Mentally ill do not belong behind bars

For hundreds of thousands of mentally ill Americans, “help” consists of a jail cell where at least they can obtain the medications and psychiatric care they need to become stabilized. 

Thanks to Washington’s own shortsighted rules, however, Medicaid eligibility terminates when a person is placed in custody; consequently, when the mentally ill are eventually released, they are on their own.  Without access to doctors, medicines or a means to pay for them, their mental health soon deteriorates and they frequently wind up back in jail.  It is a revolving door of neglect, incarceration and renewed neglect. 

{mosads}Chillingly, jail cells have become America’s “new asylums.”  In the wake of de-institutionalization of the mentally ill, the number of people suffering serious mental illness in jails and prisons is now 10 times the number receiving treatment in state psychiatric hospitals. 

In 2012, the most recent year for which data is available, there were 356,268 inmates with severe mental illness in custody, compared to just 35,000 being treated in hospitals.  In 44 of the 50 states, a single jail or prison is home to more mentally ill inmates than the largest state psychiatric hospital.

At just one facility, the Dane County, Wisconsin jail, the number of inmates being administered psychotropic medications has increased by more than 55 percent just between 2013 and 2014, by which time more than 1 inmate in 3 was receiving psychiatric care. 

More than just a repository where mentally ill people can be locked away and forgotten, our prisons and jails have become, by default, the only place they can receive the psychiatric care and medication they need.

Washington, however, has decreed that a poor person’s eligibility for Medicaid terminates immediately upon his or her incarceration. Although taxpayers pay the cost of an inmate’s medical care during incarceration, the practical effect of Washington’s rule is to ensure that the bills will be paid by the prison or jail instead of Medicaid. 

Once the mentally ill person is released from custody, however, Medicaid ineligibility has a far more insidious effect, depriving the individual of medicines or psychiatric aftercare until he or she can successfully reapply — if that ever happens.

Without medications or care, the individual’s mental state deteriorates and, eventually, he or she goes on to commit other offenses, often in a pathetic effort to get help. 

In law enforcement circles, repeat offenders are commonly referred to as “frequent flyers,” and among the mentally ill, the “frequent flyer” rate is higher than it is for other released inmates.  

In the Los Angeles County jail alone, a 2010 study found that 90 percent of mentally ill inmates were repeat offenders, with 31 percent of those having been incarcerated 10 times or more.  In Memphis, one inmate, Gloria Rodgers, was arrested 259 times before she was finally (and mercifully) committed to a state psychiatric hospital. 

Jails are singularly ill-equipped to serve as mental health facilities, and the mentally ill do not belong behind bars. Nevertheless, it has fallen on the nation’s sheriffs to initiate a long-overdue conversation on a problem that for decades has been ignored.  

For starters, Congress should reexamine an arcane Medicaid eligibility rule whose only practical effect is to deprive low-income, mentally ill individuals of desperately needed psychiatric care and condemn them (and society at large) to a dangerous pattern of recidivism.

At the very least, however Congress should reexamine a pilot program that would continue Medicaid benefits for inmates so that, upon release, they can seamlessly continue to receive psychiatric aftercare and psychotropic medications.  The nation’s sheriffs advocated such a demonstration program legislatively in 2010, but Congress never acted; it should do so now, because as sheriffs, we are convinced that doing so will reduce recidivism among the mentally ill. 

America’s sheriffs are ready and willing to engage in an honest discussion about how best to help the mentally ill so they can resume their lives as productive members of society, alleviate the burden on law enforcement — and, hopefully, avoid the tragic consequences that can result from our continued neglect. 

Mahoney is the chief law enforcement officer of Dane County (Madison), Wisconsin and serves on the board of directors of the National Sheriffs’ Association, of which Thompson is executive director.