People with Mental Illness and Cognitive Disabilities in the Criminal Justice System

1. People with Mental Illness and Cognitive Disabilities in the Criminal Justice System Bob Fleischner Center for Public Representation

2. The Problem • At least 16% of the US prison/jail population has a serious mental illness. • Of the 10 million people booked in into US jails in 1997, at least 700,000 had a serious MI • Men involved in the MH system are 5 times more likely to be incarcerated than men in the general population; women 6 times more likely. • Same sorts of statistics for people with MR

3. More problems • On any given day, L.A. County Jail holds as many as 3,300 individuals with MI • Recidivism rates for inmates with MI are over 70% in some jurisdictions • Once incarcerated, inmates with MI often decompensate • They are especially vulnerable to assault or intimidation

4. Contact with Law Enforcement • Requests for police services • On-scene assessment • On-scene response • Specialized police units • Cooperation with MI/DD providers • Training for law enforcement personnel

5. Pre-trial, Adjudication & Sentencing • Diversion efforts and programs • Effective assistance of counsel • Prosecutorial review and decisions • Evaluation and assessment • Adjudication and sentencing • Probation conditions • Incarceration

6. Legal right to mental health services • Estelle v. Gamble, 429 U.S. 97 (1996) • 8th Amendment requires that prison officials • Not be “deliberately indifferent” (subjective component) to • The “serious medical” needs of inmates (objective component).

7. Objective component – Serious medical need • Generally, prisoner have a right to treatment if health care provider concludes with reasonable degree of medical certainty: • Prisoner’s symptoms evidence serious disease or injury • Disease or injury is curable or may be substantially alleviated • Potential for harm to inmate by delay or denial would be substantial. • Bowring v. Godwin, 551 F. 2d 44 (4th Cir. 1977)

8. Basic components of prison MH system • Screening and evaluation • Treatment modalities • Qualified mental health staff in sufficient numbers • Special needs units & inpatient hospitalization • Accurate MH records • Discharge planning • QA program

9. Screening & assessment • Everyone at least upon admission • To identify MI or DD • By specially trained staff • Confidential • Prompt referral for comprehensive assessment by MH professional if necessary

10. Qualified mental health staff • Sufficient numbers of qualified and trained staff • Physicians (psychiatrists), psychologists, social workers • Reasonable case loads

11. Treatment modalities • Medication • Prescribed by psychiatrist • Monitored • Formulary should contain a range of psychiatric medications • Overall therapy program • Emergency services

12. Special units & inpatient • Special housing for more intense treatment • Transfer to psychiatric hospital or facility

13. Accurate mental health records • Accurate • Complete • Up to date • Well organized • Confidential

14. Discharge planning • Benefits • Housing • Medications • Treatment follow up services

15. Quality assurance • Studies of utilization patterns • Studies of clinical outcomes • Policies

16. Special issues • MH treatment in isolation • Use of physical restraint • Suicide prevention • Discipline • Access to programs and credits