The fiscal stupidity of Oklahoma's state dereliction of duty has cost our taxpayers an insane amount of money. Money which could have prevented the budget crises of the past 10 years.
It started with the decision of the Department of Mental Health and Substance Abuse (ODMHSAS), to shut down the mental health inpatient bed capacity, in 2010-12. This was the result of a massive budget disaster from worldwide financial forces. The public didn't stop suffering serious mental illness, but their capacity to get private sector treatment was severely diminished. Since unemployment skyrocketed, many lost the workplace health insurance which would have allowed them a better option in private hospitals. Then the public beds were the first thing cut when state agency budgets were slashed.
20 years ago, Oklahoma had about 2000 beds available to diagnose & treat serious mental illness. Now there are little more than 300 beds which cops and judges can access for emergency acute inpatient care.
The crisis was borne on the backs of our law enforcement agencies. And at a far more expensive price. As the behavior of the seriously mental ill population progressively collapsed, they were continually swept off the streets by the local cops. Our vastly growing legal code of law provided the excuse cops needed to incarcerate thousands and label them as a dangerous threat to society.
But the average daily cost of housing the mentally ill in the county jail is about $130 per day. And none of the inmates at the county jail can be forcibly medicated with psychotropic drugs. They are the most vulnerable in the jail population.
This is a major cost-shift from state funding, to county and municipal expenses. Tulsa County just passed a massive bond election to build a mental health facility in the jail. That's because about 600 of the 1600 inmates are diagnosed and treated for serious mental illness. Plenty more inmates are refusing efforts to diagnose & treat their condition.
The Tulsa County jail assesses a per-day fee to each municipal law enforcement agency which brings an arrested individual to the jail. This past year the county increased the fee from $59 per day, up to $75 per day. Mental Health care is the biggest part of the reason for the increase.
The 2 largest mental health treatment institutions are not Central State Psychiatric Hospital (Griffin) in Norman; nor Eastern State Hospital, in Vinita. No, the top 2 are;
So the decision of the state agency(ODMHSAS) to close up state operations and rent out the buildings to healthcare corporations, may have kept beds available, but not any longer available for cops and judges to use, for public safety actions.
A review of the past 5 years of ODMHSAS budget requests has left a strong conclusion that the agency does not want to restore the acute crisis beds at the state-run mental hospitals. This means that most of the money appropriated to mental health is being privatized out as grant money, contracts to corporate providers and on other projects. Serious inpatient mental illness is now just a small fraction of what the state agency spends it's money on, in direct operations.
The blame would be clearly assigned to the governor and legislature IF the ODMHSAS budget request had included and prioritized a restoration of mental health beds. But just this year, the commissioner of mental health asked for about $200 million additional dollars. Yet not one dime was designated for restored inpatient beds in the state-run operation.
Oklahoma taxpayers have paid for the institutions already. But ODMHSAS is renting out much of the Griffin campus and all of the Tahlequah campus. The rented Tulsa building has a whole wing shut down, but they are still paying rent for the empty rooms.
The civil rights abuse is an even bigger issue. When a psychotic meltdown occurs. A sufferer can take a medical leave from the workplace to go to a hospital. But they can't take a medical leave to go to jail. When they are arrested simply for refusing to get out of the street, the whole neighborhood sees them hauled of in handcuffs and sees their mugshot in the legal news. Their kids may end up in foster care. the district Attorney's staff has to process a legal case and district court dockets get tied up. If the individual gets a 90-day sentence, they come out homeless, jobless, assessed with court fees, and now they have a police record. There is a low prospect of them ever restoring their life to productivity.
But if they can be detained at a psychiatric inpatient unit, they are typically diagnosed, adjudicated, and stabilized in under a week. They are moved to outpatient status and returned to family or other arrangements. They have follow-up care and return to work within a few weeks. Their mental health court records are sealed. They have no police record. The potential for restoration is far better. The cost of intervention is far lower. The county jail no longer needs to be expanded. The per-inmate cost to the the city and county government is vastly lower.
This isn't to say that there ought be no inmates with mental illness. There will always be a significant percentage of the dangerous state population whose violent nature cannot be imposed upon society. But the vast majority of the mentally ill are not violent. They are far more vulnerable to being victimized. There will always be some serving long prison terms who incidentally have serious mental illness. But Oklahoma has one of the highest rates of incarceration. the US overall leads the world in prison population. If we were only at the average, we would not have a budget crisis.
The Treatment Advocacy Center has an excellent research paper on the wasteful spending which results from criminalizing mental illness. Here is a portion.
