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Jails struggle with mentally ill

High booking, release rates exacerbating the problem
The Cook County Jail in Chicago, with more than 10,600 inmates, is one of the country’s largest single-site jails. A recent survey showed the rate of serious mental illness among jail inmates at 17 percent, but individual jails report much higher numbers.

CHICAGO – The numbers, posted daily on the Cook County sheriff’s website, would be alarming at an urgent care clinic, let alone a jail: On a Wednesday, 36 percent of all new arrivals report having a mental illness. On a Friday, it’s 54 percent.

But inside the razor wire framing the 96-acre compound, the faces and voices of the newly arrested confirm its accidental role as Chicago’s treatment center of last resort for people with serious mental illnesses. It’s a job thrust on many of the nation’s 3,300 local jails, and like them, it is awash in a tide of bookings and releases that make it particularly unsuited for the task.

Peering through the chain link fence of an intake area holding pen, a 33-year-old man wrapped in a Navy varsity jacket leans toward clinical social worker Elli Petacque Montgomery, his bulging eyes a clue that something’s not right.

“They say I got bipolar, that’s all,” he says.

“OK, are you taking your meds?” she asks.

“When I can get them.”

Two pens over, a white-haired man with a cane huddles on a bench, booked in on a narcotics charge. He tells Montgomery he is haunted by visions of people he killed in the Vietnam War, and heroin eases the post-traumatic stress.

“I’m down here every day,” says Montgomery, deputy director of the sheriff’s office of mental-health policy. “Every morning, I hear this.”

The Cook County Jail, with more than 10,600 inmates, is one of the country’s largest single-site jails. But it is not unique. From big cities to rural counties, jails have seen a rise in the number of inmates with serious mental illnesses, most of them arrested for nonviolent crimes.

Unlike prisons – where inmates serve extended sentences – jails hold those trying to make bail while awaiting trial or serving shorter terms. U.S. jails hold about 731,000 people, less than half the 1.57 million in state and federal prisons. But last year, jails booked 11.7 million people – more than 19 times the number of new inmates arriving at prisons.

The revolving door greatly complicates the task of screening for mental illness, managing medications, providing care and ensuring inmate safety.

“Jails are churning people,” says Henry J. Steadman, a former New York state mental-health official and longtime consultant to government agencies across the country on how courts and correctional facilities deal with people with mental illnesses. “You can do things in prison, in terms of treatment and getting to know people, that is very difficult to do in a jail because of that constant movement.”

Experts have pointed to rising numbers of inmates with mental illnesses since the 1970s, not long after states began closing psychiatric hospitals without following through on promises to create and sustain comprehensive community-treatment programs.

But as the number of those with serious mental illnesses has climbed or surpassed 20 percent in some jails, many have struggled to keep up, sometimes putting inmates in jeopardy.

The Associated Press has reported at least nine of the 11 suicides in New York City jails over the past five years came after operators failed to follow safeguards designed to prevent self-harm by inmates. In one case, a mentally ill man hanged himself from a pipe on his third attempt after orders to put him on 24-hour watch were apparently ignored.

The AP’s investigation into the deaths of two mentally ill inmates at the city’s Rikers Island jail complex – one who essentially baked to death in a 101-degree cell in February and the other who sexually mutilated himself last fall – have prompted oversight hearings and promises of reform.

“The incredibly high intake rate makes it very difficult (for jailers) to do their job well because they operate in environments that are so chaotic,” says Amy Fettig, senior staff counsel at the American Civil Liberties Union’s National Prison Project, which has sued a number of jails to demand they provide federally mandated care and improve conditions for inmates with mental illnesses.

“Frankly, local jails have become the new social safety net for individuals with mental illnesses,” she says. “The only net that catches them is the criminal justice system.”

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