How Our Fragmented Psychiatric System is Failing At-Risk Communities

psychiatric system communities

According to Mental Health America, 1.2 million individuals living with mental illness sit in jail and prison each year. The states with less robust access to mental health care, including Alabama, Arkansas, Mississippi, Texas, Georgia, and Florida, are all within the top ten states for the highest overall rates for incarceration. For context, nearly 2.3 million individuals are incarcerated in the United States, meaning that nearly half of the United States’ prison population live with some sort of mental illness; usually, their first involvement in the justice system typically begins with low-level offenses such as jaywalking, disorderly conduct, or trespassing. Conversely, the states who reportedly have the most access to mental health care, including Maine, Rhode Island, Massachusetts, Minnesota, New Hampshire, and Vermont have lower incarceration rates per 100k people.

Empirically, it is clear that there appears to be a stark correlation between a lack of quality psychiatric resources and incarceration rates, but how do we keep perpetuating a cycle of imprisonment for those who clearly lack the means to get help – and why do we keep adding fire to this systemic issue?

It is primarily imperative to understand the long-lasting implications of how mental health facilities have historically failed Black Americans, which largely exists as a conflation of economic and social disparities and a lack of representation for Black Americans in the psychiatric field. In a recent article published by the Chicago Tribune, it was reported that suicide rates amongst Black Chicagoans have largely risen, even as the statewide average fell from 678 to 649 between January and June of 2019.

To resolve this prominent issue, a meeting with the Illinois Senate Human Services and Public Health committees was held to discuss topics of behavioral health and disparities in regards to mental health disorders. State Senator Mattie Hunter stated that “lack of access to [healthcare] treatment is harming Black communities, which often face more behavioral and mental health issues.” To combat such findings, the Chicago Department of Public Health announced a request of proposals that will reportedly “award more than $6.5 million in grants to community-based mental health providers” as Black Chicagoans have expressed a heightened sense of anxiety, largely heralded by systemic inequities such as implicit bias in the workplace and healthcare inequality.

Moreover, the lack of representation for Black Chicagoans in the mental health care field only leads to an uptick in the resistance to see a therapist, as Brittany Owens of Clarity Clinic in the Loop stated, which negatively contributes to stigmas in the Black community about not seeing a psychiatrist. Experiencing both implicit and explicit bias from public health officials who are supposed to wholeheartedly support Black Chicagoans regardless of race worsens the initiating/developmental steps of reaching out to a psychiatrist.

The Black Mental Health Alliance makes it clear that mental illness symptoms can appear at any point in one’s life – for instance, some illnesses tend to develop earlier in life like bipolar disorder, schizophrenia, and other personality disorders, while some illnesses are not limited to age like depression, anxiety, suicidal thoughts, substance abuse, and delirium. Thus, it is fundamental to include all ages in the discussion of how our criminal justice system treats people with mental illnesses.

So what are the most notable correlations between the incarceration of people with mental illnesses and people without mental illnesses? For one, people with mental illnesses are 9 times more likely to be incarcerated than hospitalized, and they are likely to stay in jail nearly four to eight times longer than someone without a mental illness for the same charge, according to In Miami-Dade County, an urban community in the US with the largest percentage of people, roughly 9% of the population (210,000 people), who have serious mental illnesses, such as schizophrenia, bipolar disorder, or major depression. Only 13% of these individuals receive care from the public mental health system.

Judge Steven Leifman of Miami-Dade County admits to the failure of the criminalization and subsequent exacerbation of the incarceration of individuals with mental illnesses. He notes that it completely shifts the intended aim of de-institutionalizing people to attempting to punish them in a “criminal justice” system that is entrenched with the implications of being denied housing and employment as well as the social repercussions of having been incarcerated. He further drew attention to the cyclical nature of such arrests, as it is highly likely that releasing individuals from incarceration following a period of solitude only augments the chances that they will be arrested again, as adequate treatment was ultimately not provided.

Judge Leifman notes that budgeting plays a pivotal role in the allocation of mental health resources to people who are the most at-risk. Asserting that counties should not have to compromise over certain individual needs, Leifman claims that Florida will need to construct 10 new prisons in 10 years, with overall costs surmounting to $2.5 million. In an attempt to refrain from the corrupt criminal justice system, Judge Leifman founded the Criminal Mental Health Project (CMHP) in Miami-Dade county with the hopes of mitigating past fragmentation created as a result of this defective system. By aiming to utilize local, community-based treatment, the program’s three main components (pre-arrest system, post-arrest diversion program, and competency restoration alternative program) assess the best ways to ensure that imprisonment amongst mentally ill individuals is paid the utmost attention to at all points in the process, whether it be through distributing the appropriate amounts of medication or connecting participants to the appropriate services (housing, Medicaid, etc.)

The pre-arrest system is ultimately the keystone of this process, as it draws attention to how police officers are taught about de-escalation and how to identify an individual with mental illness; more importantly, it attempts to provide officers with the means of referring these individuals to areas where they can get the appropriate treatment without having it ever make an arrest. The latter of the two programs facilitate an environment of connection, engendering a system that can treat every individual on a personal, case-by-case basis that aptly evaluates the specifications of their treatment.

Mental Illness Policy further corroborates the sentiment that the nation’s jails and prisons have largely become “de facto” psychiatric hospitals due to the lack of effective resources and with the by-product of these restrictive institutions leaving many correctional officers wholly unprepared to appropriately treat these individuals. A critical part of understanding the mass incarceration of people with mental illnesses is that the reason for their arrest is typically at odds with the circumstances that they must be in following their arrest, with the vast majority of jail inmates with serious brain disorders having been arrested for misdemeanors such as trespassing. In fact, police officers frequently utilize disorderly conduct charges to arrest a mentally ill person when no other charge is applicable – these charges are assigned at a rate of four more times than to non-mentally ill inmates.

Given the sheer lack of mental health care availability in marginalized communities, the family surrounding the individual with the mental disorder will sometimes turn in the person with pending criminal charges as opposed to sending them to a psychiatric facility, allowing them to gain treatment (albeit minimal) through incredibly unfortunate means. The conditions of the individuals only intensify in prisons, as having some sort of mental disorder makes them highly vulnerable to be harassed and/or abused by other inmates.

The paper Mental Health for Prisoners: Identifying Barriers to Mental Health Treatment and Medication Continuity further underscores that individuals with untreated mental health conditions may be at a higher risk for correctional rehabilitation treatment failure and future recidivism on release from prison. Authors Jennifer M. Reingle Gonzalez and Nadine M. Connell found that the rates of recidivism (or the tendency of a convicted criminal to re-offend) are between 50% and 230% higher for persons with mental health conditions than for those without mental health conditions. Amplifying psychiatric resources only proved to lessen these metrics, with the authors suggesting that specialized therapeutic communities, mental health courts, telemedicine, integrated family counseling, and cognitive-behavioral therapies should accompany pharmacotherapy.

The resolution is crystalline; if more emphasis is put on providing at-risk people with abundant psychiatric resources, then we will witness a concrete reduction in the United States prison population. Drawing attention to the racial and classist disparities will help accumulate awareness towards an inequitable prison structure. By facilitating local programs and individualized treatment, we can ensure that the system no longer disproportionately convicts people whose very needs have been neglected.