User:Krodriguez3/Mentally ill people in United States jails and prisons

Accessibility

A main contributing factor as to why the US is seeing a steady increase in those who are mentally ill within the prison system, can be due to the lack of accessibility in various communities. Specifically those who come from a lower income background face these issues, in which there are little to no resources being offered that are readily available for those experiencing ongoing difficulty with their mental health. The AMA Journal of Ethics discusses more specific factors as to why there are consistent high arrest rates of those with severe mental illness within communities, stating that the arrests of drug offenders, lack of affordable housing, as well as significant lack of funding for community treatments are main contributors. With the introduction of Medicaid, many state run mental health facilities closed due to a shared responsibility of funding with the federal government. Eventually, states would entirely close a good portion of their facilities, so that mentally ill patients were being treated at hospitals where they would partially be covered by Medicaid and the government. The National Council for Behavioral Health conducted a study in October of 2018, which included survey results that confirmed  “nearly six in 10 (56%) Americans [are] seeking or wanting to seek mental health services either for themselves or for a loved one...These individuals are skewing younger and are more likely to be of lower income and military background”.

Current Laws

The Federal Bureau of Prisons have claimed to have made policy changes, but those changes only apply to the rules within the system, and they did not fund resources to carry those new implementations out .It should also be noted that within the prison system, states have laws and responsibilities to ensure as well, one being within the Eighth amendment that requires prisoners' medical needs to consistently be met. The Prison Litigation Reform Act upholds this right in federal court cases.

Community Standpoint & Outcome

Social stigma regarding this issue is significant due to the public’s outlook and perception of mental health, where some may not recognize it as health factor that needs to be addressed. It is for this reason that some may avoid or deny the assistance being offered to them, thus further suppressing feelings and experiences that eventually needs to be dealt with. The NCBH notes that about one-third of Americans, or 38%, state that they worry of their peers and family members judging them if they were to seek mental help.

Without the presence of these facilities within communities, there is an outcome of mentally ill individuals carrying on with no preventative treatment or care to keep the severity of their condition to a healthy level. Just about 2 million of these individuals go to jail each year, moreover, data shows that 15% of men and 30% of women who are taken to prison, do in fact have a serious mental health condition. The National Alliance on Mental Illness further looks into the results of decreased mental health services, and they found that for many, individuals do ultimately become homeless, or they find themselves in emergency rooms, as a result of inaccessibility to mental services and support groups. Statistics show that about 83% of jail inmates did not have access to needed treatment, prior to their incarceration, within their community which is why some may be rearrested for crimes as a way to return to some form of assistance. The Marshall Project has gathered data regarding those being treated in jail, and what they found was that the Federal Bureau of Prisons implicated a new policy to be initiated that was meant to improve the care for inmates with mental-health issues. It ultimately led to decreasing the number of inmates who were categorized as needing higher care levels by more than 35%. After this policy change, the Marshall Project noted the steady decline since May 2014 of inmates receiving treatment for a mental illness. Research shows that within recent years, those with “serious psychotic disorders, especially when untreated, can be more likely to commit a violent crime”.

Prison Conditions & Effects

In the past, overall living and treatment conditions within US prisons were not up to par, which can be seen through the details and points made by the Coleman v. Brown case that went to trial in 1995. The district court judge in charge of this case, ultimately recognized the systemic failure within the system to properly care for and provide resources to mentally ill inmates. These individuals were not receiving treatment prior to prison, and were sent there with expectations from others that they would be receiving treatment there, but that expectation was not fulfilled.

With Coleman v. Brown, a special court, including three judges that can make final decisions on whether or not a problem is significant enough to enact change, came to the conclusion that overcrowding was in fact a reason for poor conditions in prisons, therefore they called for a reduction in the prison population to partially relieve said issue. Justice Alito at this time questioned whether the solution of reduction was actually helpful, when they could be looking into constructing additional prison medical and mental health facilities .Although, the decision did not take care of the living conditions that were problematic before and even after the case. It has been noted that psychotic prisoners were often held in small, narrow essentially restricted areas in which standing on their own secretions was common. As far as actual mental health treatment conditions, the waiting time to even receive care could take up to a year, and when they finally reached that date, the screenings for such lacked privacy for those being evaluated as the spaces were often shared by several physicians at a time.

A more recent case that has been discussed, is that involving previous inmate John Rudd where he was being held at a federal prison in West Virginia as of 2017. Rudd had a history of mental health disorders consisting of posttraumatic stress disorder, as well as schizophrenia. He was evaluated and diagnosed by a doctor as early as 1992. In 2017, he stopped taking his psychiatric medication, then proceeded to inform staff of his intentions to take his own life. Staff proceeded to put him in a suicide watch cell, where he would physically and violently hurt himself. Staff injected him with haloperidol, an anti-psychotic drug, to treat him ,but after some time they concluded that Rudd was not ill enough to receive proper, regular treatment and continued to categorize him as a level one inmate, meaning no significant mental health needs. Although they were aware of his pre-existing conditions, the prison staff claimed those were resolved and simply adjusted it to Rudd having an antisocial personality disorder. Prison staff in general, have also been experiencing issues for various years now. Previously in the 1990's, just about one third of positions went unfilled for mental health staff, and it became increasingly impactful on inmates when the vacancy rates for psychiatrists reached 50% and up .Staffing shortage is still seen today in which some counselors can be pulled and asked to serve as a corrections officers for the time being. This situation had worsened due to the Trump administration and the hiring freeze that was meant to reduce costs. Rudd, now out of prison and receiving counseling and taking medication, speaks on triggers within the prison environment that are not in any way healthy for those who are mentally ill.

Reform

As of late December 2018, the First Step Act (S 756) was signed into law as a way to a way to reduce recidivism and provide overall improvements to the conditions faced within federal prisons, as well as working to reduce the mandatory sentences given. Although, this Act primarily applies to about 225.000, or 10%, of individuals in federal prisons and jails, whereas this reform may not be applied to those in state prisons and jails. Some of the provisions that result from this act include staff training as to how to identify and assist those suffering from a mental illness, and providing improved, accessible treatment regarding drug abuse with programs like medication-assisted treatment.

The implementation of significantly more Certified Community Behavioral Health Clinics has been discussed as a solution to the issue of mental health in the prison system as well. It's primary goal is to cater to the needs of its specific communities and expand access to mental health treatment for everyone. The claims of an organization like this is to reduce criminal justice costs, as well as hospital readmissions, and, once again, to reduce recidivism. They strive to treat individuals with mental illness early on, rather than allowing them to carry on without professional care and general support.