The Costs of Correctional Mental Health

Prior to the 1960s, nearly 600,000 mentally ill adults were housed in state-funded mental hospitals.  A desire to deinstitutionalize the mentally ill led to a substantial drop in the number of people housed public psychiatric hospitals—down to nearly 70,000—by the 1990s.  Severe cuts to state funding for mental health treatment facilities have only contributed to this decrease in the hospitalization of the mentally ill. Now, roughly 1.3 million mentally ill individuals are incarcerated in federal and state prisons, as well as in local jails. People with mental illnesses in parole and probation populations are thought to be represented at three to four times those in the general population. A study conducted by numerous health and law enforcement officials in 2010 reported that roughly ten times more mentally ill individuals were in prisons and jails throughout the country than in hospitals and the general population. As the number of mentally ill individuals incarcerated continues to grow, so, too, do the costs of meeting these individuals’ needs in correctional facilities.

Most mental health programs within prisons and jails require an almost immediate initial assessment of mental health upon an individual’s incarceration, as well as follow-up sessions depending on the results of the initial assessment. These initial screenings are often difficult to conduct because many inmates do initially attempt to camouflage their illnesses, many of which co-occur with substance abuse issues, which must also be taken into account when considering which approach to take toward dealing with inmates’ illnesses.

Most follow-up sessions are conducted in groups because of a lack of resources for individual sessions, which diminishes the opportunity for more personalized and potentially effective treatment approaches for these inmates. Inmates are entitled to any form of empirically proven therapy or treatment that their condition warrants, but the turnover time on getting access to these treatments on an individual basis varies and is usually slow because there just aren’t enough providers for the number of mentally ill prisoners. This postponement can also pose a problem within correctional communities, as the delay of treatment can further expose an inmate’s vulnerabilities, making him or her more susceptible to not only relapse into deviant behaviors but also to exploitation and potential abuse from other inmates. Moreover, oftentimes, providers for therapy and psychiatry must come from outside facilities—a costly investment—and there are typically only a few officers to escort these providers when they arrive, also driving up costs and time for the correctional officers.

The Department of Justice estimates that approximately $15 million of American taxpayers’ money goes toward housing individuals with mental illnesses in prisons and jails, translating to $50,000 per inmate annually. Despite federal standards for mental health treatment in prisons, the resources for most facilities vary from region to region based on location, the breakdown of inmates and their illnesses, and the availability of trainable staff and people to train them. The Los Angeles County Jail, for instance, spent an estimated $10 million per year on psychiatric medications alone in 2001. Whereas, by 2005, $67 million per annum was directed toward treating 8,371 mentally ill prisoners in Ohio. Costs also vary depending on which treatments or medications are in demand at certain correctional facilities. In 2000, for example, Cuyahoga County Jail in Ohio spent $175,000 on Zyprexa, or olanzapine, alone.

Moreover, clear discrepancies exist between costs of general prison inmates and those with mental illnesses. In Broward County, Florida, for instance, housing a general population inmate costs taxpayers $78 per day, while the price spikes up to $125 per day for an inmate with a mental illness. As of 2002, state prisoners with mental illnesses received sentences averaging 12 months longer than those of non-mentally-ill prisoners. The incarceration of those with mental illnesses has contributed greatly to the problem of overcrowding in jails and prisons. Oftentimes, when caretakers or loved ones of the mentally ill find themselves unable to fully provide or seek adequate care, they resort to having the individual arrested. A misdemeanor sentence that might keep a mentally healthy individual in jail for just one night could keep a mentally ill person behind bars for up to six months, raising the cost of housing them to hundreds more than it should be.

The debate over how to properly rehabilitate mentally ill individuals convicted of crimes is not only a matter of how those individuals are treated in correctional facilities but also a question of whether the allocation of local, state and federal resources is adequate, appropriate or misdirected.

 Read the second installment of this mini-series on the costs of behavioral health care in corrections to learn more about where there’s still room for improvement.

Read more in our series on correctional and mental health: Are the Mental Health Needs of Juveniles Being Fully Addressed in Juvenile Corrections?