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National expert points out jails weren't built as mental health care facilities

Daily Oklahoman (Oklahoma City) - 8/30/2015

Aug. 30--Martin Horn has spent much of his career working and studying on the way we incarcerate criminals in the U.S. Before joining the John Jay College of Criminal Justice at the City University of New York, Horn was appointed by Mayor Michael Bloomberg to simultaneously serve as Commissioner of the New York City Department of Probation and the Commissioner of the New York City Department of Correction.

Q. Problems with mental illness and the lack of treatment options for inmates in county jails are fairly well-documented right now. What are some of the circumstances that contributed to the issues counties are facing today?

A. You have to take one step back and understand that historically and today local jails have never been considered places for rehabilitation. They have always been considered places of temporary detention for people awaiting trial. And, as a result, most jurisdictions have never invested in any kind of programming. The idea never was for prisoners to remain there for a long time. Because the prisoners have not been convicted of anything, they can't be required to participate in any programs and, as a cost matter, local jurisdictions have not invested in the kinds of services that you're talking about.

Q. In many cases, mentally ill people in local jails are there because the county does not have a mental health court system to direct them to treatment instead of jail time, compounded by the fact that those inmates often cannot produce the money needed to bail out.

A. I think the most likely culprit is with the demise, if you can say that, of the mental health system, the institutionalized mental health system, and the failure of community mental health systems throughout the country to provide the kinds of services that would be needed to substitute for institutional care. Because there is this clearly documented national phenomenon, it's not just unique to Oklahoma, where the jails are holding increasing numbers of mentally ill individuals, more than they ever have in the past -- in some jurisdictions, close to 40 percent. Because they are mentally ill and they present challenges in representing them and challenges of proof, their cases take longer to resolve.

Q. Not to mention county jails are routinely short-staffed, and the correctional officers aren't typically trained to deal with mental illness.

A. The jails were never intended to hold the mentally ill. That was never a part of the original idea. The staff training, the orientation, the recruitment, was never based on that. ... You have staff from 10 years ago, where this was not the case, who are now confronting this new reality and don't know how to deal with it and were never adequately resourced to do it.

Q. Those problems seem to be even larger when it comes to smaller rural county jails with considerably less funding for things like mental health professionals.

A. You're some correctional officer, say you're 30 years old, and you came on the job when you're 21, you've never been trained and now it's night an you've never been there alone. You've got 10 inmates in the jail in your small county jail, and one of them starts to have a psychotic episode. What the hell do you do? Who do you call? Maybe the nearest hospital is 50 miles away, and there's no psychiatrist. So, all you can do is put the guy in restraints to prevent him from hurting himself. And then you get criticized for being cruel. So, it's very difficult.

Q. What about the transfer of care for inmates moving from jails to state prisons? Is it easy for an inmate receiving some sort of mental health treatment in a county facility to have a lapse or lack of adequate transfer of care when moving to a prison?

A. I think that delays in getting treatment can allow a person to fall deeper, if they're in a depression to fall deeper into a depression, if they're manic to become more manic. Early intervention and appropriate intervention can be very helpful. It's also why we see a rise in suicides in county jails all over the country. ... There's a very clear trend showing an increase of suicides in jails.

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