(Jan. 31, 2017) Relatively small changes in common practices could dramatically reduce the mass incarceration of individuals with serious mental illness and its human and economic toll, according to a new report released today by the Treatment Advocacy Center.
Emptying the 'New Asylums': A Beds Capacity Model to Reduce Mental Illness Behind Bars uses a mathematical model to project the impact of changing any one of three factors on the logjam of jailed mentally ill defendants who cannot be tried because they are too ill, but who remain incarcerated because psychiatric beds needed to restore them to competency are unavailable.
An estimated 90,000 defendants require such services annually. Because of psychiatric bed shortages, the majority of states maintain waiting lists of such inmates, and some of the lists are months long. More than a dozen states are being sued or threatened with legal action over the constitutionality of the widespread practice.
The three impacts projected by the model were reducing the number of people with serious mental illness being arrested and added to bed waitlists, eliminating administrative and other non-clinical factors that lengthen state hospital stays, and increasing the number of beds.
Treatment Advocacy Center Executive Director John Snook called the findings game-changing. The modeling project, based on queueing theory (the study of waits), projected that:
- In Florida, diverting two mentally ill offenders per month would reduce the average forensic bed wait in the state by 75%, from an average of 12 days to three days.
- In Texas, reducing the average hospital stay from 189 days to 186 days would reduce forensic bed waits from an average of two months to three days.
- In Wisconsin, increasing the number of forensic beds from 70 to 78 beds would reduce waits for competency services from nearly two months to two weeks.
"Because hospital beds for pretrial defendants are in such short supply, very modest changes - all of them relatively low in cost - could produce drastic improvements," said John Snook, a co-author of the study. "Given the scandalous criminalization of serious mental illness in this country, these results demand immediate attention and action by state and federal policymakers."
The Treatment Advocacy Center collected beds information for the model during its 2016 research for Going, Going, Gone: Trends and Consequences of Eliminating State Psychiatric Beds. The queueing model was developed at the University of North Carolina at Chapel Hill's Gillings School of Global Public Health and North Carolina University's Edward P. Fitts Department of Industrial and Systems Engineering.
"The waitlisting of inmates with mental illness is a national disgrace and must be addressed," said Snook. "We designed this model to identify practical and feasible evidence-based practices that could improve the situation. The project's findings exceeded even our hopes.
Assessing the net cost of making the changes identified by the project was outside the scope of the modeling project, but Snook said their cost-effectiveness is self-evident.
"It is cheaper to divert people in crisis out of the criminal justice system than to jail them or to staff existing beds that aren't being used rather than creating new ones," he said. "The model gives policymakers an evidence-based tool for reducing the mass incarceration of the mentally ill and addressing psychiatric bed shortages without requiring large investments of additional resources."
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