Community Mental Health Services in the Community Jail Eric D. Nielsen, M.S.W.*
ABSTRACT: A frequently neglected group of community residents are those who find their way into jail. Jails tend to be the collecting point for many disturbed persons. This paper briefly describes the problems of the jail population and staff and suggests a policy of mental health intervention. To illustrate these points, the Mental Health Project in the Salt Lake County Jail is described as an example.
It is a commonly accepted fact that crime is a major growing social problem in the United States. In response to this growth there is an ever-increasing number of persons arrested and placed in local jails. Thus the community jail becomes an institution through which passes a variety of people, many of w h o m are in need of mental health intervention. WHAT IS A JAIL? There are between 15,000 and 41,000 jails in the United States (Fox, 1972). These institutions range in size from cage or tank type, sometimes found in smaller cities to the large city jails, housing thousands, such as the Los Angeles Jail. The 1970 Jail Census surveyed 4,037 jails and found that on the date of the survey 160,863 persons were incarcerated in them (National Jail Census, 1970). Although m a n y such persons are awaiting trial, it is interesting to note that commitment of convicted persons to jail exceeds commitment to prison by about 10 to 1 (Taft & England, 1964). There is a wide range in the size of jails, and there is also a wide variance in their quality. Many authors have described the difficult and often deplorable conditions found in jails (Menninger, 1968; Reckless, 1973). The 1970 Jail Census reported that of the facilities surveyed 13.6% had recreational facilities, 10.8% had educational facilities, 51.0% reported medical facilities, 74.0% reported visiting facilities, and 98.6% reported having toilet facilities (National Jail Census, 1970). Even the more modern facilities tend to be custodial in nature, with maximum emphasis on security. The result is a harsh, depriving environment in which a variety of persons are confined for varying lengths of time. The typical jail is run by the local sheriff and his staff. It is interesting to note that an agency geared toward the detection of crime and apprehension of offenders is also responsible for institutions to which more persons are sentenced, for corrective purposes, than prison. This arrangement points out the *Mr. Nielsen is a dinicaI social worker with Granite Community Mental Health Center, 156 East Westminister Ave., Salt Lake City, Utah 84115. Community Mental Health Journal Vol, 15(I), 1979 00i 0-3853/79/1300-0027500.95 ~) 1979 Human Sciences Press
27
28
Community Mental Health Journal
poorly defined role of the jail in the criminal justice system. Because of the large numbers processed through the jail, it is apparent that it is the most important institution in the criminal justice system; however, it is often the most neglected. WHO COMES TO JAIL? Jails detain three general groups of persons: those awaiting trial, those convicted and awaiting sentencing, and those serving sentences. Among these persons, three general types of inmates have been identified. The largest group is comprised of persons frequently described as chronic offenders. These persons have developed persistent maladaptive behavior patterns that regularly lead them to incarceration. The second group is best defined as crisis offenders. These persons have generally functioned in a socially appropriate fashion, but in response to some precipitating stress have decompensated and acted out in such a manner as to come to the attention of law enforcement personnel. The third group is comprised of those persons who are innocent of any crime. Persons in each of these groups may frequently lose, as a result of incarceration, not only freedom, but also family, friends, and job. In general, the jail is the community depository for unwanted, frightened, and marginally functioning persons. A PHILOSOPHY OF MENTAL HEALTH SERVICES IN JAIL The mental health professional is interested in antisocial behavior as a form of psychopathology not because it is antisocial and so labeled by society, but because it is maladaptive (Goldin, 1965). Clearly, the vast majority of persons who find their way into jails are exhibiting maladaptive behavior. In view of the foregoing, it appears that there is a logical basis for hospital and mental health center involvement in local jails. When considering services for local jails, three factors seem to form the basis of a mature agency policy. First is the fact that the jail is in the community. It is a community agency that deals with large numbers of community residents. The fact that the individual is charged with or convicted of a crime should not preclude him from mental health services. In fact, the arrest is frequently a very sound indication of need for mental health services. While incarcerated, the inmate is entitled to adequate health care. This should include provisions for adequate mental health care. An analogy can b e found in mental health services for residents of nursing homes. Many nursing-home patients are also patients of community mental health centers and community hospitals. These patients are not denied services on the basis of their involvement with another agency, that is, the nursing home. Clearly, the residents of local jails are in much the same situation as nursing-home residents. Both groups of patients are involved with other agencies. Both require outreach by the treatment staff. Both are community residents and are entitled to communitybased mental health services.
