Email | Print

There are 48 beds in the Albany County Jail set aside in a separate wing on the third floor for mentally ill inmates. But many days, especially during the dog days of summer, that's just not enough. On those days, Jail Superintendent Edward Szostak has to make some choices. He and his staff decide which inmates with mental illnesses are most able to handle mixing with the general inmate population. They give doctor-ordered medications, put those inmates out there and cross their fingers.

"I don't like doing it that way, but that's what I have to do," Szostak said. He doesn't have much choice. There were an average of 63 inmates each day last year classified as mentally ill. That number has been going up steadily. In 1994, there were an average of 37 mentally ill inmates. That went to 44 in 1995, 45 in 1996, 49 in 1997 and 58 in 1998.

In Schenectady County, Sheriff Harry Buffardi has 24 beds in his jail's mental health wing, up from just 10 beds in 1993. "They're always full," he said. He has room to increase the unit someday to 48 beds, if the county approves the money for expansion.

To reduce the pressure, the jail's psychiatric social worker prowls City Court sessions in the mornings, looking to head off some of the newly-arrested people with mental problems before they end up in jail. "Last year, that social worker found nearly 200 such people who had been charged with minor crimes and was able to convince a judge to send 55 of them to mental health programs instead of jail," said the sheriff.

That's welcome news for Buffardi, who spends about $32,000 a year to house an inmate. Enough suicidal people wound up in jail last year that it cost Buffardi $100,000 in overtime—a third of the entire overtime budget—to have guards watch over them. Not all suicidal people are classified as mentally ill after being screened by jail staff, but people on suicide watch are kept in the jail's mental health wing.


Discharge Planning

The Rensselaer County Jail is held up as a model for what officials can do to help mentally ill inmates find help as soon as they are discharged, instead of drifting back into the street to wind up arrested again. In the parlance of mental health professionals, that's called discharge planning—and it's a term that sprang from hospitals rather than jails. But jails are having to act more like hospitals as corrections staff find themselves dealing more with the mentally ill, and wrestling with the best way to both protect the public and help those with mental illness break the cycle of arrest.

"Jails have become by default the new psychiatric hospitals," said Collie Brown, assistant director of the National GAINS Center, a Delmar-based, federally-sponsored advocacy group and information clearinghouse on issues of the mentally ill.

For example, the Los Angeles County Jail system, which on any given day can have up to 1,500 mentally ill inmates, is now effectively the nation's largest mental hospital.

"Our system hasn't come to grips with this yet," said Brown. Brown said the roots of the problem can be traced to the 1950s, when New York and other states took the first steps toward closing down public mental hospitals in an effort to "deinstitutionalize" patients, and instead have them live in the community, where they would get treatment.

"But too many people," said Brown, "are not getting adequate help and end up entangled in the criminal justice system when they commit relatively minor offenses because of their illnesses."
"That is creating another tongue-twisting phenomenon called 'transinstitutionalization,' which means moving the mentally ill from one institution to another—hospitals to jail," said Joseph Glazer, director of the Mental Health Association of New York State.

"The vast majority of the population that used to be housed in psychiatric hospitals are today tagged with criminal records and populate our prisons and jails, or on probation or parole," said Glazer during recent testimony before a state Assembly hearing on the issue. "The number of people in state mental hospitals in the mid-1950s was about 560,000 nationwide," he said. Today, that figure has shrunk to about 62,000 people. And there are now about 830,000 people nationwide with diagnosed mental illness either in prison or jail, or on probation.

"One of the root causes of transinstitutionalization is cost," Glazer said. "Our state coffers pay less to warehouse people living with mental illnesses in prisons and jails than to treat them in hospitals or in the community. For example, it costs $125,000 a year to keep someone in a mental hospital and $45,000 for community-based treatment including housing, treatment and employment training. But it costs about $30,000 a year to keep someone in state prison," he said.


