By Maloney, Michael P.; Ward, Michael P.; Jackson, Charles M.
Corrections Today , Vol. 65, No. 2
According to the Bureau of Justice Statistics, local jails housed an estimated average daily population of 567,079 inmates as of mid-1997. This represented a 92 percent increase since 1987 (population 295,873). The trend continues as reflected in an increase in an average daily population of 9.4 percent in the single year from mid-1996 (population 518,492) to mid-1997. During the decade from 1985 to 1995, the number of jail inmates per 100,000 U.S. residents nearly doubled on a per capita basis from 108 to 193--a 79 percent increase.
While data clearly indicate an ongoing increase in the number of people incarcerated in county jails, the number of these individuals who suffer from a significant mental disturbance remains unclear. Different studies on this issue result in very different estimates. The National Alliance for the Mentally Ill and the Public Citizen's Health Research Group sponsored a frequently cited survey conducted by E. Fuller Torrey titled Criminalizing the Mentally Ill. This study concluded that more than one in every 14 jail inmates, or 7 percent, suffered from serious mental illness. Based on a cursory review of the literature, it is clear that there is a steady increase in the number of inmates with mental disorders detained in county jails. However, there are little data regarding exact prevalence and the specific characteristics of these inmates. Such data are essential before questions regarding program development, appropriate treatment and disposition can be addressed.
PROVIDING MENTAL HEALTH CARE
All jails have a constitutional mandate to provide at least minimum mental health or psychiatric care to detainees. Most jail systems are ill-equipped to provide such services, with many inmates receiving little or no treatment or experiencing long delays in the delivery of even minimal services. Further, while jail treatment is mandated, the exact nature and extent of such services is not legally clarified. Professional and accrediting bodies have attempted to provide relevant guidelines. The American Psychiatric Association, the National Commission on Correctional Health Care and the American Correctional Association generally agree that what constitutes minimum care would include some form of inmate screening and resultant identification of those with significant mental disorders. Treatment would include a range of care options that incorporates crisis intervention, ongoing psychiatric treatment (with the use of psychotropic medication when indicated), as well as availability of appropriately trained mental health staff and an ongoing staff training program.
Provision of even minimal treatment for jail inmates with mental illnesses can be a vexing problem that is extremely costly. In many cases, the availability of mental health services in the community has decreased and jails are basically used as an adjunct to the mental health system. This problem has developed insidiously over time, and services, when they are provided, have been offered on a hit-or-miss basis. Thus, the need for mental health treatment in jails appears to be growing, but the response has been limited and frequently ineffective. Contributing to the problem, and thwarting solutions, is a sometimes confusing array of data regarding such basic factors as the actual prevalence of mental disorders in jails, the types of mental disorders most often encountered and demographic characteristics of specific inmate populations.
The current study sought to provide relevant data regarding the prevalence of mental illness in a large county jail population. Because of a number of unique logistical features and the sheer volume of inmates, the Los Angeles County jail system provides an ideal, albeit complicated, arena for conducting such an investigation.
JAIL BOOKING OPERATIONS
The L.A. County jail system is comprised of eight separate detention facilities with an average daily census approaching 20,000. …