From the Street to the Cell 

Criminalizing the mentally ill

Idaho's largest psychiatric institution isn't either of the state hospitals in Blackfoot or Orofino. It looms behind barbed wire fences on Pleasant Valley Road, just a few miles into the desert south of Boise. Its entrance gate bears the title, "Idaho State Correctional Facility."

The Idaho Department of Correction (IDOC) estimates 26 percent of Idaho's 17,550 convicted offenders suffer from a diagnosable mental illness, with 19 percent requiring prescription medications. Among juvenile offenders, the number with a "mental health issue" is 44 percent. These figures don't include so-called "dual diagnoses" in which psychological problems are compounded by substance abuse. For unexplained reasons, Idaho's percentages are higher than the rest of the American state and federal correctional system, though most researchers agree the level of psychopathology is under-reported throughout. But an Idaho Department of Correction (IDOC) report from September 2004 notes that "the rate of mental illness for the adult incarcerated population is three to four times that of the general population."

The burden of care this places on Idaho has increased substantially since the 1980s when, under the label "community psychiatry," the Reagan administration emptied out government-subsidized mental hospitals and slashed their funding. Patients suffering from schizophrenia, personality disorders and mood disorders such as depression or bipolar disorder were suddenly discharged to the streets, where many remain today. Those with severe, socially disruptive impairments may still find themselves facing frequent arrests and serving time alongside violent offenders.

The economic load placed on Idaho taxpayers defies full accounting, but the IDOC estimates it spends $1.34 million annually for direct costs, including some $500,000 for psychotropic medications. Although this amount represents less than 1 percent of the department's budget, other funds are tied up in dealing with a higher number of assaults on corrections staff, lost inmate productivity and greater instances of re-incarceration.

Confronted with the sheer numbers, as well as the daily difficulties of operating such a system, the IDOC has taken steps to keep patients from simply being transferred from hospitals to the street, to a prison cell and back to the streets again. In June 2004, director Tom Beauclair convened the first meeting of the Idaho Mental Health Coalition (IMHC). Supported by Gov. Dirk Kempthorne, and with the help of a technical assistance grant from the National Institute of Corrections, the group has met regularly since. According to the IDOC, Idaho is the first state to undertake such a comprehensive effort to address community safety by improving the mental health care system for offenders.

Currently, the IMHC includes top representatives from the Idaho Department of Health and Welfare, Attorney General's Office, the Idaho Association of Counties, the Idaho Association of Family Physicians, the Senate and House of Representatives, universities and colleges, private care providers and the National Alliance for the Mentally Ill, among many others (full disclosure: the author is also a member). After hosting a series of town hall type meetings throughout the state, the group recently toured the state prison. Their current plans include organizing a statewide conference, tentatively set for Boise in June 2006.

Beauclair summed up the need for the IMHC at a recent meeting. "Inmates interact with care providers from many agencies, but the various components don't operate as one system," he said. "Many reasons are found for not working together." As such, a large part of the coalition's work has been focused on distributing information. One of its first tangible accomplishments was the compilation, through Boise State University, of a CD-ROM and Web-based Blue Book of resources still awaiting publication and posting. Early on, coalition members also identified incompatibilities in record keeping and software among agencies, especially between the IDOC and Health and Welfare, which made it difficult to track the path of individual inmates. Rep. Nicole LeFavour (D-Boise) said at a recent IMHC meething that she will initiate legislation to address this problem during the 2006 session.

Of particular interest to IMHC is the concept of mental health courts, which were pioneered by District Judge Brent Moss in Idaho Falls. Modeled after the drug courts in Ada County, coalition members say the program shows promise in helping the mentally ill avoid imprisonment, by working with prosecutors, public defenders, mental health providers and offenders to secure supervision, treatment and housing outside of prison.

Last year, the Idaho Supreme Court established these courts in six of Idaho's seven judicial districts. According to Ada County Mental Health Coordinator Kelly Jennings, Boise's version has already accepted six defendants, with another 10 pending.

"Considering that we started with no program at all, we are learning quickly," Jennings said. "We have good partners in all branches of government participating and believing in the concept." While the program remains new, she said, "When we see these clients on a weekly basis, we see a difference after two months, and they all agree, their lives are going better than before."

Roseanne Hardin, president of Boise's chapter of the National Alliance for the Mentally Ill, said she is encouraged by the program. "Mental health courts here in Boise are a small, experimental step," she said. "Some people will be encouraged to get treatment instead of waiting to be arrested. I'm not sure that the Department of Corrections provides that otherwise." However, Hardin remains skeptical. "I'm not sure the current system is calculated to get [the mentally ill] to recovery. From the families I've talked with, and from letters from inmates, people don't feel the medications or treatment they're getting are designed to get them to recovery, but more to keep them controlled. That is of concern."

Jennings and Hardin agree that still unresolved by the mental courts is the issue of appropriate, safe housing for the mentally ill. As for any direct impact or signs of progress by the Mental Health Coalition, Hardin said she has seen little change so far. "[It's] not for lack of good intentions," she explained, "but no one out there has told me yet that it's getting better."

Nevertheless, IMHC leaders see their task in long-range terms, especially when it comes to reducing the stigmas surrounding mental illnesses. The coalition continues to face problems in education shortfalls and mental health training for peace officers. In such a new system, costly gaps, duplications and redundancies in agency record-keeping also continue to hamper effective communication among courts, parole boards, local jails and the IDOC. And while inmates may legally claim constitutional rights to adequate health care, including psychiatric services and medications, state government officials have been reluctant to even provide parity for insurance premiums in case of mental illnesses.

"The correctional system is on the bottom rung of the food chain of how society wants to allocate its money," admitted Beauclair. "The system is underfunded and under-resourced." In a conservative state that traditionally prioritizes punishment over prevention, it remains to be seen if the Idaho Mental Health Coalition can generate the political will and financial resources to offer full dignity to the mentally ill outside of prison walls.

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