Treating Inmates

In the Albany County Jail, each new inmate is asked by a corrections officer about whether they feel suicidal or are under treatment for mental illness. "The officers refer as many as ten inmates a day to the jail's mental health unit, sometimes as soon as the inmate is admitted, and other times after officers notice that the inmate is acting unusually," said David Kelley, coordinator of adult forensic services.

"Sometimes, an inmate will lie to a corrections officer about being in treatment, but will tell the truth to our staff," said Kelley. "Staff then have to find out if the inmate was getting treatment outside, and the jail psychiatrist determines whether to continue or change medication or other treatment," he said.
"Each inmate is assigned either a social worker or psychiatric nurse, who meets with each inmate on average once every two weeks," said Kelley. While some inmates are allowed to have jobs inside the jail, "the majority will stay on the [mental health] unit during their time here," he said.

"The jail has tripled the number of hours during the last two years that its psychiatrist is available, so a doctor is now at the jail four days a week," said William Dickson, associate director of the county Mental Health Department. Weekend hours were added last year after advocates for the mentally ill said that some inmates were going several days over the weekend without being evaluated.

There are no clear numbers on how many mentally ill inmates wind up in county jails in New York state; that information is not compiled by the state Correctional Services Commission. But the numbers nationwide appear to be growing, according to several studies on the issue. As many as one inmate in six behind bars—or nearly 283,000 people in federal, state and county facilities—is mentally ill, according to a study last year by the federal Bureau of Justice Statistics.

That number is going up compared with earlier estimates. For example, a 1992 study by the National Alliance for the Mentally Ill found about one inmate in 14 had mental illness.
"This is a problem for all sheriffs in the state," said Tom Mitchell, counsel to the New York State Sheriffs Association. "Some counties, especially the smaller ones, are looking for ways to deal with this."

Cayuga County in western New York is building a jail mental health wing as a regional venture with several neighboring counties. State rules don't currently require jails to have separate mental health wings, but do require that mentally ill inmates get adequate treatment. Brown said the creation of separate mental health units is a double-edged sword. On one hand, it helps mentally ill inmates better respond to treatment. "Jail can be a very stressful place," he said. "So putting people in an area where they can be monitored and supervised helps. But," he said, "the very presence of jail mental health units can encourage judges to send people there, knowing that a person will receive treatment, something that cannot be guaranteed on the outside."


Longer Jail Stays

"Inmates with mental illness tend to stay behind bars longer," said Brown. "A study of New York City's Rikers Island jail found that mentally ill inmates spent an average of 104 days in custody, compared with 45 days for other inmates," he said. Brown said it is because judges are less likely to release mentally ill inmates.

Another problem is that when a person is arrested and jailed, he loses Medicaid benefits, which many mentally ill people use to pay for medication and treatment. That leaves jails and prisons to pick up the bills. Once a person leaves jail, it can take 45 days or longer to regain the benefits, which means the patient might not be able to get medication or treatment.

Under Kendra's Law—which was passed after a mentally ill man who had stopped taking his medication pushed a woman in front of a subway train in New York City—people who are mentally ill can be forced to accept treatment under court order. The law also includes $11 million to be given to counties to pay for medications of mentally ill people who have lost Medicaid benefits because of being jailed.

"In the Rensselaer County Jail, a full-time discharge planner handles seven to 10 cases a week of inmates who will be leaving the jail with mental health issues," said Forensic Mental Health Director Don Hogan. "The absence of Medicaid for such inmates is a big problem for us," he said. "To help tide over mentally ill inmates until appointments can be set up with community mental health programs, the jail issues a five-day supply of medication when they are released."

And Hogan said the Kendra's Law provisions to help counties pay for medications won't cover most people in the jails. "It only applies to people who are classified as a danger to themselves or others… Most inmates don't fit that," he said. Many community programs will accept such former inmates without Medicaid "and worry about getting paid later," he said, but others, like drug rehabilitation centers and halfway houses, will not. "And if we get someone into a shelter, and they have to wait 45 days before they get Medicaid [to pay for medication and treatment programs], we're going to lose them," he said.

"If he could solve just one issue surrounding the treatment of mentally ill inmates, it would be Medicaid coverage," said Hogan.