As Americans, we don't like to admit failure. If we think we have a better idea or a more humane answer for treating the human condition, we will pursue our idea and hold out for decades before we are willing to admit that it didn't produce the results we had hoped. Remember the war on poverty? The war on drugs?
This seems to be the case as a growing number of knowledgeable people in government and the medical profession have come to believe that our decision to embrace the deinstitutionalization of those with mental illnesses and disorders is not the best way to address this societal problem, and that it has not produced the desired results.
By definition, deinstitutionalization is the process of replacing long-term psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. It's supposed to work in two ways: the first focuses on reducing the population of mental institutions by releasing patients, shortening stays, and reducing both admission and readmission rates. The second focuses on reforming the mental hospital's institutional processes so as to reduce or eliminate reinforcement of dependency and other maladaptive behaviors.
Both are worthy pursuits and, honestly, are better than what have been our historical approaches for treating those with mental illnesses.
Generally, this movement started decades ago for three reasons: there was a social and political movement at the time toward community mental health services and away from institutional confinement; there was the advent of psychotropic drugs to help people manage themselves in their communities; there was a need to shift the cost of mental health care from the states to the federal government so we could provide universal care and mental health resources in all 50 states -- not just in the well funded states.
When we did that, it created a large federal obligation and a huge dependence by a growing population. What occurred should have been predicted: the federal government reached a point where it could no longer afford to pay for the care of the mentally ill as costs skyrocketed and demand increased. As federal funds to states were cut, state hospitals cut back their services, and in turn, the number of available beds for mentally ill patients in both public and private hospitals was reduced.
The cutbacks in facilities, treatment, and funding options has caused an explosion in the number of those with mental disorders either going untreated within our communities, joining the ranks of the homeless, or committing criminal acts, among other outcomes.
The question is how can the jail provide for the care, confinement, and treatment of the mentally ill inmate? By default and necessity, the David L. Moss Correctional Facility has become the institution for many mentally ill where deinstitutionalization and other community-based responses have either not been available or successful.
The problem at the jail isn't just overcrowding. It's the type of individuals that are a growing part of this overcrowding. And the answer for this population isn't alternative sentencing or early release. It requires treatment as part of the reentry.
On any given day at Moss, over 400 inmates are taking psychotropic drugs due to a mental disorder. That wasn't a typo. Four hundred. Every day.
The problem and responsibilities which at one time were shifted from local and state governments to the federal government have now returned to the local communities.
The new reality isn't for us to go back to putting the mentally ill in straightjackets. Clearly, some of the 26 percent of those over 18 who have a diagnosable mental disorder can be treated with medication. And some of that 26 percent need to be in a facility. But some will end up incarcerated in the Tulsa jail, too. There is no denying that.
Part of the reality is that in jail populations across the country, there will always be inmates that are more dangerous to themselves than to others. Those who have serious, untreated mental illnesses have always been with us, and the numbers have only grown. Illegal drug use has multiplied an already desperate problem. Just as important to this new reality is that most of these inmates will reenter the community at some point.
Treatment is not an option or choice while incarcerated. It's a requirement.
Thankfully, the trustees of the Tulsa County Criminal Justice Authority (TCCJA) are working on ways to deal with this reality. And these plans don't look to depend upon either the federal or state governments to figure it out or bail us out. Like it or not, this is our problem, and Tulsans will find and, where necessary, pay for the solutions.
Finding the solutions for dealing with the mentally ill inmate will have two parts. First, the jail facility itself has to have some modifications made in order to provide the secure space, treatment space, and medical space for these inmates. It is not uncommon today to find in jails a large medical facility component inside the walls of the jail. No longer are inmates shipped out to a local hospital.
Second, there has to be a professional medical and mental health service company under contract, and on site, that provides both the medical and mental health services needed. It's not enough to have a facility that is designed properly. You also have to have the proper mental health delivery service plan by medical professionals in place.
After months of reviewing comprehensive proposals from some of the best mental health care companies for jails in America, the TCCJA should have a vendor in place before the end of this year.
Like it or not, we have made law enforcement and correctional officers the doctors for some of Tulsa's mentally ill.
If we're going to do that, we need to equip those officers with the skills and the facilities to assist them in their new medical roles.
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