How coordinated care can help the justice system, jails and the mentally ill in Los Angeles

Los Angeles county is home to Twin Towers Correctional Facility. It’s an enormous concrete structure downtown, not far from the city civic center. Unlike buildings surrounding it, the correction facility has only concrete facades where windows should be. It looks incongruous and intimidating.

Twin Towers houses approximately 3,900 inmates, according to Lt. Joseph Badali, a supervisor with the LA Sheriff’s Department, speaking with National Public Radio. But that’s not enough space for the county. In fact, Los Angeles is considering constructing a new jail, NPR reported. This one would specifically provide treatment and living space for mentally ill inmates. But the proposal is likely to cost more than a billion dollars.

But the new facility might be essential. According to Badali, the majority of the inmates in Twin Towers are mentally ill. NPR cited a study estimating that there are about 2.1 million bookings of individuals with serious mental illnesses into jails each year. The number currently incarcerated in state and federal prisons is significantly larger.

But the question is whether these individuals belong there – and if moved to mental health facilities, what should the discharge management procedures be for mentally ill former felons who are reentering the community?

The de facto mental institution

The move toward community-based healthcare that began in the 1960s and 1970s helped shift the conversation on mental health, removing some of the stigma that large state hospitals – often with poor living conditions – had thrown on mental illness. But the Community Mental Health Act, as proposed by President Kennedy, didn’t come to fruition as intended. Lack of funding, facilities and professional expertise meant that many state-run communities fell apart or failed to come together, leaving, as NPR put it, the mentally ill to wander the streets. For many, trouble ensued, leading to incarceration. According to the news source, jails have to take mentally ill offenders in, but they can’t force inmates to take medication.

The LA County jail system is the largest de fact mental institution in the nation, according to NPR. The Twin Towers hospital opened in 1977, around the time of de-institutionalization ushered in by President Kennedy’s delayed Community Mental Health Act. Only around 30 inmates actually get treatment, today, even though jail officials acknowledge that the need is significantly larger.

Sara Hough, Ph.D., a psychiatrist with the Twin Towers told the news source that, as a member of the Department of Mental Health, her role isn’t to judge incarcerated patients for their crimes, but to treat them. It’s not an ideal situation, but some patients are receiving treatment.

But, according to Los Angeles Times columnist Steve Lopez, the current situation is not nearly good enough.

Lopez has written about mental illness extensively, but a recent July 2013 story in the LA Times highlighted the conditions in the LA County jails. His nightmarish descriptions include overflowing holding cells and the mentally ill grouped in with the general population – increasing their chances of sexual victimization by fellow inmates.

According to Lopez, it may be common knowledge that LA County jails are de facto mental hospitals, filled with patients not actually receiving treatment, but that doesn’t excuse the system. Failure of public policy persists, he noted in his LA Times story, and it’s costing the public significantly.

Proposals and initiatives

Mental health and crime has risen to the forefront of the national conversation yet again following the September shooting in the Washington D.C. Naval Yard. The gunman, Aaron Alexis, had been showing signs of poor mental health for a decade before the incident, according to The New York Times.

While the new billion dollar mental health facility for inmates in LA County’s jail system would offer better services to the mentally ill and incarcerated, a better solution may be to create preventative measures. By realizing – with the help of technology – a modernized version of the Community Mental Health Act’s intentions, the prospect of reducing crime by the mentally ill and keeping them out of jail becomes a reality.

With the help of behavioral health software, coordinated care platforms can be erected. These will join primary care doctors with substance abuse specialists, mental health experts, family, the justice system and psychiatrists to improve every stage of healthcare, including discharge management, so mentally ill individuals can rejoin communities in ways that are safe for themselves and the public.

Changes, such as those made by the Patient Protection and Affordable Care Act, are on the horizon and should improve care for the mentally ill in coming years. But even without much behavioral health funding, modern technology has helped facilitate better care through the hard work of mental health professionals.

These advances and programs like the LA nonprofit organization Integrated Recovery Network, a group highlighted by Lopez that helps inmates find supportive services following release, including mental health counseling, are making all the difference.