Photo courtesy Wikimedia Commons
Credit: Wikimedia Commons


A new report quantifies the experience of many states, where people with mental illness end up in jail or prison after states cut treatment dollars.

By Rose Hoban

A new report has found that as many as 10 times the number of people with severe mental illness reside in jails than in hospitals or treatment centers around the country.

The report, co-published last week by the Treatment Advocacy Center and the National Sheriffs’ Association, found that in 44 states, the largest institution housing people with severe mental illness is a jail or prison, not a state psychiatric hospital.

Across the country, an estimated 356,268 people with mental illnesses including bipolar disorder and schizophrenia are in prisons and jails, compared to just 35,000 in state hospitals – a tenfold difference.

In North Carolina, the largest state psychiatric facility is Central Regional Hospital in Butner, with 398 beds. According to the report, the Mecklenburg County jail in Charlotte, with 1,904 beds, and the Wake County jail, with 1,568 beds, “probably both have at least as many mentally ill individuals as does the state hospital.”

Many people with mental health problems end up in solitary confinement in prison when their problems, left untreated, result in them acting out. Photo courtesy Rennett Stowe, flickr creative commons
Many people with mental health problems end up in solitary confinement in prison when their problems, left untreated, result in them acting out. Photo courtesy Rennett Stowe, flickr creative commons

A prior study conducted by the Treatment Advocacy Center using 2005 data found that North Carolina had about 8,600 severely mentally ill inmates out of a total population of about 54,000. A spokeswoman from the TAC said there have not been any more comprehensive studies on people with mental illness in prison since.

The report includes a survey of each state’s mental illness treatment laws for prisons, as well as background on the percentage of prisoners with mental illnesses in each state.

The authors note that since 1970, the percentage has risen from an average of about 5 percent to 15 to 20 percent.

They add that, “There is probably no state where mental health services have deteriorated as much as they have in North Carolina over the last decade.”

No surprise

The study results were not a surprise to District Court Judge Joe Buckner, who covers Orange and Chatham counties. Buckner pioneered the use of “mental health courts” in North Carolina and has had many people with mental health disabilities in and out of his courtroom over the past decade.

“We don’t have the space for the mentally ill in jails, but that’s where they’re going,” he said.

Buckner noted that county jails have seen an increasing number of people with mental illness who commit misdemeanors in their cells since the sentencing commission told legislators several years ago that the state should spend close to $400 million to add at least 3,000 state prison beds to accommodate population growth and an exploding prison population.

Buckner said that instead, the sentencing commission made changes to how misdemeanants get sentenced. In the past, low-level misdemeanors would earn an offender 30 days of “county time” and higher-level misdemeanors requiring between 30 and 90 days would bounce an offender into the state prison system.

“So now what they’ve done at the state level, they’ve moved it from Corrections down to counties,” Buckner said. “The state prison population has gone from 47,000 down to 37,000. But as my D.A. told me, it’s not because we admitted 25 percent fewer people. They’re now all in counties.

“The counties are really getting punched now.”

Buckner pointed to a survey of all the state’s sheriffs conducted in 2008 by people from the Wake County chapter of the National Alliance for Mental Illness. In that survey, one sheriff told researchers, “We are currently inundated with individuals with mental health issues. The severe, chronic mentally ill are being arrested but often they are committing crimes as well. Many of those that I see are not compliant or refuse treatment. Then many of the others do not follow up once out of jail due to the structure of the system in obtaining appointments, medications, etc.”

Local issue

The issue of mentally ill inmates in North Carolina has recently hit headlines with the death of inmate Michael Anthony Kerr, 53, who was transferred from the Alexander Correctional Institution in Taylorsville to Central Prison in Raleigh for medical care. By the time Kerr arrived in Raleigh, he was unconscious and unable to be revived. He died shortly after his arrival at Central Prison.

Kerr had a long history of mental illness, according to Disability Rights North Carolina, an advocacy group.

News reports state that Kerr had been kept in solitary confinement while at the Taylorsville facility, a practice that’s common for inmates with mental health problems, according to the TAC report.

The authors found “grossly disproportionate” numbers of prisoners in solitary confinement, which they note often worsens the symptoms of mental illness. They also report that mentally ill prisoners have more behavioral issues, including violence against guards and other inmates.

The report also stated that inmates with mental health issues are more often victims of rape and physical abuse, stay incarcerated longer and commit suicide behind bars more frequently than the rest of the prison population.

They often are put in seclusion for long periods of time, and those who are not treated often become sicker.

Suggested fixes controversial

In 31 states, prisons can administer treatment over a prisoner’s objections by requesting a special-treatment review committee, but the process is often difficult. The report calls such efforts “grossly underutilized,”

“This causes major problems,” the authors write in the report. “Jail officials can thus be legally sued in many states if they forcibly medicate mentally ill prisoners without their consent, yet can also be held legally responsible for the consequences of such prisoners’ psychotic behavior,” including suicide.

The authors recommend reforming jail and prison treatment laws to more easily allow staff members to administer involuntary medication for inmates with mental illnesses who are gravely disabled, deteriorating or pose a likelihood of serious harm to themselves or others.

That’s different than what happens outside prison walls in North Carolina. Even if a person is under mandated treatment by a court like Buckner’s, by state law, they cannot be forced to take medications.

“What we’re seeing is what we’ve just created,” said Bebe Smith, a clinical social worker who teaches at UNC Chapel Hill’s School of Social Work. She said many people with mental health issues don’t have resources since the initiation of mental health reform in the early 2000s and many people fall through the cracks, landing in jail.

“We didn’t ever follow through on the community support that was promised when we closed state hospitals.”

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