The U.S. has the world’s highest incarceration rate, and many of those behind bars suffer from mental health issues, leading advocates to call prisons the country’s de facto mental asylums, according to a report by the Treatment Advocacy Center (TAC).

The report, issued in 2014, found that while state and county correction facilities nationwide housed 356,268 people diagnosed with some type of mental illness, state mental health facilities held just 35,000.

Funding for government mental health programs took a big hit during the recession and hasn’t recovered. From 2009 to 2013, state mental health programs collectively absorbed $4.6 billion in funding cuts, according to the National Association of State Mental Health Program Directors.

Meanwhile, state corrections’ budgets continue to rise, with prison and jail spending absorbing increasingly larger proportions of budgets, according to the National Association of State Budget Officers (NASBO). According to an Association report:

“The state inmate population has grown as well (nationally), leading many states to direct more resources for prisons and incarceration, sometimes at the expense of other priorities.”

In Arizona for example, Department of Corrections spending is set to rise by $38.6 million in fiscal year 2016 while spending for universities will drop by $101.5 million and Department of Health Services funding will fall by $10.3 million, according to the state Joint Legislative Budget Committee.

Disproportionate number of mentally ill land behind bars

Estimates vary, but as many as 26% of those incarcerated have mental health disorders compared to 18% in the general population, according to a study published in the American Journal of Public Health.

Meanwhile, as many as 60% of inmates have problems with substance abuse, which could also be considered a mental health issue, writes forensic psychologist Dean Aufderheide on the Health Affairs blog.

While some prisoners have problems like depression, others suffer from more severe disorders like schizophrenia or bipolar, Aufderheide writes. As many as 40% of people with severe mental illnesses spend some portion of their lives behind bars. He adds:

“I think we can safely say there is no doubt that our jails and prisons have become America’s major mental health facilities, a purpose for which they were never intended.”

How did jails come to house so many mentally ill?

Starting in the 1960s, states began to reduce mental health hospital funding with the idea that the mentally ill would be better served by smaller, more customized community programs. Federal funding wasn’t enough to continue funding these community programs, however, and the mentally ill were left without support, according to Aufderheide.

Those with psychiatric disorders who committed crimes were then placed in prisons, a trend that continues to today. The diminishing number of state psychiatric beds is a root cause of the burgeoning population of mentally ill in the corrections system, according to a TAC report.

The mentally ill tend to stay in jail for longer than non-ill prisoners because they post bail less frequently and, because of their psychiatric condition, tend to break prison rules, which prevents early release, according to TAC. The prolonged sentences contribute to jail overcrowding and worsen already undesirable jail conditions. TAC quotes a deputy working at a Mississippi county detention center saying:

“They howl all night long. If you’re not used to it, you end up crazy yourself.”

Jails not equipped to help mentally ill break the cycle

Research conducted at the University of Texas at Dallas found that fewer than 20% of inmates with mental illnesses were taking medication when they were incarcerated.

Once in jail, those inmates frequently go without the help they need. Although federal courts require making health services available to inmates, only those with the most severe mental illnesses typically receive needed treatment, according to research from the University of Texas Health Science Center at Houston.

Inmates with mental health conditions left untreated are more likely to commit future crimes and face subsequent incarceration, says Houston Dr. Jennifer Reingle, one of the study’s authors. As many as 70% of inmates with mental health disorders are likely to re-offend, she says, adding that counseling or group therapy may help to lower recidivism rates.

Even those prisoners without preexisting mental health issues may find it difficult to cope with jail conditions, putting them at risk of developing a disorder, the Dallas study found. Researchers Dr. Nadine Connell says:

“Someone who already has risk factors or a known mental health disorder is going to be much more likely to adapt poorly (to prison). And that could include self-harm, that could include violence and aggression against others, violence and aggression against staff or other inmates, and being unable to benefit from treatment or rehabilitation options that are available.”

Advocates hope to change the dialogue surrounding the mental health crisis in jails and reframe the issue as one of public safety and health, writes Aufderheide. If people considered mental illness a chronic illness like other diseases, he says, then perhaps more effective treatment strategies and funding options could be developed.

Corrections and chronic pain

Many of the nation’s prisoners also suffer from a mix of chronic pain and substance abuse issues, making it challenging for doctors and medical providers working in corrections, according to the National Commission on Correctional Health Care.

Many inmates enter prison with opioid prescriptions. Corrections officials don’t look on this favorably because the medications can be sold to other prisoners, used for overdose, or cause addiction.

Substance abuse is a mental health issue, and also frequently occurs in conjunction with depression or more serious mood or psychiatric disorders. Officials continue to search for the best ways of handling inmates with chronic pain, but typically focus on making sure prisoners can function and complete daily tasks, even if they’re still in pain, according to the American Jail Association.

Affordable Care Act a beacon of hope

As difficult as it is for mentally ill inmates to receive treatment while incarcerated, it’s even more difficult for them to find treatment after leaving jail. The Affordable Care Act, which expands access to health insurance and medical treatment, could alleviate that problem, according to the Chicago Policy Review.

Other possible solutions include mental health courts, which sentence people with treatment instead of jail time, reports NAMI.

What are your thoughts on the high rates of incarceration for the mentally ill?

Image by Keith Allison via Flickr

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