Mentally Ill in Jails, Part 3: Costs, Legislative Initiatives, and a Modest Proposal
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12 responses to “Mentally Ill in Jails, Part 3: Costs, Legislative Initiatives, and a Modest Proposal”
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Oh, when I get intoxicated I can always make the argument it was involuntary….
A terribly important, complicated, expensive, ethically-charged and politically dangerous discussion. Fools and policy wonks rush in…. This was the old Bacon’s Rebellion I enjoyed so much more, but if you want big readership we need to drag in race or cancel culture or socialism. And speaking of socialism, indeed most of these individuals will be qualified for Medicaid, and capturing more Medicaid support for providing health care to the incarcerated was a major argument in favor of the recent eligibility expansion. Perhaps part four….
But these problems go way beyond the run of the mill health issues in complexity, cost and that most important measurement: consequence of error. Hence the long term failure to find much satisfaction.
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The argument for Medicaid expansion relating to savings on medical costs for the incarcerated was applicable to inmates in state prisons. The inmates in jails are also eligible for Medicaid and its coverage could relieve the medical costs of localities, but I am not sure the extent to which Medicaid would cover mental health treatment.
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When one changes the rules, anyone, including people you don’t like can use the new rules. The test of whether the accused knows the the difference between right and wrong is clear. What happens when men accused of sexual assault begin claiming they are mentally impaired? Big difference between bringing in mental health assistance and changing the standards of law.
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The legislation defines mental illness pretty explicitly. And, it is always up to the court, or jury, to weigh the evidence presented.
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I was looking at the breakdown of costs between food/medical – and the costs of maintaining the jails. If we subtract food/medical, is the average cost of manpower to run the jail around $75 per inmate per day?
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Statewide, the personal services cost is $61.65 per inmate per day.
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There was a time when we had state institutions. Well, more of them. Then in the 70s they kinda went away and people fell on the streets and parks. Was this a Conservative cost-cutting action, a Liberal civil rights action or one of those rare times of convergence where everyone loses?
When my first ex-wife and I were married, her 13-yo sister was institutionalized at Hampton’s Bayberry (long gone) for drug addiction and a litany of delinquent behaviour. After several court appearances, we finally took her in and raised her for a year while she attended therapy and reconciled with my mother-in-law.
Nothing like newlyweds raising a 13-yo with psych issues. She was lucky, I suppose, she survived. Too bad about my marriage. Oh well, dodged a bullet in the end.
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The decrease in population of the state mental health hospitals resulted from a push to deinstitutionalize the residents. I guess you could say that it was a liberal civil rights issue. The idea was to get the folks out of the institutions and house and treat them in the community, which would be more humanitarian. The problem is that the state never has followed up with adequate funding for the community facilities. As a result, the jails have become the de facto “institutions” for housing many of them.
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So, a broken promise on funding and civil right. Convergence. Where I used to work there was a park near by where mostly men slept in the bushes and spoke loudly to the air. Most claimed to be vets. One of my office mates used to go down every once in awhile and hand out a couple of $100 in twenties.
Every so often the morgue wagon would show up and another Sarge or Pete was taken away.
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I think far too often we try to approach these issues with a one size fits all solution. Mental illness is a continuum, and we all fall on it somewhere. When I was in college 25 years ago, I worked in a group home for mentally ill adults. The residents (except for one) in that home didn’t have mental stability to take their medicines, get to their counseling appointments, or engage in relatively productive/benign activities. The exception was a man who had threatened a judge and was deferred from prison with the understanding that he would remain in the group home.
I suspect that there are those mentally ill folks who pose such a risk to themselves or others that we need to keep them locked up for good. There’s others who should walk freely among us. Everyone in between probably needs some degree of additional supports between those two extremes. The problem with all of this is that there’s no real objective measure that can accurately prescribe the needs of the individual.
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Good observations. They underscore what a complex issue this is.
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“Richard Bonnie, the director of the Institute of Law, Psychiatry, and Public Policy at UVa., explained that the bill establishes that, if it cannot be proved that a defendant had the specific, required mental state to commit a crime, the defendant is not guilty even if he committed the act itself.”
It sounds like the the burden of proof is being shifted from the defendant having to prove he was insane when he committed a crime, to the prosecutor being required to prove the defendant was not insane. I would not call that progress. We’ll still have the binary issue Steven Benjamin complained about – there will still be no middle ground.
Fixing the either/or issue would involve establishing varying degrees of culpability based on the defendant’s mental state, not just declaring him “not guilty” because the prosecutor cannot prove the person is not insane.
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