The document discusses health disparities among the mentally ill in the criminal justice system. It notes that there are too many mentally ill inmates not receiving appropriate treatment. It presents alternatives like mental health courts and providing more treatment in and after incarceration. The best alternative is found to be providing meaningful treatment in prison due to its efficiency, promoting equity, and potential to significantly reduce recidivism rates. While tradeoffs exist, reform is needed to address the lack of treatment for the over 350,000 incarcerated mentally ill individuals.

1. Health Disparities
Among the Mentally Ill
in the Criminal Justice
System
Priscilla Dorogoff - Jannat Esmail - Christi Parsons
Andrew Sinclair - Arthur Smith

2. Problem Statement
• Problem: There are too many inmates who are mentally
ill and who are not getting appropriate treatment
o Happens at all stages of the criminal justice system
o Result of a severe lack of resources or alternatives
o One policy will not fix problem

3. Assemble Evidence
• 2012: Estimated there are 10x more mentally ill in
prisons than psychiatric hospitals
• Strains the criminal justice system as a whole
• Unique case-processing requirements and treatment needs
• Recidivism rates 2.4x higher than other inmates. 3.3x higher for bipolar
inmates

4. Assemble Evidence
Conditions
• Longer average sentences
o In California, average sentence for burglary for mentally ill is 30% longer
• Stress of prison life worsens illness
o Solitary confinement commonly used due to lack of options
o Higher rates of sexual assault victimization and suicide.
• Only 1 in 3 state prisoners have received mental health
treatment since incarceration

5. Assemble Evidence
Deinstitutionalization
• One of the primary causes is the lack of psychiatric
facilities
• From 2005-2010: Number of psychiatric beds reduced
by 14%
• Minimum number of psychiatric beds: 50 per 100,000
o 2011: 19.44 per 100,000
• In 44 states, one prison or jail in the state is holding
more individuals with a serious mental illness than the
largest remaining psychiatric hospital

6. Assemble Evidence
Previous Policy
• Mental Health Courts
• 2000: America’s Law Enforcement and Mental Health
Project Act
• California Proposition 36
o 1700 nonviolent offenders, mentally ill offenders releases
• Washington v. Harper
o Underutilized
• When Ohio increased psychiatric bed capacity,
recidivism dropped to 27%
o National Average: 50%
o Ohio still considered to have a bed shortage

7. Alternatives to Incarceration of
the Mentally Ill
• Reform the way the Mentally Ill are sentenced
o Use more Mental Health Courts
• Provide more treatment while incarcerated
• Continue treatment after incarceration
• Status Quo- Do not reform current policies and continue
the punitive incarceration of the Mentally Ill

8. Modification of Current
Incarceration Policies
• Allow mentally ill patients to use Mental Health Courts
o Specialized Court that combines community supervision with inpatient or
outpatient professional mental health treatment.
• Where appropriate, provide a non-prison sentence for
any defendant charged with a nonviolent crime/ non-
serious offense.
o Preponderance of the evidence shows the crime was committed due to the
mental illness
o The cost of such treatment is significantly less than the cost of incarceration.

9. Provide Meaningful
Treatment in Prison
• Judge orders the provision of meaningful mental health
services as part of the terms of incarceration sentence
• Will have more oversight
• New Mental Health Prison Oversight Court would be
established to provide initial sentencing
recommendations to trial court judges who request the
court’s input.
• Oversight Court could change treatment plan during term

10. Continued Treatment
After Incarceration
• Prior to release, evaluate all mentally ill prisoners and
determine their level of competence
• Refer inmates needing help to mental health centers that
can continue care.

11. Status Quo No Change
• According to the American Psychiatric Association, on
any given day, between 2.3 and 3.9 percent of inmates
in state prisons are estimated to have schizophrenia or
other psychotic disorder; between 13.1 and 18.6 percent
have major depression; and between 2.1 and 4.3
percent suffer from bipolar disorder. (Aufderheide, 2014).
Study of Mental
Health Court in
Oakland, California
between the years of
2010-2013 (Proxmire ,
2013).

