Today's Houston Chronicle features the following article about the revolving door of severely mentally ill homeless offenders in the Harris County Jail ("Finding escape behind bars," July 21, 2008). Many of these inmates have been arrested on dozens of occasions; many have substance abuse disorders in addition to mental disorders.
As the number of these chronic inmates continues to increase, the cost of both incarceration and treatment has soared to $87 million annually. While some organizations have launched new programs aimed at providing support for severely mentally ill homeless people immediately upon their release from jail, the demand for services still far outpaces the limited resources available.
Here's the article in full:
"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 earlier this month — 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."
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An earlier post on the mental health care system (and its impact on criminal justice issues) in Harris County is available here.
More on Healthcare for the Homeless-Houston is available here.
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