Some 90,000 people in prison have been judged "incompetent to stand trial." In all but three states, they must then be treated back to a competent state. Usually they are sent to state mental hospitals for this, yet there are far too few beds available for them there.
In the first half of the 20th century, the U.S. housed far more people in mental hospitals, but starting in the 1950s, a push to "deinstitutionalize" the system – as well as federal cases brought against hospitals for horrific abuses there – led to budget cuts and the closing of hospitals rather than states working to reform them, Leifman said.
Thus, state hospital beds for the severely mentally ill fell dramatically from 337 per 100,000 persons in 1955 to only 11.7 per 100,000 in 2016.
As a result, severely mentally ill persons are "languishing" in jail and even dying there, advocates warn. "Incarcerating pre-trial and convicted criminal offenders with serious mental illness is so common today that jails and prisons are routinely called the 'new asylums.' They are anything but protective," said the report "Emptying the New Asylums" by the Treatment Advocacy Center.
The prison system does nothing to help an existing case of mental illness, and all too often exacerbates it. Studies have shown the deleterious effects of prolonged solitary confinement on someone's mental condition, and for those with serious mental illness, a prolonged stay in prison can cause crippling damage to their health.
"If you want to really improve your public safety, improve the community mental health system."
There may be no immediate option for people in this situation, said Kianna Richardson, a correctional support specialist with Catholic Charities of the Archdiocese of Washington, D.C. The jail or prison cannot release someone who is not competent to stand trial onto the streets without treatment.
"It would be kind of difficult just to work with them, because they may refuse services, and in turn, they may go through the same cycle and commit another crime," she told CNA.
One way to help seriously ill inmates get the treatment they need more quickly would be to make "small changes" to the waiting system at state hospitals, said participants at the AEI panel.
The Treatment Advocacy Center contracted with the University of North Carolina and North Carolina State University to gather and analyze data from five state hospitals. Their findings led them to believe that changes could benefit the system.
In Florida, for instance, where 120 inmates per month will need to be treated for illnesses before they stand trial, "if you divert two of them, the average bed wait drops from 12 days to 3 days," Doris A. Fuller noted. In Wisconsin, if eight beds were added to the state hospitals, the average waits for a bed would fall from two months to two weeks.
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The importance of post-jail treatment
However, even after mentally ill inmates are released from jails and state hospitals, if they are not properly treated in their communities, they are at high risk of recidivism.
"Putting someone in jail with mental illness for even a few days and then releasing them – which everyone gets released – is not an improvement of public safety," Leifman insisted at the panel. "Most of them have serious trauma issues, and jail re-traumatizes people."
"If you want to really improve your public safety, improve the community mental health system," he added.
Matthew D. Chase of the National Association of Counties pointed to the example of Leon County, Florida, which established a system where non-profits met officials at the jail at midnight to take in homeless individuals and inmates with serious mental issues.
They were sent to various groups who worked with mental health, domestic violence and substance abuse cases, among others, he said, where previously these people would have gone straight onto the street.