New Report: How to Improve Mental Health Care in Correctional Institutions

Correctional systems must provide more effective treatment for the seriously mentally ill, who comprise 15-20 percent of the incarcerated population

New York, NY – Last month, Ohio Governor Mike DeWine noted that over 90 percent of the state’s psychiatric beds are being occupied by people sent by the courts to restore mental competency before standing trial. This situation, which leaves few beds for law-abiding citizens with mental health issues, is not unique to Ohio and is the result of policies which, beginning in the 1950s, closed numerous psychiatric hospitals across the nation, a movement known as deinstitutionalization.

Though these policies aimed at replacing the asylum-based system with community-based care, this shift never materialized, resulting in a dire shortage of inpatient psychiatric beds and the concentration of hundreds of thousands of seriously mentally ill adults in jails and prisons after failing to receive the care that could preempt illicit behavior. Correctional institutions may be suboptimal settings in which to treat serious mental illness, but the current reality is that correctional mental healthcare represents one of the most important mental healthcare systems in the nation. In a new Manhattan Institute report, senior fellow Stephen Eide argues that policymakers should pursue reforms to make the corrections-based system more effective—to the benefit of the seriously mentally ill as well as community systems.

Eide proposes seven recommendations for reform:

1. State governments should assume more responsibility for funding jail-based mental healthcare.
2. Correctional mental health systems should target resources in accordance with their special responsibility to the seriously mental ill.
3. Correctional institutions should collect, keep, and report better data on their mental health programs and their seriously mentally ill population.
4. Medicaid’s IMD Exclusion should be repealed to ameliorate the country’s dearth of psychiatric beds.
5. Correctional institutions should make more use of long-acting injectables during discharge, which have been shown to reduce arrests and rehospitalizations.
6. Correctional institutions should eliminate overuse of administrative segregation (the isolation of inmates from others), without completely abolishing it, while investing more in special mental health housing.
7. Correctional institutions should refrain from relying on telehealth when onsite clinical staff are available to provide quality care to mentally ill inmates.

According to conventional estimates, the seriously mentally ill constitute 6% of the American population but comprise 20% and 15% of the population in jails and prisons respectively. And the rate of non-treatment among the incarcerated is one-half whereas that rate is only one-third for the general population. These conditions pose serious problems as virtually every incarceration-related adverse outcome—including victimization, rape, suicide, administrative segregation, and recidivism—is worse for the seriously mentally ill. If adopted, Eide’s proposed reforms promise a means of better serving this troubled segment of our population.

Click here to read the full report.