Jail reform must include mental health

Thank you, Gov. Baldacci, for your consolidation proposal and the focus it brings to Maine’s correctional crisis.

Maine, like the rest of the nation, is dealing with the outcome of failed public policy: deinstitutionalization of people with mental illness and the war on drugs. Both well-intentioned policies, have had unintended consequences. We closed psychiatric hospital beds but never built an adequate community system of care. Without adequate medical follow-up, people with serious and persistent mental illness can easily run afoul of the legal system and wind up in prison. Not surprisingly, they have.

In addition we have put many people with substance abuse diagnoses behind bars instead of treating their illness. The result? At mid-year 1998, there were an estimated 283,800 mentally ill offenders incarcerated in the nation’s prisons and jails. In September 2006, the Bureau of Justice Statistics reported that 64 percent of jail inmates had mental illness (60 percent were actively symptomatic and 24 percent met criteria for a psychotic disorder) and even more had substance abuse problems. If things go on as they have, we will build even more jails and prisons, but the crisis will continue.

The signs that a new direction needs to be taken – and fast – are multiple: 21 jail and five prison inmates dead from suicide or drug related problems since 1998; multiple lengthy study commissions with many recommendations, but few implemented; a joint action plan between the Departments of Health and Human Services and Corrections – under way but behind schedule; a jail, built for capacity for 10 years, now full; new jails under construction at great cost to property taxpayers; local jail diversion programs across the state struggling keep people with mental illness out of jail. Band-Aids are being applied where surgery is needed.

NAMI Maine’s condolences go out to the 26 families who have lost loved ones. Our condolences, too, to Sheriff Glenn Ross and the employees of the Penobscot County Jail. They have worked tirelessly alongside NAMI Maine for the past three years to fix what doesn’t work well in the jail, to prevent jail suicides, to make the public aware of the problem, and to help the state find solutions. The fact that another life was lost in the jail so recently is heartbreaking and evidence that more is needed.

Certainly Sheriff Ross has been asking for help for a long time as the number of inmates in his jail has continued to rise and their mental health problems tax the resources at the jail. Most jails in Maine, including the Penobscot County Jail, routinely attempt to care for significantly more inmates than the jails were built to house. Worse yet, due to the cutbacks needed to address budget shortfalls in the community mental health system, mental health services across the state are being curtailed, rather than expanded.

Perhaps, now that the governor has turned his attention to the jails – a real solution will be found. But, it won’t be found in simple number crunching, jail closings, planned savings in administration, or placing the county jails under the umbrella of the Department of Corrections. Although all options should be on the table, and some of the governor’s ideas may bear fruit, if the underlying policies that send more than 40,000 people through Maine’s jails each year (50 percent of them for probation violations and 64 percent with mental health problems) aren’t changed, we won’t solve the problem. We will just be putting on another Band-Aid.

It is no longer possible to see the jail and prison crisis as separate from the state’s mental health system. People with mental illness must have both immediate access to emergency services and adequate long-term care for their illnesses so that they do not fall into the criminal justice system.

Inmates must be carefully assessed, both when they are admitted and when they are ready for release, to assure that those with mental health and substance abuse needs get those needs met. We must take a long hard look at access to community mental health services, the mental health service system’s ability to work with the correctional system, the quality and capacity of both systems, how we use probation, the separation of high risk inmates from those who are more appropriately served in alternative sentencing programs, and our overall philosophy about incarceration and understanding of the results we are getting.

The governor has started the debate. Let’s hope it results in serious consideration of the overlap between behavioral health and corrections and solutions designed to fix what is broken.

Dr. Lani Graham is a family practice physician with more than 20 years’ experience in public health in Maine. She serves on the Governor’s Advisory Council for Health Systems Development. Carol Carothers is the executive director of the National Alliance on Mental Illness of Maine.