Too Little Bills, Too Many Bars

We’re all familiar with the budget cuts that are causing havoc within the Texas legislature at this point. Who isn’t aware that Texas is facing a $27 billion dollar shortfall. As of May 4, 2011, the Senate passed their version of the state budgets. While the Senate version is more generous than the House version of the budget (they plan on spending $12 billion more than the House), every state agency will take a hit. While I’m sure we have all heard about the impending budget cuts that will be affecting the Texas public school systems, what we haven’t heard about is how budget cuts will affect the prison system. For a system that already is short on funds, further budget cuts will be extremely detrimental, especially on already underserved populations such as prisoners with TBI or PTSD. The House version of the budget would result in a 16.5% gap between what TDCJ requested and what is provided by the House budget. The House budget plans on cutting funding for providing services for prisoners with special needs (including those with PTSD and TBI) by 45.1%. Imagine the impact this will have on services!
Join in the discussion on budget cuts to our prisons by checking out these sites for more information related to the proposed budget cuts to Texas state prisons:

Interim Digest

brokenchains.us/tdcj/prison-issues/budget.html


Texas Tribune: Procedural Move Allows GOP to Pass Senate Budget

Texas Tribune: Advocates -- Prison Health Cuts Will Prompt Lawsuits


TCJC: Impact of Cuts Under HB 1

Time Article: Decriminalizing Mental Illness

This article from 2007 does a great job of re-iterating (well, pre-iterating, I suppose) the problems with the fact that we don't have a functioning mental illness infrastructure in this country. As we've said in this space before, it takes a lot more money to imprison the mentally ill than it does to treat them: "Taxpayers in Miami-Dade County spend $100,000 each day to house the mentally ill in prison; moreover, studies show that people with mental illness stay in jail eight times longer than other inmates, at seven times the cost."

It also includes a short history of policy in the United States that goes into a little bit more detail than "Reagan closed the state hospitals in the 1980s," including the nugget that President Kennedy signed a bill in 1963 to create the first national network of mental health facilities. But then he was assassinated, the Vietnam War distracted us, and the project was never funded.

Solutions: Transcendental Meditation

Check out this article about transcendental meditation behind bars. It doesn't discuss mental health or PTSD specifically, but there is evidence that Transcendental Meditation can be helpful in treating the symptoms of PTSD, and also evidence that it helps with anxiety in general.

Sin or Symptom: Does it Matter?

The Brookings Institute (another centrist think tank) has an article by Stephen J. Morse in their "Future of the Constitution" series that presents an interesting counter-argument to the statement that serves as the inspiration for the title of the blog. If scrolling down is to much trouble, allow me to remind you: “The difference between a crime of evil and a crime of illness is the difference between a sin and a symptom.”

Morse recounts the story of a man, Collera, who has a long history of violence and anti-social behavior. Collera is driving one day, and gets into one of those maddening situations where you're stuck behind a slow vehicle and can't pass. But instead of cursing and shaking his fist and maybe flipping off the guy in front of him, Collera commits vehicular manslaughter.

The article goes on to establish that Collera has a genetic profile that is associated with anti-social conduct when paired with severe abuse. The genes in question affect neuro-transmitter levels in a region in the brain that is associated with behavior regulation. And, it just so happens that Collera is indeed the victim of severe abuse.

Now, to be fair, Morse does state that Collera's evaluation results "make no mention of disease or disorder." But the point seems a minor one. Whether the brain abnormality is the result of genetic predipostion or damaged tissue (as in the case of TBI), the salient point is that the person's biology, their physiology, has an effect on their behavior.

Morse argues that, "Human beings are part of the physical universe and subject to the laws of that universe, but, as far as we know, we are the only creatures on earth capable of acting fully for reasons and self-consciously." He warns that, as our genetic and neurological-imaging knowledge and technology progresses, it may eventually undermine "all ordinary conceptions of responsibility and even the coherence of law itself."

His point is, essentially, that this knowledge undermines the idea of free will. And it does -- or it could. Implicitly, it seems like he's arguing that we shouldn't put too much stock in this technology, or this knowledge, because it goes against everything we've believed about ourselves up to now. I think that's the wrong response, though.

First of all, I disagree with Morse when he says we're capable of acting "fully for reasons and self-conciously." I think we all dearly want to believe that we're "rational human beings," but actually we're mostly "dumb animals," with a veneer of rationality on top. Much of the time, I think we use that rationality to explain our actions to ourselves after the fact, rather than actually acting rationally in the first place. This isn't a criticsm, so much as it's an observation.