12. Select the Criteria
• Criteria measures outcomes/ consequences
• Mental standards for evaluating the results of action
• Introduces values and philosophy into the analysis
• Most important- whether or not the projected outcome will
solve the policy problem

13. Evaluative Criteria
• Efficiency- maximizes satisfaction and individual
happiness.
o is the most important in cost-effectiveness and
benefit-cost analysis

14. Evaluative Criteria
• Equity- maximizes equality, fairness, and
social justice

15. Recidivism Rates for Mentally Ill Inmates
• A person's relapse into criminal behavior
• Measured by criminal acts that resulted in rearrests,
reconvictions or return to prison within three years of the
prisoner’s release

16. Why are Recidivism Rates so
High for Mentally Ill Inmates?
• When patients are moved out of large state mental
hospitals into community-based outpatient settings,
treatment centers could not handle the large arrival of
patients
• Many are homeless and suffer from substance abuse

17. Weighting Conflicting
Evaluative Criteria
• The analyst imposes a solution
• Our interest is underrepresented in government and
politics
• The analyst understands this underrepresentation
• Permitted to right the balance

18. Alternatives
Reform the
way mentally
ill individuals
are screened
and treated in
prison
Provide meaningful
treatment in prison
Continue
meaningful
treatment
after prison

19. Criteria
Efficiency
Equity/Fairness
& Justice
Recidivism
Rates

20. Alt 1: Reform How Mentally Ill are Screened
and Treated
Efficiency
•Cost of screening
and treatment is less
than incarceration
Equity
•Adequate screening will help the
offender function better and be
prepared to return back to the
community. Less chance of
suicide and violence.
Recidivism
Rates
• Mentally ill inmates that
are isolated from the
general prison
population will likely
want to better themselves
and not return to prison

21. Alt 2: Provide Meaningful
Treatment in Prison
Efficiency
Early intervention leads
to cost savings in both
the prison system and
health system.
Equity/Fairness & Justice
In prison treatment will
provide inmates with a
fair chance to recover.
Treatment will also
maximize an offender’s
ability to “fit in” once
released.
Recidivism Rates
95% of prisoners return
to the community.
Providing mental health
services in prisons will
lead to a reduction in
crime rates.

22. Alt 3: Continue Meaningful
Treatment after Prison
•Providing these
services will likely keep
offenders from re-
entering prison
•Mental health programs
are less expensive than
the cost of incarceration.
Efficiency
•The mentally ill
confront challenges as
they reintegrate into the
community.
•Providing them with
equitable support will
help them reintegrate
better.
Equity •Mentally ill inmates
who received after
prison treatment for up
to a year were twice as
likely to refrain from
entering prison as those
who did not receive
treatment.
Recidivism
Rates

23. Efficiency Equity/Justi
ce
Recidivism
Rates
Reform
Mentally Ill
Sentencing
Efficient Equitable Reduced
incarceration
Provide
Meaningful
Treatment in
Prison
(Best Alt.)
Most
Efficient
Provided the
most Equity
to mentally
ill
Showed a
high
reduction in
recidivism
rates
Continue
Meaningful
Treatment in
Prison
Somewhat
efficient
Equitable Reduced
incarceration
Criteria
Alternatives

24. Treatment in Prison
Outcomes
71% reduction in
number of days
spent homeless
50% reduction of
days spent in jail
40% reduction in
number of days
spend in a
mental health
facility

25. Tradeoffs
Determining
who to treat
Managing
inmate behavior
Controlling the
prison
environment and
its affects on
mental health
Difficulty for
inmate to adjust
to prison life

26. The Decision Maker
• The Federal Bureau of Prisons (BOP)
• The Congress in regards to Medicaid
• Between 2004-2013 the BOP spent majority of funds on
miscellaneous professional services, office furniture,
social rehabilitation & fences and gates.
• Total annual budget of $6.820 billion.

27. The Congress
• Increasing recidivism rates are associated with a lack of
access for the mentally ill.
• Medicaid expansion under the ACA needs to be
implemented by all states.
• For individuals currently incarcerated Medicaid will
finance inpatient services if provided by a licensed
medical facility in the community.

28. The Result
• Increased resources for those incarcerated.
• Rehabilitation for the mentally ill.
• The BOP must work together with Congress to push the
decision makers

29. Our Story
• The problem: A lack of resources and services are
resulting in offenders with mental illnesses receiving no
treatment.
• Alternatives: Mental Health Courts, the mentally ill
should receive different sentencing, and provide more
treatment while incarcerated and after.
• Criteria: Efficiency (screening and treatment will save
money), Equity (treatment in prison will provide inmates
with a “fair” chance), reduction in recidivism rates.

30. Our Story
• Projections: Less chance of being homeless, reduction in
days spent in prison, and a reduction in days spent in a
mental health facility.
• Trade offs: managing inmate behavior, adjustment
issues, trying to control the operation of prisons, and
determining who is considered mentally ill.
• The 350,000 incarcerated mentally ill inmates need
treatment and thus the policy changes need to begin.