Problems Associated with Having Seriously Mentally Ill Persons in Jails and Prisons
Jails and prisons are not created to be de facto mental hospitals. They are not structurally appropriate for patients, and the staffs are not recruited as psychiatric caretakers. Not surprisingly, there are many problems associated with placing large numbers of seriously mentally ill individuals into jails and prisons. Among these problems are the following:
(a) Mentally ill offenders are “frequent flyers”: Since the county and state corrections systems are separate from, and usually not coordinated with, the mental health system, most mentally ill persons leaving jails and prisons receive little, if any, psychiatric aftercare. Consequently the recidivism rate is thought to be higher than it is for other released prisoners. In jails and prisons, repeat offenders are commonly referred to as “frequent flyers.” In the Los Angeles County Jail, 90 percent of mentally ill inmates are repeat offenders, with 31 percent having been incarcerated ten or more times. Houston’s Harris County Jail in 2008 included two mentally ill individuals who had been booked 30 times since 1999 and 45 times since 2001. Also included was a 34-year-old woman diagnosed with schizophrenia who had been charged with 12 felonies and 31 misdemeanors. At the Palm Beach County Jail, Jonathan Goode, diagnosed with schizoaffective disorder, was booked 49 times in 40 months between March 2006 and July 2009. The record for repeat offenders probably belongs to Gloria Rodgers, who after 259 arrests in Memphis, was finally committed to a state psychiatric hospital. Like many frequent flyers, Rodgers considered the Shelby County Jail to be her home. Similarly, Linda Kraige, diagnosed with bipolar disorder, has been in Virginia’s Roanoke County Jail so many times that, when asked to name her best friend, she named the deputy at the jail.39
(b) Mentally ill inmates cost more: Mentally ill inmates cost more than non–mentally ill inmates for a variety of reasons, including increased staffing needs. In Broward County, Florida, it costs $80 a day to house a regular inmate but $130 a day for an inmate with mental illness. In Texas prisons “the average prisoner costs the state about $22,000 a year,” but “prisoners with mental illness range from $30,000 to $50,000 a year.” Psychiatric medications are a significant part of the increased costs; in July of 2002 at Ohio’s Clark County Jail, prescription drugs costs for inmates exceeded the costs of feeding inmates. Psychiatric examinations are also expensive. In Palm Beach County, each time Jonathan Goode was arrested he was required to have a psychiatric exam, each costing $2,000, producing an expenditure of $98,000 over 40 months. Finally, there is the cost of an increasing number of lawsuits, such as the suit brought in New Jersey in 2006 by the family of a “65-year-old mentally ill stockbroker [who was] stomped to death in the Camden County Jail.”40
(c) Mentally ill inmates stay longer: In Florida’s Orange County Jail, the average stay for all inmates is 26 days; for mentally ill inmates, it is 51 days. In New York’s Riker’s Island Jail, the average stay for all inmates is 42 days; for mentally ill inmates, it is 215 days. The main reason mentally ill inmates stay longer is that many find it difficult to understand and follow jail and prison rules. In one study, jail inmates were twice as likely (19 percent versus 9 percent) to be charged with facility rule violations. In another study in the Washington State prisons, mentally ill inmates accounted for 41 percent of infractions even though they constituted only 19 percent of the prison population. Another reason mentally ill inmates stay longer is that they are often held for months awaiting the availability of a bed in a psychiatric hospital.41
(d) Mentally ill inmates are often major management problems: Because of their impaired thinking, many inmates with serious mental illnesses are major management problems. For example, in 2005 in Mississippi’s Hinds County Jail, one inmate was described as having “tore up a damn padded cell that’s indestructible, and he ate the cover of the damn padded cell. We took his clothes and gave him a paper suit to wear, and he ate that. When they fed him food in a styrofoam container, he ate that. We had his stomach pumped six times, and he’s been operated on twice.” In the Southern Ohio Correctional Center in 2004, a mentally ill inmate who had been sent to jail for stealing a bicycle was described as follows: “He was the type of individual who was very difficult to work with. [He’s] been very aggressive towards staff, including, I believe, by spitting on staff members and throwing body waste. And so there wasn’t a lot of empathy for him. . . . The tendency would be for somebody like that to just [say], ‘Let’s lock him away. . . . let’s just not have anything to do with him.” In Wisconsin a 2010 audit of three state prisons reported that “between 55 percent and 76 percent of inmates in segregation [isolation] are mentally ill.” 42
(e) Mentally ill inmates are more likely to commit suicide: Multiple studies have shown that approximately half of all inmate suicides are committed by inmates who are seriously mentally ill. A 2002 study in Washington State reported that “the prevalence of mental illness among inmates who attempted suicide was 77 percent, compared with 15 percent [among inmates] in the general jail population.” In California in 2002, the Los Angeles Times headlined: “Jail Suicides Reach Record Pace in State,” and added: “Some experts blame the recent surge on forcing more of the mentally ill behind bars.”43
(f) Mentally ill inmates are sometimes abused: Men and women who work as correctional officers in jails and prisons apply for the job expecting to work with criminals, not individuals with serious mental illnesses. Many of the correctional officers do not understand, and have little or no training in, how to work with mentally ill inmates.
Pete Earley, in his excellent book about mentally ill people in jails, described a conversation he had with correctional officers in Miami’s Dade County Jail:
"I was told the inmate had been punched several times in his kidney area and his arm had been twisted behind his back while, as one officer said, '..he was given a talk-to about his lack of respect and manners.” . . . “You need to instill fear in these inmates or they won’t listen to you,” one explained. “Especially crazy inmates, ’cause if you don’t scare them, then they will hurt you.” . . . “We don’t have any way to control these inmates except with behavior modification, which is a nice way to say: putting our hands on them if they get out of line. I mean, how else can we keep them under control? You tell me?',"44