Behind the bars
(This editorial originally appeared in The News &Observer of Raleigh.)
If North Carolina had sufficient resources to provide care and treatment for mentally ill persons in prison, everybody would benefit. But in the current state of things, the system cannot work and it does not work. A study funded by the Governor’s Advocacy Council for Persons with Disabilities finds the combination of incarceration and treatment for mental disease woefully flawed and in need of intense attention. The philosophy driving changes in North Carolina’s care for the severely mentally ill these days is that sufferers are better off in community programs closer to their homes than they are in state hospitals such as Dorothea Dix in Raleigh, which is closing.
As a concept, the idea of community-based care isn’t bad on the surface. But when it comes to providing such care with counties hiring private services instead of offering the care themselves — an approach the state has directed — there are serious challenges, first among them money.
And a lot of that care goes through county jails, which clearly aren’t equipped to offer mental health care adequate to meet the needs of inmates. Jails are jails and hospitals are hospitals, and it’s hard to merge those missions. In fact, it’s virtually impossible to do it without a lot more money for jails and for care. ‘‘You’ve got the intersection of two systems that are really stretched to the max,’’ is the way one of the study’s authors, Anna Scheyett of UNC-Chapel Hill’s School of Social Work, put it.
A federal Department of Justice estimate says two-thirds of local jail inmates suffer from mental illness. That means there might be more than 11,000 inmates in this state in that situation.
It’s ridiculous, and unfair, to expect that county jailers can discern which inmates need care for mental illness and then determine what kind of care they’ll get, keep track of their medications and so forth. The jailers have their hands full managing the jails. The study quotes one jailer’s view of the situation: ‘‘It seems like instead of hospitals we’re building more and more prisons, and they’re being filled with people with mental illness.’’
Legislators are addressing some of the issues with mental health care, but more attention and money are needed. It is difficult and complicated and expensive. But this is a system in distress, and without prospects of much improvement.
Do we really want to be a state where there’s nowhere for those with serious mental illness to go — unless they go to jail, where they can’t get the help they need? And the fact is that many jail inmates, locked up awaiting trial or unable to post bail, haven’t been convicted of a crime. Jail can become a convenient holding place for people whom society finds inconvenient to deal with.
This isn’t a ‘‘bleeding-heart’’ argument. It is compassionate: people with severe mental illness need care just as that person who’s injured in a car accident needs care. And it is practical: isn’t the state better off if people can be restored to productive lives instead of left to suffer?
Something needs to be done. Something must be done.