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October 25, 2012

Essay on Budget Cuts and Mental Health Programs

The ineffective handling of mentally inmates largely due to budget cuts in mental health programs has become a cause for concern. The recession that hit the United States particularly and other first world countries had fully taken its toll on the mental health programs in prison. As a result, the mentally retarded or ill inmates are vulnerable to committing suicides making the problems for the government all the more compounded. They are not treated well due to scarcity of funds allocated to mental health programs and are eventually forced to lead a horrible life with no end or aim in sight.
 As a matter of fact, in most of the prisons in America, the superintendents, inmates and other concerned officers cite the ineffective handling of mental health programs as due to budgetary cuts. This has become a pressing issue. According to the security staff, the reduction in drug treatment programs and academic and vocational training and classes has led to a significant increase in the mental illness, violence and frustration on the part of the inmates.  Between 1991 and 1998, the state cut more than 1,200 positions in the program. Meanwhile, the prison population of about 56,000 inmates rose to more than 70,000. Although the department argues that education has risen by 9 percent between 1995 and 1999 (4 per cent of the prisoner population during this period in comparison, the steep job losses in the program position particularly instructors, librarians and consultants at the beginning and mid-1990s have had a corrosive and durable.
At Great Meadow Correctional facility, for example, a maximum security prison for men in 1680 vocational training programs have been reduced from 17 in 1990 to 6 in 2000.
Approximately half of the inmates, about 800 men, were not included in programs, vocational training or university during in fall 2000. Over 125 prisoners have been on the waiting list for GED preparation classes in power. The prison library was closed for over a year because of budget cuts.
The researchers locates a relationship between state spending on mental health and the possibility that inmates will not be able to deal with a serious mental illness due to the lack or inadequate treatment facilities in prison.

Americans who face severe mental illnesses are now three times more often in jail instead of a hospital, the report by the Treatment Advocacy Center revealed. The analysis is based on surveys of prison and jail and state investigations of psychiatric inpatient beds and an assumption based on published data, only 16 percent of people in jails and prisons suffer from a serious mental illness. The TAC report is entitled "More people with mental disorders in prisons than in hospitals.”

What is presented in the report is not the actual number of people suffering from mental disorders in jails or prisons from state to state, but a comparison of different and potentially distressing, the prison population compared to Population inpatient psychiatric hospital, and therefore the probability that a strong mental patient is kept in prison rather than being locked up in the hospital.
According to the U.S. Department of Justice, which published an assessment report noted that the need for mental health services in correctional facilities, by mid-1998 more than a quarter million people with mental illness were housed in the nation’s jails and prisons. An additional 548,000 persons with mental illness were on probation. The study found that nearly a third of state prisoners (30.2%) had received mental health services at some time. More than half of that group (16.2% of all state prisoners) either reported a current mental condition or had been hospitalized overnight for a mental or emotional problem (U.S. Department of Justice, 1999).

The majority of inmates suffering from serious mental illness in state prisons and local jails are generally believed to be low-level and non-violent offenders. Stringent drug laws and a lack of inexpensive accommodation for the inmates are reasons that compel the inmates with serious mental illness to battle with the criminal justice system (Kemp, 2007).
This kind of condition creates a most important quandary for state and local officials about how the mental health system should be able to deal with the criminalization of seriously mentally ill inmates. The resolution to this problem demands proactive harmonization of mental health programs with criminal justice systems.
There are some inmates with serious mental illness who become serious and violent offenders, and it goes without saying that these offenders must be confined for their treatment within the framework of criminal justice system. Scores of people with mental illness who do not abide by the law commit irritant crimes that are associated with their illnesses (Pallone, 1991). Such violations can be categorized as trespassing, vagrancy, and unsettling the peace. In such cases, it is at the disposal of officers to decide whether to imprison the person or facilitate him or her with the mental health care service.
Officials throughout the criminal justice system, from law enforcement and the courts, to corrections and parole, are usually devoid of ample familiarity with mental illness. Even though a nominal level of treatment may be guaranteed in these settings, it is rarely part of a comprehensive treatment plan (Kemp, 2007).
 The number of inmates with illness in the criminal justice system has risen mainly for two glaring reasons. In the first place, they do not have access to effective community-based mental health services due to the budgetary cuts. Plus the mentally ill people do find any refuge to seek. As a result, such population becomes more like a nomadic lot who attempt to medicate themselves with the self-prescribed drugs and treatment programs. The result is self-evident. They then face severe experiences adding to the problems of themselves and prison officers and state.
Secondly, the stringent laws and inadequate mental health facilities have lead to the increase of the incarceration of the offenders.

