s Maine Sunday Telegram highlighted a fault in the state’s mental health system wide enough to drive a consent decree through. County sheriffs properly point out their jails do not have the resources to safely house mentally ill inmates. The larger question for Maine is why so many mentally ill residents are neglected so thoroughly that they end up in the criminal-justice system.

A recent study by the U.S. Justice Department found 276 of the 1,113 inmates in Maine’s county jails, or 24 percent, received psychotropic medication. In Maine’s three state prisons, 367 of the 1,562 inmates, or 23 percent, were on such medication, or receiving mental health therapy or counseling. That’s much higher than the national average – and can lead you to conclude that either Maine, as some corrections officials contend, is diagnosing people at a higher rate than most states or that it still hasn’t fully figured out that mental illness counts as a set of treatable, noncriminal afflictions.

But even for those who accept that Maine has a better-than-average diagnosis rate, it doesn’t explain the absence of treatment for inmates described in the Telegram story. All jails seem to have is a couple of ways of keeping inmates from killing themselves while they await the potential approval of calming drugs. But that is hardly enough – even a restraining chair, according to the story, couldn’t prevent one inmate from biting the inside of his cheek and spitting blood at his jailers.

Maine can still see the effects of its aggressive deinstitutionalization policies of nearly a generation ago in its prison population today, but there is something more, as well. Because it is socially acceptable to treat mental illness as something wholly separate from physical illness, because a chemical imbalance in the brain is considered a different species altogether than a chemical imbalance in, say, a thyroid, the public will accept insurers strictly limiting or denying coverage of mental illnesses. This has several effects, including keeping mental health care largely the province of a state system rather than a component of the general health care system. This, in turn, reinforces the idea that this type of disease is, in fact, unrelated to physical illness and regulates levels of care based, among other things, on the level of sales and income taxes a state happens to collect.

Certainly, problems Maine has had with a lack of care for the mentally ill have diminished considerably in the last six or seven years as more resources have been devoted to them, but just as certainly the problems remain serious in homeless shelters, jails and prisons.

And as serious as they are and as justified officials there are in wanting adequate mental health services, the shortages of care in these places are merely a sign that care is being rationed in the community, where treatment could allow an otherwise law-abiding resident to avoid jail and allow the community to avoid the financial and human drain that the current failure of care causes.