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Our local mental health crisis

Today’s must-read is this op-ed by Dr. Stephen Schnee, the executive director of the Mental Health and Mental Retardation Authority of Harris County, about mental illness and the Harris County jails.

The Harris County Jail is now the largest mental health facility in Texas. Approximately 2,400 inmates a day are now diagnosed with a psychiatric illness that medically justifies the provision of psychiatric medications. There are almost as many psychiatrically ill inmates in the jail on psychiatric medications as there are patients in all of the Department of State Health Services hospital beds across the entire state.

Let that reality sink in.

How is this occurring? Several critical factors contribute to this disturbing trend. First, many individuals with a serious mental illness need early access to appropriate professional diagnosis and treatment and, often, supports to achieve and maintain stability in their psychiatric condition. These conditions aren’t, as a general rule, cured by medication. Stabilized, yes — cured, no. These individuals need education about the condition, available treatment options, impact on personal capabilities, stability and maintenance over time, etc. — all of which are made more difficult by the nature of these disorders affecting the information-processing organ of the body — the brain. These are neuro-chemical — disorders of the brain. And, if one throws into the mix that many untreated or undertreated folks with mental illness self-medicate with street substances, alcohol or both to ease the internal pain, one has a recipe for people recycling in and out of the criminal justice system because their behaviors run afoul of the law.

The discrepancy between the funded treatment capacity (8,500 per month) for only the three eligible diagnoses of schizophrenia, bipolar disorder and major depression (let alone all the other serious psychiatric conditions for which people end up in jail) is huge. A conservative estimate of the incidence/prevalence of these three diagnoses in Harris County is 170,000.

There is a growing awareness among our key county officials that the county simply can’t afford to continue housing this growing population in the jail. More cost-effective options for certain misdemeanor offenses by people with mental illness are under active consideration. This will require literally building out an array of services and supports that don’t currently exist in the form or quantity necessary to effectively impact this subpopulation.

Yes, he’s talking about an expansion, probably a big one, in government services. I realize words like those will get knees jerking in certain quarters, but let’s face it: We’re already expending vast public resources on this problem, and it’s getting worse. We need to do a better job of it, and that’s going to require a different approach, for just as using the emergency room is the least efficient way to deliver health care to those who can’t otherwise afford it, using the jails to deal with the mentally ill has got to be the least efficient way of handling that problem. Perhaps if we were already doing something different, we wouldn’t have such severe and longstanding problems with the jails, and we wouldn’t feel the need to spend millions of dollars to build a new jail to house all the inmates we can’t current squeeze in. Point is, we’re paying for all this now. We may as well get a better return on our expenditures.

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