In Virginia last year, there were over 12,000 admissions of severely mentally ill persons to our local jails. Widespread jailing of the mentally ill can be understood only within the larger context of public policy toward the chronically mentally ill in our communities. I will be discussing the findings and recommendations of our Joint Task Force on the Mentally Ill in Virginia's jails in light of the pressing need for more comprehensive community programs for the chronically mentally ill.
The Task Force
Last year, Dr. Joseph Belivacqua, Commissioner of the Department of Mental Health and Mental Retardation, and the Director of the Department of Corrections appointed a Joint Task Force to assess the needs of the mentally ill within Virginia's jails and to make recommendations. Among the members of the task force were a sheriff, a judge, a prosecutor, a legislator, a jail administrator, DOC officials, and clinicians who have worked in jails.
The Task Force visited jail sites throughout Virginia. We interviewed law enforcement officials community mental health workers, correctional officers, jail nurses, physicians, and inmates. We conducted a survey of all of the state's jails and reviewed pertinent literature.
We found that over 6% of the inmates admitted to Virginia jails each year are psychotic. This figure translates into 12,000 admissions per year. Psychiatrists use the term "psychotic" for the most severe form of mental illness in which an individual's thinking is so disordered that he loses touch with reality. A psychotic person's thoughts are grossly disorganized. He may be actively hallucinating.
The figure of l,000 (6%) represents only the most severely disturbed persons. Approximately 25% of jail inmates need to be seen and evaluated by a mental health service. The problems of these inmates range from depression and massive anxiety to self injury and suicide attempts. The suicide rate among jail inmates is sixteen times that of the non-incarcerated population.
In many jails, over half of the inmates have significant alcohol or drug problems. Newly admitted intoxicated inmates are at particularly high risk for suicide. Acute withdrawal from alcohol or drugs can present as a medical emergency with potentially fatal consequences.
The prevalance of epilepsy or seizure disorders among jail inmates is several times that of the general population. National studies place the proportion of mentally retarded inmates in prisons at around 10%. The number of retarded persons who are currently within Virginia's jails is unknown.
Jailing The Mentally Ill
We found that a substantial proportion of the sickest group that gets jailed--the psychotic inmates--often face only minor misdemeanor charges such as trespassing, failure to identify, or disorderly conduct. What comes to mind is the young man who is picked up by police as he wanders down the median strip of an interstate partially clothed and talking to himself, while gesticulating wildly; or the disheveled elderly "bag lady" who, frightened and paranoid, refuses to leave McDonalds at closing time.
Who are these people and why do they get jailed rather than taken to get help? They are often young people who suffer from the major mental diseases: schizophenia or manic depressive illness. In an earlier era, less than a generation ago, they would have spent their lives in the old state hospitals. They have been called "the young chronics" or, to use a more apt phrase, "veterans of the mental health wars". Dr. Richard Lamb, a psychiatrist who has worked with this group of individuals for the past twenty five years, has written with regard to the chronically mentally ill in the Los Angeles County jail: "... the lives of a large proportion of these inmates are characterized by chaos, dysphoria and deprivation in a world for which they are ill prepared. They cry out for control and structure, as do their families and neighbors, but who listens or wants to believe? …