Time Bombs on the Streets : Mental Health: Our county jail houses more mentally ill people than the largest hospital. Treatment is essential.

The Los Angeles County Jail has become the largest unofficial mental hospital in the United States. According to professionals who have worked there, 15% of the jail’s approximately 24,000 prisoners--3,600 individuals--are seriously mentally ill with schizophrenia or manic-depressive illness. Those individuals total 641 more than are held in America’s largest medical facility for the mentally ill, Pilgrim State Hospital in New York. The 3,600 mentally ill individuals in the Los Angeles County Jail are, in fact, the same number as the total held in California’s four state hospitals (Napa, Patton, Camarillo and Metropolitan). Each day, seven days a week, approximately 1,000 new prisoners are booked into the Los Angeles County Jail, of which 150 are seriously mentally ill; there is no other psychiatric facility in the world that admits 150 new patients each day.

The situation in Los Angeles is part of a national trend, one of the consequences of having abolished 80% of all state mental hospital beds since 1955 without adequate follow-up and outpatient care for patients being released.

America’s jails and public shelters have become the new mental hospitals. Several studies in different parts of the country have shown that approximately 10% of all jail inmates and 30% of all public shelter residents suffer from schizophrenia or manic-depressive illness. These are now known to be disorders of the brain, like Parkinson’s disease, multiple sclerosis or Alzheimer’s disease.

The situation in Los Angeles County is more serious because its public mental-health services have for many years been among the worst in California. Budget cuts within the last year have decimated outpatient services and pushed the system to the point of collapse. Even the nationally recognized Skid Row Mental Health Clinic at Sixth and San Pedro streets has lost half of its staff within the last year. In October, for the first time, the clinic no longer had the staff to run outreach teams to treat homeless mentally ill people living on the streets and in the parks; many of these untreated individuals will end up in County Jail.

Most individuals with serious mental illnesses are not dangerous if they are treated; studies have shown that the crime rate for the treated mentally ill is lower than that for the general population. If they are not treated, however, some individuals with mental illnesses do become violent. They do so because they believe that others may be trying to hurt them so they strike first, or they may be ordered by “voices”--auditory hallucinations--to commit violent acts. Or they may simply be so confused that they are unable to act logically.

In 1983, Dr. Richard Lamb at the University of Southern California followed up 85 seriously mentally ill persons in Los Angeles County who had been charged with crimes. Of this group, 92% had been arrested for felonies (the majority for murder, attempted murder, rape, armed robbery and assault with a deadly weapon) and 86% had had previous psychiatric hospitalizations. Yet two years after their arrests, 64% had been released and, in more than half of the cases, there were no plans for follow-up or treatment.

The situation is significantly worse now than it was in 1983. Each day, seven days a week, the Los Angeles County Jail releases approximately 150 seriously mentally ill individuals who have been charged with crimes. There is nowhere to refer them for outpatient care because the county clinics are already full. Families are often frightened of them, knowing that these people will deteriorate without their necessary medications.

The situation in Los Angeles County is on a collision course with catastrophe. Violent episodes are not merely threats or probabilities, they are statistical certainties. And the greatest tragedy of all is that such episodes are completely preventable.