A prison makes a poor mental hospital;
new approach would be cheaper, more humane

Michigan taxpayers could save millions of dollars every year, not suffer any hardship and do humanity a service. How?  Simply by shifting treatment of the mentally ill from state prisons and local jails to a system of outpatient treatment and mental health courts.

This would also reverse a mistake of epic proportions. Over the past decade, the ugly truth is that the treatment of thousands of mentally dysfunctional people in Michigan has moved from state mental hospitals to prisons and jails. 

We may not have intended this, but it's what happened. In an interview last week, Wayne County Chief Probate Judge Milton Mack, who has studied these matters for years, noted: “In Michigan, jail or prison has become the primary inpatient center for the mentally ill.” 

How did this happen? 

To save money, from 1987 to 2000, the state closed most of its mental hospitals, putting thousands of patients on the streets in communities that were ill-prepared at best for the challenge. Without supervision, in many cases they quit taking their medicines. As a result, many became confused and sometimes anti-social, and often wound up committing criminal offenses that swelled both county jail and state prison populations.

The state closed the mental hospitals largely to save money -- but it has long been clear that this was short-sighted. It costs a lot to use prisons or local jails to do a job for which they are vastly unsuited: Serve as treatment centers for the mentally ill. 

The data tells the tale: Though the numbers have been dropping slightly, there are now 43,000 prisoners in state prisons, housed as an average cost to the taxpayer of $34,000 per inmate per year, according to the Michigan Department of Corrections. Of those at least one-fifth are severely mentally ill, according to Judge Mack.

 He also thinks as many as half of the rest may suffer from lesser mental disability or substance abuse.

Something has to be done -- and there is a possible solution. Lynda Zeller, deputy director for behavioral health and developmental disabilities in the Michigan Department of Community Health, notes that the legislature in 2009 appropriated $1.75 million for pilot programs in nine local mental health courts. 

These programs require offenders ruled mentally ill to take treatment, including psychotropic medicines, and at a cost average of less than $5,000 per patient per year. 

If all the most mentally ill state prisoners were transferred to local mental health courts – admittedly an unrealistic goal – the annual savings would be just under $3 million a year.  These numbers do not include inmates in local jails, half of whom are mentally ill, according to a 1999 Wayne State University study.

Together with the Michigan Mental Health Association, Judge Mack is working on a rewrite of a portion of the mental health code. The idea is to convert the old inpatient model (state hospitals) to an outpatient one (community-based treatment). 

The proposal would authorize involuntary treatment of those adjudged mentally ill, including being required by a judge to take proper medication. 

“If we fix the mental health system in Michigan, we reduce the numbers of mentally ill in prisons and jails, we save lots of money, and we improve treatment for people who need it,” says Judge Mack.

He isn’t the only official interested in this. In his special message on health this fall, Gov. Rick Snyder concluded, “A disproportionate share of persons with behavioral issues ultimately end up behind bars.”  He called on everyone to come together to work out ways to reduce “the number of persons with mental illness, substance use disorders, and disabilities in our prisons and jails.”

Zeller calls this work an “absolute priority.” Last year, a  Michigan Supreme Court report evaluated the results of local mental health courts. Nearly all participating counties reported positive mental health outcomes and increased education and employment.
 
And according to Zeller, the actual per-inmate cost was even smaller than anticipated -- less than $4,000.  “On the evidence so far, the experiment looks very promising,” she says.

That doesn’t mean there aren’t differences in approach that need to be sorted out. Judges and law enforcement professionals, for example, tend to think community mental health folks are too concerned about their clients’ rights. Mental health professionals grumble that focusing on law and order risks good outcomes. 

Add to that the complication of a two-year-old opinion from then-Attorney General Mike Cox, which indicated that counties have to bear the cost of treating mental illness among jail inmates, casting doubt whether state-funded programs are acceptable.

But if we can make this new approach happen, it will be a win-win-win. Taxpayers win because money is saved. Prison and law enforcement officials win because it’s effective to treat the mentally ill on an outpatient basis.  And the mentally ill win, because taking their meds in an environment where treatment includes education and employment services gives them hope for a reasonably normal life.

All of us should give this idea enthusiastic support.

Former newspaper publisher and University of Michigan Regent Phil Power is founder and president of the Center for Michigan, a nonprofit, bipartisan think-and-do tank. The opinions expressed here are Power’s own and do not represent the official views of the Center. He welcomes your comments via email.

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