At the beginning of January, California prisons started unloading prisoners onto local jails, as part of a plan to address prison overcrowding. Known, charmingly, as ‘prison realignment,’ the idea is to distribute the responsibility for prisoner care to local communities, even though many of them are struggling to meet their own social services needs as it is. Of course, the idea of simply letting prisoners out is unthinkable and would upset the social order of things. We couldn’t have that, after all.
Hence, jails braced for an influx of new inmates, and many were poorly prepared. Within days, concerns about overcrowding were coming up all over again, along with worries about paying for the needs prisoners, especially in counties strapped for cash. Some had enough funds to get by for several months, but feared what would happen if more funding wasn’t forthcoming. An entirely legitimate concern, given California’s budget woes and the falls in tax revenues across the state.
And within days, articles warning about the mental health implications also started blooming, indicating that some counties may have a serious problem on their hands. Rates of mental illness in prison tend to be higher than in the general population, and prisons provide very poor mental health services. Some people bring their mental illnesses with them; they are more likely to be profiled for crimes and arrested, less likely to be able to defend themselves, more likely to be victimised and in a position where they may need to commit crimes to get to safety. Others have latent mental illnesses exaggerated by time in prison, which can contribute to depression, anxiety, and a host of other problems, just like any other overcrowded, hostile, unsafe environment.
Consequently, many counties ended up saddled with people who had poorly treated or entirely untreated mental illness. And were utterly unequipped to deal with these new inmates. Which was a recipe for disaster; it was perhaps astounding that it didn’t blow up almost immediately, because the writing was clearly on the wall. Leaving people with mental illness in the general population, for example, can be endangering for everyone, while isolating people with mental illness can lead to increased mental health problems.
Many California counties don’t have enough funds in their budgets to provide basic mental health services to unincarcerated residents. They hack and slash their mental health budgets and seem astonished when this ends poorly, when people who can’t access mental health services experience crises. These crises are much more expensive than providing care in the first place would have been, but counties don’t seem interested in recognising this. These budget cuts mean that people can wait weeks or months for appointments even when they are referred, let alone when they seek help on their own.
And they also mean that the quality of care available is limited. People on public assistance seeking mental health services, or people using public clinics as pay or insurance patients because there are limited providers available, primarily receive medication. Counseling, therapy, and other treatment modalities are not made available because they are too expensive. The goal is on quick ‘control’ and high patient turnover. It takes 10 minutes to meet for a quick medication appointment once a month, versus an hour of therapy a week.
The government pays for medications, and medications are what people get, even if this is not necessarily what they need. Support in the form of housing assistance, help with tasks of living, and other services is much harder to get because it’s too expensive and time consuming. Counties are already struggling just to get enough health care providers and rooms to make medications available with something vaguely approaching supervision. Many mentally ill people fall through the cracks entirely because there’s no time for followup, for tracking cases, for checking in with people.
If these are what services look like on the street, you can only imagine what they look like in county jails. Jails are not really designed for long-term prisoner housing, and lack many of the services at prisons, along with the framework to make those services available. While a jail might be able to handle a mental health crisis, it would stumble to do so. It would need time to find providers and decide how to proceed. As for actual consistent mental health care, inmates may be left out in the cold; the jail can’t afford counseling, let alone medication maintenance, especially for someone without a diagnosis who clearly needs to be evaluated.
Jail staff also lack training in handling mentally ill people, which puts mentally ill inmates at increased risk of brutality and abuse. They account for a large percentage of use of force incidents in California jails, for example, and may struggle to be heard when they attempt to report abuses and violations of prison protocol. They can also be vulnerable to abuse by other inmates, who may target them as people who are unlikely to be heard and cared for.
California has a brewing mental health catastrophe on its hands, and it is likely to get extremely ugly. Prison realignment has had a number of profound consequences, and this is one of them. In a state with an already deeply broken mental health system, pushing that system to the limit is not bound to end well, and the people who are going to be hurt by it are not the ones in charge. As usual, it is mentally ill people who will suffer as a result of poor policy decisions, inadequate training, and a general lack of interest in ensuring that the basic needs of human beings are met.