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You had questions about inmates with mental illness. We have answers

Virginian-Pilot - 12/22/2018

Dec. 22--People with mental illnesses like schizophrenia and bipolar disorder are dying in jails all over the country. Below, reporter Gary Harki answers your questions about his reporting on the intersection of the nation's criminal justice and mental health systems.

I want to know who they were. Who were the humans who died? Nobody cares about these stories unless humans are being given proper respect. Trust me. -- Emily

I think what you're saying here is that no one cares about faceless statistics, that people's stories are what will make real the issue of how jails deal with mentally ill inmates. I agree, which is why we tried to tell as many stories as we could through the database of 434 jail deaths that we've created. If you click on an individual name you can find links to stories about that case. We tried to put in as much information as we could. In some cases, there's just not much that we know.

How many of those who died were known to the mental health system, yet allowed to go untreated? My guess is it will be near 100 percent, showing it is not identification that is the problem, it is the refusal to treat. -- DJ Jaffe

I don't know the answer to that question, and I don't think there's a way to gather that information accurately. We counted deaths where there was some prior indication of mental illness -- from family, previous police encounters, known mental health history, etc. But we cannot get access to these people's mental health records, which is what you'd need to track your initial question accurately. The federal Health Insurance Portability and Accountability Act (HIPPA) is used by government bodies throughout the country to keep secret the health records of even deceased persons.

Mental Illness is a broad term that encompasses as many diagnoses as exist in the DSM 5. I wonder what the prevalence of "schizophrenia" and "bipolar" is among the inmates. -- J. Bailey

We counted 102 inmates with a diagnosis of schizophrenia or schizoaffective disorder who died in jail. For bipolar disorder, we counted 113. Of those, 35 were diagnosed with both. Please keep in mind, however, that's what we could count. I suspect some of the people we included in the database had these diseases -- maybe had even been diagnosed with them -- but we had no indication of that. We did the best we could with the information available.

For more information about the prevalence of serious mental illness in jails and prisons, please see this report by the Treatment Advocacy Center and this report by the Bureau of Justice Statistics.

What alternative custody options exist in southeastern Virginia and how long are the waiting lists? -- Sally Moore

If a mental health facility has a waiting list, then it really isn't a good alternative to jail from the police perspective. It's easier for police to take someone to jail -- and get back to policing -- than to a mental health facility.

There's not really a diversion facility -- somewhere for police to consistently take people in the midst of a big mental health crisis in lieu of jail -- in the area. There may be a few beds open here or there, but the situation fluctuates and most likely if police believe someone in southeastern Virginia needs help or can't be left alone or with family, they're going to jail.

When someone is charged with a crime, a judge may find that the person is not competent to stand trial. That often happens when someone has a mental illness. The judge then will order that person be sent to a state mental hospital to be restored to competency. Currently the wait time for a bed there is two weeks, according to the Virginia Department of Behavioral Health and Developmental Services.

I would like to know how many of them had been offered mental health care or psychiatric assessment and had refused, and if so, whether anosognosia played a part in their resistance to treatment. -- Saundra Schmidt

This is not something we can answer based on the data we collected and what would be publicly available about these cases.

Do you think jails will eventually get inmates help to cope? Maybe with meds or having professionals evaluate them? I suffer from mental illness and often wonder about those suffering behind bars. -- Wendy

There are plenty of solutions out there for jails, city and county governments who want them. It starts with preventing people with mental illness from winding up in jail in the first place, then treating them while they are in jail and when they are released, and finally having accountability when someone dies or is mistreated.

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