ALL COUNTIES — ALL COUNTIES: Every day, judges send mentally ill people to prison for crimes they committed without taking their medication or visiting mental health professionals on a regular basis.
Lawmakers and the criminal justice system in North Carolina are struggling to address this complicated problem in a political climate that lends little priority to mental health issues.
As some of the state’s most vulnerable people have fallen through the cracks of society and had difficulty getting the treatment they need, many have found themselves in trouble with the law.
State-run mental hospitals have more admissions than ever, and North Carolina’s overcrowded prisons and jails have become treatment centers by default.
When a person with mental illness is arrested for a crime, law enforcement officers aren't always prepared to deal with a mentally unstable person. The mentally ill person moves through the system along with criminals considered lucid and sane.
“What has happened systemically and throughout our country is our jails are getting full of people with mental illnesses and we’re spending a lot of corrections money on them and they’re not getting any better because that’s not where they belong,” said Debbie Dihoff, director of North Carolina’s chapter of the National Alliance on Mental Illness. “They belong in treatment facilities.”
Dihoff advocates that law enforcement officials undergo crisis intervention team training, which helps officers identify mental illnesses and recognize that a person battling a mental illness may just need to take their medications without winding up in jail.
About eight communities in North Carolina are using this training. In these areas, the percentage of encounters between police officers and people battling mental illness that ended in an arrest has dropped from 20 to 1, Dihoff said.
Statistically, Dihoff explained, people with mental illness get arrested more often, get convicted more often and spend a longer time behind bars than people without mental health problems.
Prison System Perspective
While incarcerated, receiving quality and continuous mental health care can be difficult. North Carolina’s Division of Prisons maintains that it provides a comparable quality of care behind bars to state hospitals and even private institutions.
County jails, however, are often not equipped to deal with people with mental illness. Furthermore, while a person is incarcerated, they often lose their medical benefits, so after they are released, some have difficulty getting their medications and wind up being arrested again.
John Carbone, the head of the Division of Prisons’ mental health department, said the conventional opinion is that anywhere between 5 and 10 percent of the prison population require mental health services. He explained, however, that this figure can be deceiving because it if difficult to determine what qualifies as a mental health problem.
Inmates sometimes have situational depression or anxiety in adjusting to prison life and may seek therapy or other mental health services, without having any history of long-term mental illness. While the number of inmates seeking mental health care has certainly grown, Carbone said, the reasons for that growth are not clear.
A Reform Movement in Need of Reform
In 1999, the Supreme Court passed the Olmstead decision, which upheld people with disabilities’ right to seek care in their own communities rather than being institutionalized in state-run mental health facilities.
Mental health reform efforts in North Carolina began in 2001.
State hospitals nationwide began closing their doors in favor of private companies providing care on a local level. Dorothea Dix, a state mental health facility in Raleigh, is closing in the next few months to move to the newly built Central Regional Hospital. Planners have promised to maintain Dix’s bed capacity in the new facility.
The intention may have been good, but mental health reform has produced some devastating side effects, according to NC Policy Watch’s executive director Chris Fitzsimon. He says the rush to privatization has been premature and confusing for mental health patients and their families seeking services from the for-profit treatment facilities.
Debbie Dihoff believes many local mental health care providers have struggled to keep their doors open.
“It’s like we took one system apart before the new one was built so it would work right,” Dihoff said.
Fitzsimon agrees, alleging that funding earmarked to sustain the switch to privatization went instead to balance the state’s budget under Governor Mike Easley.
“You can’t dramatically shift from institutions to local community services unless there are local community services. The communities weren’t ready, the funding from the state that was promised wasn’t there, and just as importantly, the bureaucratic or the system infrastructure wasn’t in place to handle providing the services,” Fitzsimon said.
He argued that the “missteps and miscalculations” of the mental health reform movement have had a direct impact on prison populations. Yet legislators fail to address either problem.
“It’s not a sexy accomplishment of a legislator to claim that he or she invested more money in drug treatment or mental health or prison reform. Instead they’d rather apparently just wait until things get into a crisis and spend more money building new prisons,” Fitzsimon said.
Your Opinion
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