Second of all, instead of ignoring the unpleasant fact that physiology has an impact on behavior, it seems to me that we're better served by using this knowledge as much as we can. Instead of waiting until someone has committed a crime and then squirming with the truth that it's actually not surprising given his history and physiology, shouldn't we instead try to figure out who is at high risk ahead of time, and give them tools to deal with their disability? Because, for all that it's invisible, and behavioral, surely a genetic or neurological pre-disposition to violence is as much a disability to be coped with as, say, diabetes. And we don't imprison people for that.

What Happens when Mentally Ill Prisoners Become Mentally Ill Citizens

The Urban Institute is a think thank that was formed in 1968 as an outgrowth of President Johnson's awareness of a "need for independent nonpartisan analysis of the problems facing America's cities and residents." A listing of U.S. Think Tanks by Ideology from Spero News lists the Urban Institute as "centrist," which seems like a fair assessment, based on my admittedly surface-level inspection. If anything, a somewhat left-leaning bias might be evidenced by what they research, though now how. That is to say, they concern themselves with social issues, rather than concentrating on economics or foreign policy.

Anyhow, The Urban Institute published a report in 2008 examining health and re-entry. They looked at Physical Health, Mental Health, and Substance Abuse. They're a national think tank based in Washington, D. C, but they did their data collection in Texas (and Ohio).

The results are interesting, they're sobering, but in many respects, they're not really surprising. Here are some highlights (or lowlights):

Prevalence

• 6% of men and 18% of women had the trifecta -- a physical illness, a mental illness, AND substance abuse.
• Fifteen percent of men and 35% of women reported mental health conditions, based on self-report data. The authors of the study estimate that the actual prevalence is double that.
• About 40% of respondents did not receive any treatment for their mental illness while in prison.
• About 16% of men and 31% of women self-reported PTSD

These numbers are roughly in line with our previous research. The one number that jumps out at me as being incongruent is the 12% of female prisoners that we reported as having "Serious Mental Illness," as opposed to the Urban Institute's number of 35%. There are a couple of possible reasons for this discrepancy. The first is that the 12% number actually comes from jail detainees. Whoops -- that's an oversight on our part (and one I've noted in the earlier post). The other difference is that the 12% figure refers to serious mental illness, defined in the NIJ report as acute symptoms of schizophrenia, major depression, and/or bipolar disorder. The Urban Institute's criteria for mental illness was presumably broader. And of course, the assessment methodology was different, too. Generally speaking, research about mental illness in jails and prisons is thin on the ground, which is why we've typically pulled percentages from only one study each. It's almost surprising that our numbers match The Urban Institute's as well as they do.

The Urban Institute's report, though, isn't just about prevalence. It's concerned with the re-entry experiences of folks with mental illness (and physical illness & substance abuse). Here's what they found in that regard:

Effects of Mental Illness on Re-entry

• "Respondents with mental health conditions reported poorer outcomes in most domains." In other words, as much as it sucks when you're trying to re-integrate into society to have a physical illness or a substance abuse issue, it sucks more to have a mental illness. It's worth noting that TBI was not on the list of the Urban Institute's physical illensses.
  
• Mentally ill people of both genders had more problems finding a place to live after release than those who weren't mentally ill. Interestingly, the timing of this varied by gender -- men were more likely to be homeless 8-10 months post release, and women were more likely to be homeless 2-3 months post-release. For both, at 8-10 months post-release, the homeless rate was about 20%. It's just that for women, this was the same as folks without a mental illness. Which is chilling in its own right.
• Part of the reason for the increased homelessness is less family support for the mentally ill. And part of the reason for that is violence -- the mentally ill folks were more likely to have been the victims of violence, and to have perpetrated violence, than those who weren't mentally ill.
  
• By three months out of prison, only about 36% of mentally ill men & 26% of mentally ill women had found employment. This was much lower the the rates by non-mentally ill folks.
• And finally, mentally ill men & women were more likely to engage in post-release criminal behavior, which isn't surprising, given that they're having problems finding places to live and jobs to support themselves.

Policy Implications

The Urban Institute had a number of policy recommendations, but for the most part, it boils down to case management services, starting well before a prisoner's release date, and including linking them to support services that exist in the community, as well as things like Medicaid and SSI Disability. Sounds like a good idea to me.