The demographics of people in jails and prisons no longer surprises most of us. While African Americans make up 12% of the total U.S. adult population, they make up one third of the prison population. On the other hand, Caucasians make up two thirds of the total U.S. adult population, and only one third of the prison population. The population is also disproportionately men, specifically men in their young twenties.
They are also frequently mentally ill. Among local jail populations in Maryland, 63% of men and 75% of women suffer from mental illness. This is significantly higher than the global averages of 20%.
Dr. Mercedes Hernandez, Director of Mental Health at the Prince George’s County Correctional Center in Maryland, estimates that at least one third of the jail’s population struggles with mental illness. Of these patients, Dr. Hernandez says about “60% have a dual diagnosis with substance use disorder.” Her colleague, Dr. Meskerem Asresahegn, a physician of Prince George’s County Correctional Center, says they are constantly making cost-benefit analyses regarding which inmates need care because of limited space in the infirmary. She says that she “cannot give the care [she] would like to because there are so many mental health patients with more immediate needs.”
Prince George’s County Jail is a “new generation jail.” It is only 30 years old, and its design involves remote surveillance. In typical units, double occupancy cells are clustered around a common area and a secure control booth from which an officer observes inmate activity. These “new generation” jails aim to have effective supervision, more competent staff, increased staff and inmate safety, manageable and cost-effective operations, improved effective communication, better classification and orientation, and just and fair treatment of inmates. However, when it comes to the treatment of mentally ill the jail is still lacking in resources.
Prince George’s County is not alone.
In Maryland, 5,200 inmates were diagnosed with mental illness in 2017. A 2018 report by the National Conference of State Legislatures estimates that the percentage of seriously mentally ill inmates are likely to be higher – about four to six times higher than the general population. Nationally this would mean that in local jails across the country, approximately 2 million inmates have serious mental illness.
A 2016 Treatment Advocacy Center report found that in Maryland, the likelihood of incarceration instead of hospitalization is 2.6 to 1. This is due in part tothe continual shrinking of available hospital beds in Maryland. While the nationally accepted best practice is for psychiatric hospitals to maintain 50 beds per 100,000 people, hospitals in Maryland only have 15.5.
This national trend started in 1963 with President John F. Kennedy’s Community Mental Health Act. Though implemented to destigmatize mental illness and move patients out of hospitals into community clinics around the country, many communities were not able to keep up with demand, and almost half of the planned clinics were never built. The result has been a terrifying re-institutionalization of the mentally ill into prisons.
Communities need greater support for their mentally ill and both Dr. Hernandez and Dr. Asresahegn agree that this is true for Prince George’s County. Many of Dr. Asresahegn’s patients have known her for almost 18 years because their recidivism rate is so high. While these patients are in her care, she says, the doctors at Prince Georges County Jail are diligent about making sure inmates are taking their medications properly and receiving the services they need. When these patients are released back into the community, they are typically unable to find their medications, doctors who will support them, and even proper housing.
As a result, they often end up back in a cell.