By Sam McCann
Dashon Carter, 25, of Staten Island, missed nearly 100 medical appointments while incarcerated at Rikers Island — mostly because prison officials failed to accompany him to the clinic. He struggled to access the mental health medication he needed and was effectively left to fend for himself. Carter died by suicide in his cell on May 7, 2022. He was in general custody despite an extensive history of mental illness and a stint in a psychiatric hospital just two days before his death.
“He didn’t have a support system,” Carter’s high school friend Ray Robinson told The City. “He just had to really rely on himself and his loved ones.”
This type of neglect is all too common and is a direct consequence of the criminal justice system, which often acts as the primary point of intervention for people’s mental health needs. In the United States, people with serious mental illnesses are more likely to have contact with law enforcement than to receive any form of treatment. In addition, ten times more people are held in detention centers and prisons than in public hospitals – some of which is partly rooted in the sell-off, with the number of public hospital beds down 94 percent since the 1950s. State hospitals themselves were often punitive, and in the 1960s Congress passed a law to replace them with community mental health centers. But few of these centers were ever built, and governments failed to put money into programs like crisis response teams or treatment options. Instead, funds flowed into prison and jail systems, which are now the nation’s largest providers of mental health care.
But prisons are not essentially therapeutic environments and are woefully ill-equipped to provide these services. About three out of five people with a history of mental illness do not receive treatment while incarcerated. They are also more likely to be disciplined and spend three times longer in solitary confinement. The trauma of incarceration, compounded by the lack of adequate treatment and reentry resources, creates a revolving door in which people with mental illness are unable to stabilize their lives.
This is bad policy: mental health services available outside prisons are not only more effective, but also more cost-effective than incarceration. Failure to invest in treatment instead comes at a direct cost to people’s ability to live their lives, yet officials continue to pour more money into jails and prison systems that are completely incapable of meeting basic mental health needs. People with mental health needs are not a threat to public safety at all – in fact, they are more likely to be victims of crime than perpetrators. Imprisoning people who need treatment is both unjust and destabilizing, subjecting them to the trauma of incarceration without adequate services. This is the real risk to public safety.
In Los Angeles and New York, Vera works to address acute mental health crises in local jails. In both cities, significant investment in mental health services can build safety and reduce prison populations.
Los Angeles: A successful program requires investment
Forty-one percent of people in the Los Angeles County jail system have mental health needs. That number has risen 21 percent since 2020, part of a decade-long increase in the number of people with serious mental illnesses in county jails. The Los Angeles jail system is the largest mental health institution in the United States, and the county spends $548 a day to incarcerate people in mental health units despite the cost of only $207 a day to house and treat them in the community .
“By default, we have become the largest medical facility in the country. And we are a prison,” Tim Belavich, director of mental health for the Los Angeles County Jail System, told WWLP. “I would say that prison is not the appropriate place to treat someone’s mental illness.”
But according to a RAND Corporation study, 61 percent of inmates with mental illness can be safely diverted to existing alternatives to incarceration, such as the Office of Diversion and Reentry (ODR) residential program. Incarceration actually increases the likelihood of recidivism, forcing people with mental health needs into a vicious cycle of incarceration without ever receiving treatment. Community-based diversion programs, on the other hand, build public safety and reduce re-arrest rates by meeting basic needs. There is no reason for public safety to keep people incarcerated instead of ensuring they get the treatment they need.
The ODR housing program is extremely effective. It offers permanent supportive housing and intensive clinical support to people with serious mental health needs charged with crimes in lieu of imprisonment. The program model recognizes that the path to stability is not linear and treats housing as a key pillar of success. Even if the client has other interactions with the criminal justice system, ODR works to get them back into the program with the consent of the prosecutor and judge. Some of the program’s most successful clients needed multiple chances to re-engage. This continued support ultimately addresses two of the county’s most pressing issues: homelessness and the revolving door of the criminal justice system. One study found that 86 percent of participants had no new convictions after 12 months, and 74 percent had stable housing after 12 months.
These promising results require support. However, the ORS does not have enough funding. Investing in 3,600 new mental health treatment beds, including for ODR Housing clients, will reduce the county’s reliance on the jail and achieve its goal of closing Men’s Central. ODR’s success so far shows that these new beds and services will reduce recidivism in Los Angeles by providing people with options that help stabilize their lives instead of leaving them in jail when they need treatment. The Los Angeles County Board of Supervisors is set to issue a supplemental budget this September, a key opportunity to invest in a program that could serve as a national model.
New York: Prison budget cuts could build more supportive housing
Rikers Island is facing a mental health crisis. Fifty-three percent of people held at the prison complex had a mental health diagnosis in fiscal year 2021, up from 46 percent the previous year. Cases of self-harm have risen sharply as a result of the ongoing humanitarian crisis in New York’s prisons, which killed 16 people in 2021 and claimed another 11 lives this year.
As in Los Angeles, treatment in New York’s jails is grossly inadequate or non-existent. Despite a $2.7 billion budget, the city’s Department of Correction (DOC) consistently fails to provide needed medical care to people in custody, with thousands of missed appointments each month leading directly to death. Earlier this month, a judge ruled that the city must pay more than $200,000 to people who missed appointments while in DOC custody.
People with mental illness are also subject to punitive treatment and longer stays in New York’s jails. The average length of stay for the general population on Rikers Island is 222 days. People in DOC custody for 24 hours or more who receive mental health treatment, however, are held an average of 357 days, or 61 percent longer.
The city pushed to create new secure mental health units at Rikers. This decision is fundamentally inadequate because prison conditions are incompatible with the treatment needed to address mental health needs. And despite the bloated budget, DOC has delayed bringing even this deeply compromised solution online.
Instead of pouring money into programs that will continue to fail New Yorkers with mental illness, the city should invest in housing. New York spends an average of $556,539 per person per year to keep people locked up. In contrast, providing supportive housing costs only $41,833 per person per year.
The city can and should invest in therapeutic services that allow people and communities to succeed and thrive at a fraction of the cost of incarceration. Mobile crisis response teams and crisis stabilization centers can provide alternatives to detention. Supervised release, secure hospital beds, and semi-secure treatment programs can provide alternatives to detaining people at Rikers Island. And supportive housing can provide stability for people with mental health needs to avoid criminal justice system involvement and hospitalization in the first place.
Dashon Carter should still be alive today. Smart investments that address mental health needs in the community, not in prison, will build safer neighborhoods across the country and reduce our failing reliance on incarceration.
Originally published by Vera Institute of Justice