NaphCare Perspective: Why are so many people with mental illness in jail?

by Amber H. Simpler, Ph.D., ABPP, Chief Psychologist, NaphCare
February 11, 2020

According to the Department of Justice, more than 50% of individuals in correctional institutions experience symptoms of mental illness, with more than 18% of those presenting with signs and symptoms of severe mental illness (SMI), such as psychosis or mood instability. Comparing this to the early 1980s – when approximately 6.5% of inmates presented with SMI – we must ask, have prevalence rates of SMI tripled in the past 40 years? If not, how can we explain why so many individuals with mental illness are in jail?

Anecdotally, there are at least two avenues by which people with SMI end up in jail, as well as remain in jail well beyond the average length of stay. Individuals who are acutely ill tend to behave in ways that call unfavorable attention to themselves. For example, the seemingly homeless man who talks (maybe screams) to unseen others on the crowded city street, frightens passers-by and gets charged with disrupting the peace. Or the paranoid person who instinctively lashes out to protect herself when approached by an officer is charged with assault.

Once in jail, someone with SMI may remain detained for significantly longer periods of time than other inmates, even when charged with lessor and/or non-violent offenses. For some, the perception that psychiatric illness equates to increased risk of violence may explain the prolonged detention. For others, the question of competency to stand trial is raised, requiring a forensic evaluation – and in some cases, subsequent admission to a forensic hospital for competency restoration treatment, which can take months, even years to accomplish.

While the rates of SMI in the inmate population have almost tripled, the number of hospital beds available to treat individuals with SMI have significantly declined. In the 1950s, there was one psychiatric bed for every 300 Americans. Now, the ratio is more aligned with one psychiatric bed for every 3,000 citizens. And the beds that are available are largely filled by patients who are under criminal court orders, not civil commitments.

Explanations for the shortage span the gamut – from budget cuts to promotion of community based treatment. In either case, the end result is the same – the need vastly exceeds available resources, and those suffering the consequences are people who are least likely to be in a position to advocate for themselves or their rights.

NaphCare aims to lessen the extent of this problem by enhancing our approach to mental health treatment in jails. Through advanced treatment programs and therapy units, we are able to help our patients reach a level of psychiatric stability to ultimately prepare them for a safe and healthy return to the community. Additionally, by implementing jail-based competency restoration programs, we can avoid lengthy delays for admission to state hospitals and quickly initiate treatment efforts aimed at resuming adjudication. At NaphCare, we refuse to accept that jails are modern-day warehouses for the mentally ill, and we’re committed to designing solutions that are better for our patients, our partners and our communities.

As NaphCare’s Chief Psychologist, Dr. Simpler collaborates with mental health providers to improve clinical and operational processes within correctional settings and evaluates sites to assist with new initiatives such as mental health crisis stabilization units and jail based competency restoration programs.