Dashawn Carter, a 25-year-old from Staten Island, missed nearly 100 medical appointments while detained at Rikers Island — mostly because corrections officers 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 had been detained in the general population despite an extensive history of mental illness and a stay in a psychiatric hospital just two days before his death.

“He had no support system,” Carter’s high school friend Ray Robinson told The City. “He just had to really rely on himself and the people around him.”

This type of neglect is all too common and a direct consequence of the criminal justice system often acting as the primary point of intervention for people’s mental health needs. In the United States, people with serious mental health problems are more likely to have contact with law enforcement than to receive any form of treatment. Furthermore, ten times more people are held in prisons and jails than in state hospitals – a number partly rooted in disinvestment, with the number of state hospital beds shrinking by 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 those centers have ever been built, and governments have failed to invest money in programs like crisis response teams or treatment options. Instead, funding has flowed into the jail and prison systems, which are now the nation’s largest providers of mental health care.

But prisons and jails are not inherently therapeutic environments, and they are woefully ill-equipped to provide these services. About three in five people with a history of mental health conditions do not receive treatment while in prison. They are also more likely to face discipline and spend three times longer in solitary confinement. The trauma of incarceration, coupled with a lack of adequate treatment and reentry resources, creates a revolving door in which people with mental health conditions are unable to stabilize their lives.

This is bad policy: mental health services accessed outside jails and prisons are not only more effective, but also more cost-effective than incarceration. Failure to invest in treatment comes at a direct cost to people’s ability to live their lives, yet officials continue to pour more money into prison and jail systems completely unable to address basic mental health needs. People with mental health needs are by no means a threat to public safety – in fact, they are more likely to be a victim of a crime than a perpetrator. Imprisoning people who need treatment is both unjust and destabilizing, subjecting them to the trauma of incarceration without adequate services. This is the real danger to public safety.

In Los Angeles and New York City, Vera is working to address acute mental health crises in local jails. In both cities, significant investments in mental health services can increase 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 increased 21 percent since 2020, part of a decade-long increase in the number of people with serious mental health conditions in county jails. The LA jail system is the single largest mental health facility in the United States, and the county spends $548 a day to incarcerate people in mental health units, despite a cost of only $207 a day to incarcerate them. placed them in community-based housing and treatment.

“By default, we have become the largest treatment facility in the country. And we are a prison,” Tim Belavich, director of mental health care for the Los Angeles County jail system, told WWLP. “I would say that a prison is not the right place to treat someone’s mental illness.”

But according to a study by the RAND Corporation, 61 percent of inmates with mental health conditions can be safely diverted to existing alternatives to incarceration, such as the Office of Diversion and Reentry (ODR) Housing program. Prison actually increases the likelihood of recidivism, trapping people with mental health needs in a vicious cycle of incarceration without ever offering them treatment. In turn, community-based diversion programs build public safety and reduce incarceration rates by meeting basic needs. There is no public safety reason to continue to keep people in jail instead of making sure they get the treatment they need.

The ODR Housing program is extremely effective. It provides permanent supportive housing and intensive clinical support to people with serious mental health needs charged with crimes in lieu of incarceration. The program’s model recognizes that the path to stability is not linear and treats housing as a key pillar of success. Even if a client has another interaction with the criminal justice system, ODR works to get them back into the program with the agreement of the prosecutor and judge. Some of the program’s most successful clients needed multiple opportunities to reengage. This sustained support ultimately addresses two of the most pressing issues in the county: homelessness and the revolving door of the criminal justice system. One study found that 86 percent of participants had no new felony convictions after 12 months and 74 percent had stable housing after 12 months.

These promising results require support. However, ODR is underfunded. Investing in 3,600 new mental health treatment beds, including ODR Housing clients, would reduce the county’s reliance on the jail and advance its goal of closing Men’s Central. ODR’s success to date shows that those new beds and services would reduce recidivism in Los Angeles by providing people with options that help stabilize their lives instead of incarcerating them when they need treatment. The Los Angeles County Board of Supervisors will issue a supplemental budget this September, a key opportunity to invest in a program that could serve as a national model.

New York City: Shrinking prison budget could build more supportive housing

Rikers Island is facing a mental health crisis. Fifty-three percent of people held at the jail complex had a mental health diagnosis in FY 2021, up from 46 percent a year earlier. Cases of self-harm have increased as a result of the ongoing humanitarian crisis in New York City’s prisons that killed 16 people in 2021 and claimed 11 more lives already this year.

As in Los Angeles, treatment in New York City’s jails is grossly inadequate or non-existent. Despite a $2.7 billion budget, the city’s Department of Corrections (DOC) constantly 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 health problems are also subject to punitive treatment and longer stays in New York City jails. The average length of stay for the general population at Rikers Island is 222 days. People in DOC custody for 24 hours or more who receive mental health treatment, however, are held for an average of 357 days, or 61 percent longer.

The city has pushed to create new secure mental health units at Rikers. This solution is fundamentally inadequate, as prison environments are incompatible with the treatment required to meet mental health needs. And despite a bloated budget, DOC has delayed bringing this deeply compromised solution online.

Instead of pouring money into programs that will continue to fail New Yorkers with mental health conditions, 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, it costs just $41,833 per person per year to provide supportive housing.

The city can and should invest in therapeutic services that enable 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 arrest. 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 involvement with the criminal justice system and hospitalization in the first place.

Dashawn Carter should still be alive today. Smart investment that meets mental health needs in the community, rather than in prison, will build safer neighborhoods across the country and reduce our failing reliance on incarceration.

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