Andy Whyman: Culture shift needed to effect change in jail system
October 8, 2014
Are you interested in decreasing your taxes? Read on. First, a brief history. In the early years after the American Revolution, people who were peculiar, poor, mentally disabled or chronically inebriated were jailed, sometimes chained, and subjected to horrific conditions to "cure" them of their ailments.
"Poor laws," imported from England, criminalized certain behavior and filled the jails with the indigent mentally ill.
Over time, these barbaric conditions gave way to a realization that fresh air, decent food, a clean bed, sympathy and understanding, might make people feel better, and that punishment made them worse. This produced the modern state mental hospital movement.
Removing the mentally ill from jail and providing care in mental hospitals had the two-fold advantage of allowing jails to function more effectively and improving the lot of the mentally ill.
Beginning 50 years ago, a "War on Drugs" combined with the elimination of 1 million state mental hospital beds changed America.
State jails and federal prisons began filling up with drug users and the mentally ill. Once filled, more jails and prisons were built … and these were filled. A "private prison" industry was added.
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The cost of building prison beds is $250,000 per bed. Incarceration in a California jail costs $25,000 to $50,000 per year. Acute mental health services in jail cost $1,350 per day.
Presently, states have far more people with mental and substance abuse problems in jail than in hospitals. In California, there are four times as many mentally ill in jail than in hospital, and in Nevada the number rises to a state-leading ten.
If incarceration cured illegal drug use and mental illness, then tax dollars might be well spent. But it doesn't. Instead it prolongs these disorders, contributes to re offending, and drives cost skyward.
Which brings me to a landmark study, conducted at the request of the Placer County Board of Supervisors and publicly presented to them on Sept. 9, 2014. The results of this study are striking, and likely applicable to countless similar justice systems in other jurisdictions.
The Placer County correctional system costs $150 million, almost 20 percent of the entire county budget. The study explains how the system functions now and offers detailed recommendations about how to improve efficiency and outcomes.
The numbers tell a remarkable story: "Only 5 percent of all felony arrests are for serious violent crimes." That leaves 95 percent of felony arrests for crimes that are not considered serious and violent crimes.
Who are these people? Many of them, consistent with national statistics, are persons with drug, alcohol and/or mental problems.
Sixty-two percent of misdemeanor bookings were either alcohol- or drug-related; further, 19 percent of felony bookings and 31 percent of misdemeanor bookings were intoxicated at booking.
For inmates serving a jail sentence of 30 days or longer, 60 percent had either a substance abuse or mental health issue. The annual jail admission rate is 3,500 people — 31 percent are admitted for narcotics offenses.
The average sentence length for a narcotics offense is 164 days and 298 days for a felony DUI. There is a "high use of incarceration as a sentence."
The study also found a sample of seven offenders who were booked 221 times and spent 1,068 days in jail; 94 percent were nonviolent and 29 percent were for narcotics offenses.
What this data tells us is that there are a substantial number of non-violent offenders serving a considerable jail sentence who have drug and/or mental health problems.
Recommendations for system changes follow from the data. Most importantly, jail admissions can be reduced by a host of initiatives.
These include drug detoxification, diverting the mentally ill with multiple bookings to stabilization resources, pre-booking drug treatment diversion, more mental health treatment, sentencing nonviolent offenders to Drug Courts, expanding jail treatment programs and vocational options.
So where does the county go from here? There are work groups inside the system looking at the data. Well and good.
But much heavy lifting will be required to implement these recommendations. For one, a culture shift is required. Old shibboleths need to be discarded.
For example, incarceration of those with substance use and mental problems doesn't generally effect positive change, but supervision and modern treatment using the least restrictive alternative does.
Change won't be accomplished by demands or threats, but rather by reeducation. Some will resist these "new ideas." Addressing that population will require patience and courage.
There has to be funding reallocation. Mental health expertise is not seamlessly built into the system, and creating opportunities for clinicians to work with law enforcement will take time.
There are preconceptions that need to be addressed. The correctional system generally assesses mental health personnel with suspicion, believing them to be soft on crime naive do-gooders. Mental health personnel view correctional personnel as harsh, punitive, and indifferent to emotional suffering.
Overall, this document describes opportunities to make life better at reduced cost for a significant part of the offender population. Let's see what happens.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at email@example.com.
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