Growth of mentally ill inmates raises concern in Mich.

Michael Gerstein, and Jonathan Oosting
The Detroit News

Lansing — The number of Michigan’s mentally ill prisoners is growing, a development that is prompting the state’s incoming House speaker to make the issue one of his top priorities next year.

The number of prisoners classified as having a mental illness has risen from 8,213 inmates in 2012 to 9,395 inmates this year — a 14 percent increase, according to the Michigan Department of Corrections.

Many of the state’s inmates with the worst mental illnesses cost an average of $95,233 per year to house in the Woodland Correctional Facility, according to the Department of Corrections. The average prisoner costs about $35,253 per year.

“Look at the savings we would have if we were to get these individuals on their meds and get them the help they need before they commit that violent crime and we’ve got to lock them up for life,” said House Speaker-elect Tom Leonard of Dewitt, who will start leading the Republican majority next month.

The state prison system has had to contend with “a slow but steady increase” in the cost of treating mental illnesses in prisons, state Department of Corrections spokesman Chris Gautz said.

“I think the public probably doesn’t have a good appreciation or understanding … of the lengths we go to treat them because they’ve been sent to us,” Gautz said.

The mental health community and law enforcement have long complained that jails and prisons too often become warehouses for the mentally ill. After most of the state-run psychiatric facilities closed in Michigan, “jails became the de facto mental hospitals,” said Terry Jungel, executive director of the Michigan Sheriffs’ Association.

Treatment is often lacking in prison and jail for those with severe mental illnesses, experts said.

That’s why Leonard said he wants to make mental health reform and doing more to keep people with mental illnesses out of prison one of his top priorities in the new two-year session that begins in January. He said he does not have any specific plans, but wants to assemble experts and lawmakers to tackle the problem.

“We need to look at earlier intervention for those that suffer some type of mental illness,” Leonard said. “It’s not only the right thing to do, it’s not only a public safety issue for people around this state, but it’s also a cost savings if you look at it going forward.”

The incoming speaker admits there is no “silver bullet” solution for the state’s mental health system. But Leonard said he plans to bring as many experts together as possible to discuss how to rein in costs and offer better care to patients before they wind up arrested or behind bars.

The cost of drugs

Mentally ill inmates comprise about 23 percent of Michigan’s more than 41,000 prisoners. Up to 64 percent of county jail inmates have a mental illness, according to the office of Gov. Rick Snyder.

Taxpayer-funded prisons spent more than $3.8 million on psychotropic medication for inmates with mental illnesses this year from an annual $300 million prison health care budget. Snyder issued an executive order that resulted in pilot programs in Wayne and Oakland counties, among other areas, testing “jail diversion” strategies for the mentally ill.

Fortunately, psychiatric drug costs have stayed relatively stable for prisons since 2012, Gautz said.

“The real cost savings has to be looking at the long term, 10-15 years down the road,” Leonard said.

It’s a sentiment shared by Lt. Gov. Brian Calley, who in November signed a Leonard-sponsored bill that aims to extend outpatient care to more Michigan residents suffering from severe psychological illnesses.

The update to the 2004 “Kevin’s Law,” signed by Democratic former Gov. Jennifer Granholm, allows a family member to seek involuntary psychological treatment earlier for an individual and takes into account someone’s impaired judgment when experts determine if someone should be treated against his or her will.

The updated law helps make it easier for the mentally ill who leave a hospital, jail or prison to receive assisted outpatient care, Calley said. It aims to treat an individual’s illness, which could have been a factor that led to jail or prison.

Michigan’s system was “built in a very reactionary way” that “most often waits until somebody hurts themselves or others before treatment is ordered,” Calley said. “And then it’s just hospitalization.”

After discharge, mental health experts have the opportunity to help former inmates “transition back into the community” and become more stable, productive citizens, he said.

Leonard touts the “Kevin’s Law” update and laws that expand access to specialty mental health courts as improvements in Michigan. But he admits there’s still a lot of work to be done.

“Being a coalitions builder,” Leonard said, “I want to bring everybody to the table, early next year, and see what are the types of the legislation we need to push to ensure we’re helping those individuals get the help they need before they commit a violent crime.”

‘Therapy ... hard to come by’

Most of the state-run psychiatric facilities closed in the 1990s under Republican former Gov. John Engler. Many people with mental illnesses ended up in prisons because the state’s community-based treatment system didn’t always pick up the slack, experts have said.

Today, a big factor that leads many to prison is an inability to hold down a job or find permanent housing, said Bob Sheehan, CEO of the Michigan Association of Community Mental Health Boards.

When people emerge from prison or a psychiatric facility where they received shelter, food and treatment, it can be difficult to get a job or housing, Sheehan said. Landlords are often reluctant to let people with severe mental health issues rent property anyway, he said.

Without housing, a job and proper treatment, “your chance of recovery is very slim,” Sheehan said.

When the mentally ill end up incarcerated, it is often “very damaging,” said University of Michigan law professor Margo Schlanger, who specializes in civil rights and criminal detention issues.

“Therapy is very hard to come by in prison,” Schlanger said.

Prisoner advocate Natalie Holbrook, program director for the American Friends Service Committee, praised the state Department of Corrections for training its staff to recognize and address trauma, but said more comprehensive training could be done. She urged better training for first responders and police officers to help people get mental health treatment before they’re thrust into the criminal justice system.

Imprisonment can make mentally ill individuals less likely to hold a steady job, pay rent or take care of other necessities when they are released, which can “be very dangerous for the public,” Schlanger said. It sometimes can become a hopeless cycle, she said.

Many people experience a long and painful road to find the right chemical cocktail to keep psychotic symptoms in check. It’s trial and error with any patient on psychiatric medication, Schlanger said.

“And that kind of labor-intensive, patient-focused, flexible care is very, very rare in prison,” she added.

Every Michigan prison has a “qualified mental health professional” — either a nurse practitioner, social worker or a psychiatrist — to help inmates cope with mental health issues and said inmates can receive therapy, Gautz said. When it comes to treatment quality, he said, “We can accommodate most of them.”

Almost every Michigan prison has an outpatient mental health team, Gautz said. Three prisons also have residential units where those with severe psychiatric issues are quarantined from the rest of the prisoners.

One of them is the Woodland Correctional Facility in Whitmore Lake, which opened in 2009 and contains prisoners with mental illnesses severe enough that they “cannot function adequately in a general prison population,” according to the Department of Corrections.

The Snyder administration doesn’t have a new plan for reducing the costs of mentally ill inmates, but welcomes Leonard’s initiative.

“A big thing to reduce the cost is to have them not come to prison in the first place,” Gautz said. “The money you don’t spend is obviously a big savings.”