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The number of persons with a severe mental illness (SMI) in U.S. jails is growing, requiring treatment services most jails are unprepared to offer, according to a report by The Pew Charitable Trusts released on Jan. 24.

“Although the central purpose of jails is to detain people who engage in criminal behavior and pose a threat to public safety, the poor health status and lack of regular care among justice-involved individuals make the facilities a potentially important site for health care interventions,” the report stated.

“This disconnection between the stated purpose of jails and the health demands now placed upon them is clearly illustrated by the prevalence of behavioral health conditions in jails, such as a serious mental illness (SMI, defined as schizophrenia, psychosis, bipolar disease and serious and persistent depression), a substance use disorder, or both, known as co-occurring disorders,” Pew added.

The report cited a study finding that 20 percent of people in U.S. jails have an SMI compared to 4 percent of the general population.

Another study was referenced in which 75 percent of sheriffs’ departments surveyed reported an increase in persons with an SMI being housed in their jails.

Two studies of New York City jail populations found that, on average, persons with an SMI stay in jail twice as long and have a higher recidivism rate than those without a mental illness.

A key driver behind these trends is the closure of inpatient mental health institutions over the last 60 years, with the result that “by the end of the 20th century, the number of public psychiatric beds had decreased 95 percent from 1955.”

William Gupton, former assistant commissioner of rehabilitative services for the Tennessee Department of Correction and currently the Shelby County Corrections Center director, cited similar figures in’s 2015 documentary “Through the Door.”

“In 1985, the sad truth to this system is that there were 850,000 mental health inpatient beds around the country. To this day, we only have about 40,000 to 50,000 of those beds left,” he said. “These folks are going somewhere. And a lot of them are showing up at our county jails and definitely in our prison system.”

Efforts to provide mental health services to incarcerated persons with an SMI have been uneven and dependent on available resources, with larger jails (250 or more beds) more likely to offer treatment.

“Like people who disproportionately use hospital emergency department services, those with mental illness repeatedly enter a correctional system that is mismatched to their underlying need, resulting in an inefficient use of public dollars,” Pew stated. “To the degree that the high users of both community health and correctional systems overlap, these individuals are responsible for a major portion of county spending across agencies but without desirable outcomes to show for it.”

The full Pew report is available here.

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