Not too long ago my wife and I were watching a documentary about a jail.  We witnessed the behavior of an obviously mentally ill inmate and I was asked “don’t they have a separate place where they can help medically with a person like that?” I had to stop and give thought to what may be a normal occurrence to me but may seem very out of place and even cruel to someone with no experience with anyone who has ever been incarcerated, yet alone been to prison themselves.  

Most of you know that I was once a heroin addict and I was also in and out of prison in California during most the 1980’s ….and not as a volunteer back then, so I know whereof I speak.  My wife and I also spend many hours every week within two prisons in South Texas and I have spent a lot of time with inmates, staff, wardens, volunteers, and chaplains and let me say before I get too deep in my thought process that during that time I’ve witnessed many good things happening when it comes to helping the incarcerated. But I started to think about the correlation between the availability of drug rehabilitation and mental health services to low or no income people and how that effects the incarceration statistics.  

As a child I can remember people talking about insane asylums or mental health facilities, but as an adult I don’t hear about them anymore. What happened?  Long-term care facilities and psychiatric beds have disappeared over the past few decades, sparked by a trend toward deinstitutionalization of psychiatric patients in the 1950’s and 60’s, says Dominic Sisti, Director of the Scattergood Program for Applied Ethics of Behavioral Health Care at the University of Pennsylvania.  For many low-income patients, Medicaid is the only path to mental health care, but a provision in the law prevents the federal government from paying for long-term care in an institution.  A severe shortage of inpatient care for people with mental illness is amounting to a public health crisis.

I was amazed at a study by Mental Health America, which ranked every state according to the availability of mental healthcare versus the incarceration rate in each. Basically, the states with less access to mental health care have more adults who are in the criminal justice system. Six out of 10 states with the least access to mental health care also have the highest rates of incarceration, Texas being among them.

Often their involvement with the criminal justice system begins with low level offenses like vagrancy, trespassing, disorderly conduct etc. So where do all these people go?

Looking at drug and alcohol addiction and what is available to battle this epidemic is even more of a disaster. Now don’t get me wrong, if you have insurance and or money, mental healthcare and/or programs to treat drug or alcohol addiction are readily available, though I’m not real sold on the level of care in many of the very costly drug and alcohol programs available.  

A couple of years ago we placed a family member in a 28-day drug program in the Texas Hill Country and this may be a shock but insurance paid over $35,000 for that short stay.  Mental healthcare is usually far more expensive.  If you were to do a Google search for low-cost drug rehabilitation, well lets just say once you do the leg work and dig in there is very little available and most of those that are available are usually provided by inner city churches. Again, don’t get me wrong any help is good especially if you are killing yourself with drugs or alcohol.

Statistics on drug and alcohol addiction are quite shocking. In 2017, an estimated 20.7 million people age 12 and older needed treatment for a substance use disorder. Only 4 million people received treatment, which is about 19% of those who needed it. One of the evils of addiction is how deceiving it is to those who are addicted.  For example, of the 18 million people who needed but did not receive treatment for substance use only 1 million or 5.7% of those people felt they needed treatment. Knowing this, you can see that admitting you need help is the toughest battle and having access to mental healthcare to get to that point can be a game changer for a large group within our society. 

Where am I going with all this? Of the 2.3 million people in America who are currently incarcerated more than 65% meet the criteria for addiction. Around 75% of incarcerated individuals who suffer from a mental illness also struggle with substance abuse, and the opposite is also true.  So in asking where do all these people go I can tell you that a very large number end up in the state level prisons and jails. Not taking anything away from these correctional facilities, but this is not necessarily a good place to be when you are struggling with mental health issues or addiction.  When you look at Texas prison employees for example and see that the starting pay for most of their employees is around $17.50 an hour and the only requirements are a high school diploma and a clean record, it is easy to assume that they probably don’t have the required skills or mindsets to be able to help these individuals. In addition, the turnover rate for these employees is 42% during their first year.   The better the economy gets the harder it is to fill these positions (many of these employees leave for jobs in the oil fields that pay much better).

In conclusion, addiction is considered a highly treatable disease and recovery is attainable. I know this because I have been there and done that.  About 10% of American adults who are at least 18 years old say they are in recovery from alcohol or drug abuse but due to lack of funding in these areas we are pushing the majority of individuals who suffer from mental illness and drug addiction into our correctional institutions (out of sight out of mind) where little if any professional help is available.

You may be asking yourself at this point “why is this even my problem?”  Look at it this way – 95% to 98% of the 2.3 million people in prison are coming home eventually and they will be moving in right next door, but don’t get too worried because chances are 65% of them will return back to prison within three years of their release if they don’t get help. Your co-worker, wife, son, brother, sister, mother, uncle, father, friend, husband may be one of them. We all know someone or even have someone in this revolving door program and there are many of us who lost loved ones along this journey.  The first step in helping them is awareness.

For more information:  

American Addiction Centers

Mental Health America

Texas Department of Criminal Justice

Bureau of Justice Statistics

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