Prison as ‘psychiatric warehouse‘

IU criminal justice researcher studying diversion programming

By Susan Williams

Public policy has changed provision of mental health care from hospitals to communities. As a result, incarceration has become a societal coping mechanism for the “socially troublesome.”

According to a recent National Mental Health Association (NMHA) news release, “our nation’s jails and prisons have become the psychiatric warehouses of the new millennium. The rate of serious mental illness in the prison system is three to five times that in communities. In addition, 33 percent more individuals with mental illness are in jails than in psychiatric hospitals.”

Mary Lee Luskin, an associate professor of criminal justice at Indiana University’s Bloomington campus, studies the court system and the mentally ill. She confirmed the NMHA’s numbers.

“Studies suggest that between six and 15 percent of jail inmates are mentally ill,” she said. “They are likely to be incarcerated longer than someone who is not mentally ill, and incarceration can be particularly harmful to them. Jails are neither humane nor efficient settings in which to treat mental illness.”

According to Luskin, the reasons for such high numbers of mentally ill persons being incarcerated are many. Among them a shift of mental health care from hospitals to communities and changes in mental health law, which means that “socially troublesome” in dividuals who might once have been institutionalized are left to cope the best they can.

“In many jurisdictions, however, the treatment, housing and other services needed by mentally ill people are inadequate and not well designed for the needs of those who are most likely to come into contact with the law,” said Luskin. “Arrest and jail may be the only alternatives police see. Once stigmatized by arrest and incarceration, though, it may become even more difficult for the mentally ill individual to get access to services.”

The NMHA has called for more research into alternatives for the mentally ill who have encountered the legal system, including diversion programs, an area Luskin is currently studying.

Diversion programs come in a variety of looks, but all are intended to identify mentally ill defendants accused of minor crimes and to divert their cases from criminal prosecution into mental health treatment, said Luskin. Some cities have experimented wi th specially trained police officers who respond to crises events with the intent of avoiding arrest. Others resemble an Indianapolis program Luskin studied recently, Psychiatric Assertive Identification and Referral (PAIR). The program is a cooperative e ffort of the Marion County Courts, the prosecutor and public defender offices, mental health treatment providers and the Mental Health Association of Marion County.

“Potential cases come to PAIR through screening of new arrestees at the jail by a mental health treatment professional and from a variety of other sources, including attorneys and mental health professionals,” Luskin said. “If it is agreed that a particul ar defendant is appropriate for diversion, the mental health services provider who will treat the defendant develops a treatment plan, which becomes part of the formal, one-year diversion agreement.

“The court monitors the defendant’s compliance with the treatment plan and progress through bi-monthly compliance hearings at which the defendant must be present. If the defendant successfully completes the diversion program, the criminal charges are dism issed. Criminal prosecution is resumed against those who fail to comply with the program’s requirements.”

During the early 1990s, a survey of more than 1,000 jails indicated few diversion programs—only 52. But since then, said Luskin, the numbers have grown rapidly, and she expects that growth to continue. “Such programs are likely to become more and more com mon, because of the considerable burdens imposed on jails and courts by mentally ill defendants and because of support for diversion among advocates for the mentally ill,” she said.

In general, diversion programs are still too new for them to be labeled an unqualified success. But Luskin said that evidence suggests that a well designed program can reduce the amount of time defendants spend in jail and the risk of re-arrest. “Successf ul diversion programs depend most importantly on communication and cooperation among all involved,” said Luskin. “They also seem to recognize that mentally ill offenders often have multiple needs. And my own research shows that programs also need to be ca reful that their criteria for accepting defendants into diversion are explicit and uniformly applied.”

Luskin has just started on a new research project also geared to mentally ill defendants. It is a survey of Indiana public defenders who represent mentally ill persons in civil and criminal proceedings affecting their clients’ treatment and liberty. It qu estions them regarding their beliefs about mental illness and their experience with mentally ill clients. “Defenders’ answers to these questions affect how they go about representing their mentally ill clients and the chances, in turn, that the clients re ceive appropriate treatment or criminal dispositions,” said Luskin. “The results of the survey will help us to understand the difficulties public defenders face in representing mentally ill clients. It will also assist us in designing materials or trainin g that can help them in their work.”