Treating Mental Illness Behind Bars

the Psychiatry Advisor take:

The drastic reduction in the number of  hospital beds for psychiatric patients at state hospitals over the last 60 years had led to a dramatic increase in the number of people in prison with mental illness. One estimate says that there are 10 times as many mentally ill persons in prisons than in state hospital beds.

The relatively small number of beds available has led to another major problem: The clogging of hospital emergency departments with psychiatric patients with nowhere to go and not enough resources to treat them, according to David R. Rubinow, MD, chair of the Psychiatry Department at the University of North Carolina School of Medicine.

"The increased acuity of patients and the inadequate financial support for hospital staff result in an increased incidence of violence and injury and a reluctance to admit new patients,” Rubinow writes in the American Journal of Psychiatry. “After discharge, mentally ill patients without follow-up treatment deteriorate and wind up exhibiting behavior that routes them through the revolving door of the emergency department or to jail. And once in jail or prison, those with mental illness often do not receive adequate treatment”

Citing a report from the Treatment Advocacy Center, Rubinow says that implementing jail diversion programs and promoting the use of assisted outpatient treatment for at-risk individuals are ways of improving mental health for prisoners.