Cutting Correctional Health Care Expenses Through Better Mental Health Programs

Mental Health Care for the poor and uninsured in our country has been relegated to our jails and prisons.  Visit any jail today and you will find people that are only there because they cannot function in our communities without long term mental health care.  The expense of housing these inmates often pushes the health care budget into the red. 

Sasha Abramsky, the author of, “Ill-Equipped: U.S. Prisons and Offenders with Mental Illness, notes, “There are three times as many men and women with mental illness in U.S. prisons as in mental health hospitals. The rate of mental illness in the prison population is three times higher than in the general population.”

A plan on treating these mental health cases, and providing care and treatment after their release can save your community millions of dollars.  Here is a story from the Boston Globe that illustrates this point:

Prisoners in their minds and bodies

Email|Print| Text size – + By Leslie Walker and Bonnie Tenneriello

February 2, 2008

THOMAS IS on the phone. He’s back from the hospital after he slashed his body again. He is alone in his claustrophobic 6-by-9-foot cement room. He has nothing to distract him, because he has smashed and eaten pieces of his property in the past. Thomas is a mentally ill prisoner who has had violent outbursts and has lived in solitary confinement for years. He is once again suicidal and says, “I’m locked in a box. I’m just thinking about one thing, the last day of my life.” But he does not want you to tell the prison authorities about his thoughts. That action will result in his placement on a “mental health watch,” where he will not even have his clothing or a mattress.

As much as this client is suffering in segregation, there is nowhere else to put him. He has assaulted guards, prisoners, or himself too many times to put him in the general prison population.

The Massachusetts Correctional Legal Services receives calls like this on a daily basis. Some prisoners have succeeded in killing themselves. Eleven of the 16 prisoners who committed suicide in the last three years were held in solitary confinement.

There is a more humane way of treating the most disordered prisoners. Safe, high security residential treatment units provide the kind of training and treatment prisoners like Thomas require. Since 1989, the Department of Correction has been told by its own experts that it needs such units at maximum-security prisons. While some treatment beds are finally in the works, the numbers are far from adequate. More important, there is still no guarantee that prisoners too sick for segregation will be excluded.

Proposed legislation would ensure that these prisoners are kept out of solitary confinement and, if needed, sent to a mental health treatment unit. The bill, sponsored by Representative Ruth B. Balser, would bring Massachusetts in line with the more humane practices of many states that have these units, including California, New York, Wisconsin, Indiana, New Mexico, Texas, Ohio, and Pennsylvania.

Many of these units are the result of lawsuits charging that holding the mentally ill in solitary confinement violates the Constitution’s ban on cruel and unusual punishment. A lawsuit filed by the Disability Law Center and others in federal court seeks an end to the practice in Massachusetts.

The Patrick administration should welcome policies that keep prisoners with serious mental illness out of segregation, and the Legislature should provide the resources. Residential treatment will involve some start-up costs, but the financial payoffs will be great. Every time a prisoner mutilates or tries to hang himself and goes to the hospital, it costs $3,000 to $10,000 in medical care, including surgery, correctional overtime pay, and transportation. As the Globe recently documented, there were 513 such self-injuries last year. If treatment units prevent even half of them, $750,000 could be saved. Additionally, a 30-day evaluation at the prison mental hospital costs more than $6,000. If a unit prevented just 50 evaluations, Massachusetts could save $300,000 annually.

Treatment also makes sense from the point of view of correctional workers. They are the ones who cope with the bloody self-harm, the feces thrown or smeared on cells and bodies, and the bodies removed lifeless from their cells. The bill would help make sure they get training in understanding and coping with mental illness, and reduce the danger of working in segregation by reducing the torment within its walls.

The biggest savings, both in financial and human terms, however, will be in public safety. Solitary confinement cripples these prisoners further, sending them back to our communities without the skills to function. Without treatment, they have little ability to cope and are far more likely to reoffend, at a cost of more crime victims and about $45,000 a year to reincarcerate each one of them. If treatment units reduce recidivism by just 1 percent, the state could save $1.7 million a year in reincarceration costs alone.

Treating mentally ill prisoners instead of isolating them makes sense and the public knows it. A recent Boston Foundation survey shows that the public strongly supports treatment and programs that reduce recidivism, even if it costs money. Whatever one believes the goal of incarceration should be, surely it is not to destroy the mind of an already ill human being through months or years of isolation.

Leslie Walker is executive director and Bonnie Tenneriello is a staff attorney at Massachusetts Correctional Legal Services.