[NYAPRS Enews] HC: TX Co. Looks at Boosting Housing And MH Support to Cut Prison Population

[Matt Canuteson]

Finding Escape Behind Bars

When Jail Is The Only Place Mentally Ill Inmates Get Treatment, They
Come Back, And It Costs $87 Million

By Bill Murphy   July 21, 2008   Houston Chronicle 

 

At the Harris County Jail, deputies and health care workers have a name
for them - frequent fliers.

 

They are mentally ill homeless people who return to jail so often,
sometimes on minor charges, that they become familiar to the psychiatric
staff.

 

During a recent survey, county officials found that more than 400 of the
jail's 11,000 inmates were homeless and suffered from a major mental
illness: schizophrenia, bipolar disorder or a chronic
depressive-psychotic disorder. They were among 1,900 inmates on
psychotropic medications.

 

When the mentally ill homeless leave jail - and leave behind its mental
health care staff - many stop taking medication and end up on the street
again. Treatment resumes only when they commit a crime and return to
jail or their dementia overwhelms them and they are brought to an
emergency psychiatric center.

 

Treating the mentally ill as they cycle through jail and emergency
psychiatric wards is expensive. A county budget analyst estimates that
it costs $80,000 a year, per person.

 

At the jail, spending on mental health care has risen to $24 million
annually, and the combined cost of incarcerating and treating the
mentally ill is $87 million annually.

 

"The jails have become the psychiatric hospitals of the United States,"
said Clarissa Stephens, an assistant director of the county's budget and
management services office who has been studying the jail's mental
health costs.

 

The Commissioners Court is so concerned about the rising costs that it
has retained a consultant - psychiatrist Avrim Fishkind - to study
whether providing outpatient services and supervised housing would
reduce the numbers of mentally ill revolving through the jail.

 

"The costs of reincarcerating and court costs far outweigh what the
costs would be if you housed, clothed and supervised the mentally ill,"
Fishkind said.

 

A June survey of more than 11,000 inmates revealed:

*About one-quarter suffer from mental illness or once suffered from it.

*Of those on medication, 978 suffered from schizophrenia, bipolar
disorder or a severe depressive-psychotic disorder.

*Of the 978 with a major mental health disorder, 423 likely were
homeless.

*Of the 423 homeless with a major mental health disorder, 97 percent had
been arrested at least once before during their lifetimes; 43 percent
had a prior arrest during the last 10 years.

 

On the day of the survey, the jail's mentally ill homeless inmates
included:

*A 39-year-old woman booked 45 times since 2001.

*A man, 26, booked 30 times since 1999.

*A man, 52, booked 33 times since 1992.

*A man, 25, booked 20 times since 2001.

 

Some of the mentally ill - many of whom also are substance abusers -
keep committing crimes and getting rearrested, in part, because few are
properly supervised when they are released, said David Buck, a Baylor
College of Medicine associate professor and president of Healthcare for
the Homeless-Houston.

 

Houston isn't alone in facing this issue. After many mental hospitals
were closed in the 1970s and 1980s, countless patients were released in
cities that were ill-equipped to house those who needed such care.

 

"What happens here happens in many communities. We are criminalizing
mental illness," said Betsy Schwartz, president of Mental Health of
America of Greater Houston, a nonprofit that promotes effective
treatment for the mentally ill.

 

Left To Find Her Own Way

Patricia George, 34, said her thinking always becomes clearer when she
returns to jail and gets back on medication. 

 

In the past 20 years, George, who says she is bipolar and schizophrenic,
has been charged with 12 felonies and 31 misdemeanors, with most of the
bookings in Harris County. In all, she has spent nine years in jail.

 

Like other mentally ill inmates, George has been expected to find her
way - with no car and little money - to mental health providers, to line
up counseling and to fill prescriptions for her medication in the weeks
after her release.

 

In the meantime, medications she was taking in jail wear off, she said
during an interview three days after her July 5 release from jail.

 

"Just walking down here (for the interview), I'm starting to hear
voices," said George, who finished a six-month sentence for
prostitution.

 

Not Filling Prescriptions

Many of the mentally ill never fill their prescriptions or return to
counseling, said Steven Schnee, director of Mental Health and Mental
Retardation Authority of Harris County, a government agency that
provides mental health care locally. They just return to their former
lives, usually on the streets. 

 

George, who often is homeless between jail stints, hopes she can avoid a
return to jail this time. She has been working with Healthcare for the
Homeless-Houston, which started a program that helps released mentally
ill inmates find housing and reach appointments with mental health
providers and counselors.

 

Michael Seale, director of the county jail's health services, said the
mental health staff becomes frustrated because inmates stabilized in
jail drift into psychosis when they get out.

 

"Whatever good work we've done may not have any value two or three weeks
after they get out," Seale said.

 

The jail - which has come under scrutiny recently for inmate deaths and
was inspected by federal investigators last week - spent about $10
million on mental health care in 2004. Two years ago, only 600 inmates
were on psychotropic medications.

 

But staffing and funding then wasn't nearly adequate for the increasing
numbers of mentally ill inmates.

 

Since mental health wards have been expanded, the jail now has beds for
244 mentally ill inmates, including 70 who are acutely ill.

 

The jail contracts with Harris County Psychiatric Center for 24 more
beds.

 

The jail's mental health team delivers medications to an additional
1,650 inmates through outpatient treatment.

 

The team is big, employing 82 health care workers. That includes eight
psychiatrists, 18 psychiatric registered nurses, 34 psychiatric
technicians, seven licensed vocational nurses and 12 employees who
screen incoming inmates.

 

Chief Deputy Mike Smith of the Sheriff's Office said the jail's mental
health operation is comparable to the biggest non-jail mental health
hospitals in the state.

 

Smith, as head of the jail, is among those credited with upgrading its
mental health services.

 

"I've had people say I better watch what I say or I'll come across as a
liberal," he said. "We shouldn't be treating our mentally ill in the
jails. We should be treating them in the free world."

 

Advocates say the number of mentally ill cycling through jails and
psychiatric wards can be greatly reduced.

 

Many need to be placed in permanent supervised housing, Schwartz said.

 

Those who are less ill could be placed in apartments and monitored at
least weekly by case managers.

 

But in Harris County, there are fewer than 1,500 rooms or apartments
where the mentally ill can receive supervision or services, Schwartz
said.

 

About 10,000 such units are needed.

 

"If these kind of housing opportunities existed, there would be far
fewer mentally ill in jail," she said.

 

http://www.chron.com/disp/story.mpl/metropolitan/5898439.html 

 

 

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