Jails are not hospitals
County’s ill-advised plan for competency treatment
Jails have become the new psychiatric hospitals, even though they aren’t cut out for the work. Allegheny County officials would be well-advised to consider this truth as they pursue plans to offer in-house competency treatment to inmates deemed too mentally ill to stand trial. Jails are for criminals. Sick people belong in hospitals, even if the goal is to make them well enough to return to jail one day.
To be sure, county officials deserve credit for trying to resolve a thorny problem. Defendants mentally unfit for trial languish for days or months in the county lockup while waiting for a bed at a state hospital, where competency treatment normally is provided. Calling the delayed access to treatment unconstitutional, the American Civil Liberties Union has, for years, fought with the state to make more hospital beds available.
The county’s proposal is a poor alternative. Providing competency treatment in jail flies in the face of the conventional wisdom about corrections and mental illness. People with mental illness are more likely to get sicker than better behind bars and more likely to rack up disciplinary offenses and serve longer sentences than other inmates.
It’s difficult enough to manage inmates who have some level of control over their psychiatric problems. To care for those too sick even to stand trial is another challenge altogether. Jails are designed to detain people, not treat them.
It’s highly unlikely, as Witold “Vic” Walczak of the ACLU told the Post-Gazette’s Shelly Bradbury, that officials could convert some portion of the jail into a medical unit capable of providing the same level of care as a state hospital.
Other red flags are the legal prohibition against holding a mentally incompetent person in a penal setting and the jail’s checkered record on inmate health care. The jail has struggled to get health care right. There is no reason to believe it could set a high bar for competency treatment.
The dilemma regarding mentally incompetent defendants is a direct result of deinstitutionalization, which simply went too far.
Pennsylvania has shed thousands of beds and closed some hospitals, including Mayview State Hospital in South Fayette 10 years ago, because of the philosophical shift to treating mental illness in community settings rather than institutions.
While the intention was noble, the implementation, in Pennsylvania and other states, has been flawed at best and disastrous at worst. The outpatient treatment system is not strong enough to support all of those needing care, and there aren’t enough hospital beds left to serve those who are severely and chronically mentally ill.
So more people with mental illness end up homeless or turn up in beleaguered jails and prisons.
It has not worked and it cannot work.
No one wants to go back to the days of too many people being too easily and quickly institutionalized. But we need mental hospitals and an adequate number of beds for those who are truly sick.
Instead of moving to provide competency treatment at the jail, the county should join the ACLU in pressuring the state to open more beds in state hospitals. Competency treatment is a state responsibility. The county jail has enough challenges already.