Since 1980, the country’s overall confinement rate has increased alarmingly. As of July 2001, there were 1.2 million state prison inmates and 150,000 federal prison inmates. Since 1990, this reveals a 75% surge in state inmates and a 100% rise in federal inmates (U.S. Department of Justice, 2000). Researchers observed that individuals with mental illness were detained more frequently than the general population (7.2% versus 1.7%). Consumers with substance abuse histories were even more likely to be arrested (14.4%) (Scott, 2009).
Persons with mental illness who cross the threshold of the criminal justice system have already had considerable previous involvement. The fraction of jail inmates with six or more prior sentences is 30.8% compared to 25.6% for inmates with mental illness. They experience unpleasant incarceration that further adds to their mental and psychological woes. Inmates with mental illness are commonly not accepted increasing the risks of discipline issues on their part arising out of their mental illness and symptoms.  State prison inmates with mental illness are handed down sentences that amount to about 12 months longer than the sentences of other prisoners on average.  (Scott, 2009).
To make the matter even worse, generally correction officers mistake the behavior of mentally ill inmates for disciplinary problems instead of approaching it in clinical terms. The inmates who maim themselves or try to commit suicide are let off with a disciplinary warning on the charges of inflicting self-harm. Correction officials bring into play a procedure of ever more unkind punishments, such as extra time in lockdown, in a bid to reinforce discipline among the mentally ill inmates who act quite weirdly. Inmates who fling or at times even threaten to toss bodily fluids or take part in other germ-infested acts are placed on a more restricted diet such as that of the loaf.  Consequently, the three servings of a day for them are reduced to mere tasteless and dense bread as their diet for a week.
Given these ruthless conditions, the results are not startling requiring any justification. The recent study of Poughkeepsie Journal discovered that a lopsided number of suicides were committed in disciplinary lockdown. Between 1998 and 2000, 54% of prison suicides took place in special housing units. It must be noted that this rate is 14 times higher than the suicide rate among inmates of general population. (Miller, 2011)

The New York State Commission on Correction, a body responsible to investigate and account for the deaths in custody threw harsh criticism on the mental health officials. It came out after the death of mentally ill inmate Carlos Diaz who had a history of reeling from psychological problems committed suicide after a gamut of misdemeanors he experienced in solitary confinement.  He stayed there for 15 years. It is a well-grounded fact that the inmates who serve longer sentences in SHUs are more prone to exhibit suicidal tendencies. The death of Diaz once again proved the lack of sufficient mental facilities and failure of state prison system due to the budgetary cuts especially after recession.  

