January 19, 2023

Pennsylvania’s jails are becoming de facto psychiatric hospitals
Jails across Pennsylvania are reporting a troubling influx of people with severe mental health issues since the pandemic whom they are ill-equipped to care for, according to the Prison Society’s latest quarterly survey of county jails.

Dear Prison Society Supporters:

Jails across Pennsylvania are reporting a troubling influx of people with severe mental health issues since the pandemic whom they are ill-equipped to care for, according to the Prison Society’s latest quarterly survey of county jails.

Over two-thirds of county jails that responded to our questions said they’ve seen an increase in the number of people with serious mental health issues in their custody. Nearly as many admitted that they don’t have the resources or ability to provide appropriate care for these vulnerable individuals. 

“Pennsylvania’s jails are sounding the alarm about the growing mental health crisis behind bars, desperate for leaders in state government to pay attention,” says the Prison Society’s executive director, Claire Shubik-Richards.

The state’s woefully inadequate mental health system and the stressors of the pandemic are at the root of the problem. Yet elected officials are allowing the situation to persist, even with new resources available to address the extensive gaps in care.

“They just shouldn’t be in jail”

PrimeCare Medical, which provides medical services in over half of Pennsylvania jails, said its own data confirms that serious mental health problems are on the rise. Pamela Rollings-Mazza, a psychiatrist and the company’s chief medical officer, said the severity of mental illness she sees among people in jail is something “I would see if I was working in a state hospital—an acute care hospital.” 

“They just shouldn’t be in jail,” Rollings-Mazza said. “County jails have become in essence the de facto hospitals. And they’re not designed to be that."

Dozens of county jails contacted by the Prison Society said they lack enough mental health providers, appropriate housing, and training to manage the overwhelming numbers of people in crisis. In Crawford County, the jail’s eight intake cells have become a makeshift “mental ward,” where corrections officers keep watch on up to a dozen detainees deemed at risk of suicide or who show signs of mental illness. 

“We have nowhere else to put them,” said Crawford County Warden Jack Greenfield.

Often, the only alternative is to try to commit people with serious mental illness in jail to a local or state hospital. But, “nine out of ten of the local hospitals will refuse our patients because they're inmates,” Rollings-Mazza said. And beds in the state’s two forensic hospitals are in short supply—combined, they have only about 360 beds for the entire state. Jails report that incarcerated people endure months-long waits for a placement and must pass an onerous bureaucratic process to be admitted.

As they languish in jail, people with mental illness deteriorate and may be subjected to further mental and physical trauma. In rural Fayette County, Deputy Warden of Treatment Angela Kern said they are typically kept isolated within the “small cells and bars” of the Victorian-era jail, because the jail has no other place to keep them safe. Over time, she said some fall into a deeper depression, refusing to take their medication, eat, or bathe themselves.

In the worst cases, people with serious mental illness face a very real risk of death in jails, whether by suicide or at the hands of correctional staff. Rollings-Mazza said they can get into trouble when they are unable to comply with the rules that order prison life. 

“If you’re a patient who’s actively psychotic and is not in touch with reality, it’s hard to understand why you have to follow a time frame, and you have to eat at this time," she said.

Nearly 1 in 3 “use of force” incidents reported by Pennsylvania county jails involve a person experiencing a mental health crisis or with a known mental illness, according to an investigation by WITF and NPR. One of them was Ishmail Thompson, who was pepper-sprayed and placed in a restraint chair with a spit hood over his head when he wouldn’t cooperate with staff in the Dauphin County jail. With the hood covering his face, the 29-year-old stopped breathing and was sent to the hospital, where he later died. 

Stalled pandemic relief funds can help

When they passed the state budget last summer, lawmakers designated $100 million in federal pandemic relief funding to shore up mental health care. But by year’s end, they still hadn’t approved a spending plan for the funds, even after a behavioral health commission appointed for the task published detailed recommendations. The commission’s report recommended $23.5 million go toward helping people involved with the criminal justice system, including expanding treatment resources in county jails, pre-arrest diversion programs, and crisis intervention training for law enforcement officers. 

Rollings-Mazza said a shortage of community providers and the disruption of services during the pandemic set the stage for the mental health crisis in jails. The recommendations for the rest of the $100 million would help address this issue, expanding treatment in the community and building up the mental health workforce.

The Prison Society’s executive director calls on elected officials to authorize the spending without delay. “With legislators back from recess and a new governor sworn in, Pennsylvania's leaders need to approve these much-needed resources with the urgency this crisis demands,” Shubik-Richards says.

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