One could argue many people who end up incarcerated have some sort of mental health problem. They may have turned to drugs to self-medicate and gotten crossways with the law. Someone who kills a high school football coach or smiles when a judge delivers a harsh sentence isn’t right in the head.
One might also argue that it is no coincidence that while the number of patients in psychiatric facilities has plummeted, the number of people in prisons with mental health problems has skyrocketed. As the United States moved away from institutionalization for the mentally ill, Iowa prisons became de facto mental health institutes.
The Des Moines Register editorial board was reminded of this by a recent article in the Wall Street Journal titled “The New Asylums: Jails Swell With Mentally Ill.” The newspaper surveyed the corrections departments in all 50 states about inmates with mental health problems. Of the 23 states that responded, Iowa had the highest percentage of prisoners with a mental health issue — an astounding 51 inmates out of every 100. That’s more than twice the percentage in California and four times more than in South Carolina.
Why is mental illness so much more prevalent in Iowa prisons?
It appears other states may have only reported personality disorders, said Fred Scaletta, assistant director of the Iowa Department of Corrections. “In Iowa, the percentage for just those offenders is 28.4 percent,” he said. Yet if Iowa had reported only offenders with diagnosed personality disorders, the state still would have a higher percentage of inmates with problems than 15 of the 23 states, according to the Journal’s reporting.
The other reason Iowa might stand out nationally: This state does a better job than other states of identifying offenders with diagnosed mental illness upon entry into the prison system. Then the state tries to help them.
In addition to maintaining several mental health units, the state coordinated more than 11,000 appointments for inmates using a videoconferencing system to connect them with mental health professionals. It worked to extend mental health services to former inmates, too. Iowa will soon be facilitating services to offenders in community-based corrections. A new pilot program provides three months of psychotropic medications to recently released and discharged inmates.
Iowa’s corrections system deserves credit for all this, yet the prisons can only do so much. This state must do a better job of connecting Iowans struggling with mental illness to health services so they do not end up in prison in the first place. Integrating mental health services into the larger health care delivery system will improve access to care and remove the stigma of mental illness.
After many years, there is hope. The Iowa Legislature reformed Iowa’s county-based system that delivered mental health services to the uninsured. Unfortunately, Gov. Terry Branstad vetoed an appropriation for $13 million to help counties continue to offer services as they transition to the new system. That was a shortsighted move that will only cost Iowans money elsewhere when these people do not have access to care.
Also, the health reform law will provide previously uninsured Iowans with health coverage to pay for care. This may encourage hospitals, with an established infrastructure across the entire state, to offer more mental health services, including crisis response teams and mental health units.
Iowa ranks near the bottom nationally for the number of psychiatrists per capita. In addition to trying to attract more students to psychiatry as a profession, medical schools should do a better job of training all medical students to treat mentally ill patients. When a psychiatrist isn’t available in rural Iowa, family physicians need the knowledge to help these patients.
In the meantime, Iowa’s prison system needs adequate funding to be both incarceration facilities and mental health institutions. The goal of corrections is to rehabilitate offenders so when they are released, they are no longer a threat to the rest of us and can go on to live productive lives. A big part of that rehabilitation is helping those with mental illness. That requires resources.