Another pressing problem that contributes significantly to the ineffective handling of mentally unstable inmates is the absence of proper housing prison system for the mentally dysfunctional and disturbed inmates. Superintendents bemoan the administrative and economic impediments they regularly encounter in transferring psychotic inmates to the SHU to Central New York Psychiatric Centre (CNYPC) located in Marcy. It offers a 210-bed facility to ensure therapeutic environment for the incarcerated mentally ill inmates. Given the availability of space at CNYPC, only the short-term stabilization treatment is offered. Once an inmate is stabilized he is forced to return to the SHU to serve his remaining disciplinary sentence. In some instances, he is likely to get even worse within a short period of time only be transferred again to CNYPC and stabilized temporarily, and be transferred back to the SHU. This cycle further contributes to the deterioration of the inmate’s mental state and condition. 
As many as eleven percent of New York State inmates have dubbed as seriously ill by the Office of Mental Health(OMH). 7,400 inmates have been estimated to be on the OMH caseload. They either receive psychotropic medications or counseling or both of them. The seriously ill inmates face difficulties in the disorganized world of prison more precisely the maxim-security prisons where all such inmates are accommodated.
Quire unsurprisingly, a disproportionate number of inmates finally receives disciplinary confinement. The pertinent laws in this respect allows for the punishment of mentally ill inmates instead of therapeutic procedures for them. DOCS and OMH have, unfortunately, not been put into practice in a way that can prevent the mentally ill prisoners from being punished harshly. The psychiatrist responsible for monitoring the conditions of inmates in SHU cite this as the failure of OMH arising out of their over diagnosis and their lack of training to fully address the mental diseases of the inmates. 

  Eighty percent of the mentally ill inmates are mostly involved in substance abuse. In order to meet the needs of the inmates, the state prison system put in place three different substance abuse treatment programs namely ASAT(Alcohol and Substance Abuse Treatment); CASAT (Comprehensive Alcohol and Substance Abuse Treatment) and RSAT (Residential Substance Abuse Treatment). All the drug treatment programs in prison are run in collaboration with DOCS and affiliated non-profit agencies. They are specialized in the addiction treatment. Despite the fact that New York outnumbers others in terms of having drug treatment beds in the state prison system, many DOCS-driven programs have failed to reap desirable result rendering unable to cope with budgetary limitations. The inmates, deemed as the beneficiaries of these programs, on the other hand express their dissatisfaction over the running of these programs. They maintain that they rather have to face cancelled and deferred classes and witness the lack of professionally-driven facilities that must be there to ensure their therapeutic treatment. 
  The sadder fact is that Governor’s 2003 budget pressed for the abolition of all the remaining drug treatment programs which were being run by the external agencies. Even more tormenting and startling was the proposal that aimed to end the contract of state with Phoenix House---a leading agency in the treatment of the addictions. This program is one of the few in the country that could come up with a validated success rate. Through this program, about seventy percent of drug offenders who benefit from this rigorous program remain drug-free up to five years or more.     
The most priceless feature of Phoenix House which has its presence in the New York State prison system is that inmates initiate the program while being in prison at Marcy Correctional Facility and are then referred to a housing treatment program in the community. The permanence of care is guaranteed and so is the quality of treatment.  More significant fact is that the offender serves the remainder of his sentence in the real world instead of the unkind and disagreeable premise of prison. The inmates then make attempts to remain drug-free find some work to harmonize and normalize their lives.  
The research shows that the long-term mental treatment programs in prison have proved to be effective because the continuity of such programs help the inmates in overcoming their anguished mental state and leap back to the normal life. It also prevents them from further engaging themselves in crime and other drug addictions.
 But the Governor’s budget proposes, in the aftermath of recession, to end contracts with the external agencies such as Phoenix who provide community-based drug treatment program. 
The statistical analysis report prepared by TAC noted that as many as six states were aiming to spending most on mental health but on the contrary, most of the states were having mentally ill persons in jails and prisons. TAC has come up with recommendations that can help the state and jail officials to mitigate the quandary of the mentally ill inmates. They call for assisted outpatient treatment, that is to say, the mentally ill people must be given medications under the court order and as a pre-requisite condition for their survival in the community. It will also reduce the rate of suicide among mentally ill inmates.  The mental health programs should come in place and give offenders a choice to choosing between preferring to go to jail or mental treatment programs.
The Department of Justice and Institute of Medicine should work in closer relationship with each other as they can decrease the number of mentally ill people suffering in jails. They also demand that the Medicaid Institute for Mental Diseases (IMD) be repealed since this would allow for more federal funding for the treatment of mentally ill people.  


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