Eric D. Nielsen
29
Second, 10 times more offenders are sentenced to jail than to prison. This is, ostensibly, for the purpose of changing their behavior. Yet, most jails in the United States are custodial institutions, with no treatment staff employed. Throughout correctional facilities, the professional is not minding the store. The Task Force on Corrections (1967) estimated that the ratio of treatment staff to prisoners is 1:179 nationally. In 1971 a survey noted that for 230 adult correctional facilities only 60 full-time psychiatrists were employed (Silber 1974). These figures point out the difficulty of prisoners having access to treatment staff. The situation in jails is generally much worse, yet more persons are sentenced to jail than to prison. Mental health treatment opportunities should be made available to persons sentenced to jail in order to rectify this situation. Third are the apparent needs of the jail as a community agency. Mental health consultation and education are services that jail staffs require. Jail staffs nationally tend to be inadequately trained in human behavior and frequently are composed primarily of individuals new to the job. Emphasis is on security and management of inmates. Officers typically are ill prepared to recognize and manage difficult inmates, such as psychotic and potentially suicidal inmates. Training that includes mental health concepts and frequent consultation with mental health professionals can serve to reduce the number of offensive incidents and encourage the identification and referral of decompensating inmates to mental health staff. The establishment of such consultation and education services also provides the vehicle by which the system may be influenced. Jail facilities and procedures can and frequently do aggrevate psychological conditions and can contribute to the appearance of psychiatric symptoms where none were evident prior to incarceration. Where unhealthy conditions exist, a mental health staff used as outside consultants and advocates is in an excellent position to encourage modification of the jail environment and procedures. MENTAL HEALTH SERVICES IN A JAIL: AN EXAMPLE Salt Lake County is served by three community mental health centers. Over the last 2 years a mental health project in the Salt Lake County Jail has been developed by the Granite and Salt Lake City Community Mental Health Centers. The Salt Lake County Jail is a maximum security facility capable of detaining 350 persons. The average inmate census is around 280 persons. Yearly, there are between 16,000 and 20,000 persons booked into the jail. The average stay awaiting trial is 34 days. Originally the mental health services offered were on a crisis basis and typically involved hospitalization. This has gradually grown to include a wide range of services. As the scope of the project has grown, many other agencies involved with the public offender have come to rely on mental health staff for treatment and evaluation. Currently the mental health project receives between 90 and 100 referrals per month. Below is a breakdown, by agency, of the referrals received.
30
Community Mental Health Journal
Referral Source
Courts: City, District, and Justice Attorneys: prosecutors and defenders Department of Court Services Jail Administration Public health physician and nurses Self Family Other Total
Percentage
13 6 7 18 27 22 2 5 100
The data suggest that a large number of agencies, as well as the inmate himself, frequently see mental health evaluation or treatment, or both, as beneficial. Although many inmates are not seen beyond one interview, many others engage in a therapeutic alliance that continues beyond their period of incarceration. Approximately 50% of those inmates who are offered treatment contracts while incarcerated continue with this contract when released into the community. Many advantages accrue to this voluntary treatment system. It eliminates the problems of forced treatment, which generally tends to produce poor results (Borgman, 1975). This service makes treatment available to persons w h o are in a transitional state and generally feel a more intense need. The process of arrest and confinement frequently produces anxiety and personal discomfort that is otherwise lacking in the more chronic-offender types. Mental health intervention during this key time can result in psychological movement not possible otherwise. Those inmates who do not continue in treatment u p o n release are often back in jail a few months later and again psychologically and physically available for intervention. Experience with a large number of these persons shows that there is a cumulative effect that is evidenced by (a) longer intervening periods between stays in jail, (b) movement to less serious offenses, and frequently (c) there comes a time when these persons do continue in treatment on their release. Many forms of treatment have been used with inmates. These models have included chemotherapy, hospitalization, crisis intervention, long-term individual psychotherapy, and family and group psychotherapy. The project averages four hospitalizations per month. Of those hospitalized, inmates who are charged with relatively minor crimes are hospitalized at local facilities. Usually this process involves requesting that the charges be dropped in lieu of a civil commitment. Occasionally some inmates become voluntarily hospitalized via a similar process. Other inmates charged with more serious offenses are initially evaluated in the jail and subsequently sent to the Utah State Hospital. Most of these cases involve extended evaluations to determine competency. Initial evaluation in the jail provides a valuable screening device and eliminates inappropriate hospitalizations. Such evaluation frequently leads to consultation with attorneys about how to work with their clients (Sabot, 1971). Family therapy has frequently been the treatment of choice. Particularly where the identified patient is a young man whose attempts to separate from
Eric D. Nielsen
31
the family have involved criminal acts. Time-limited contracts for treatment of these families have assisted the identified patient to find a healthier w a y to separate from the family. It has also provided an avenue to do primary prevention work with younger brothers and sisters. The clinical work in the Salt Lake City Jail has revealed a fairly consistent set of diagnostic categories for the inmates receiving service. Of the referrals seen in treatment or evaluation, the following breakdown shows the type and percentage of problem area: Problem Area
Psychosis Organic brain syndrome Narcissistic personality disorder Other symptoms, i.e., anxiety states and suicidal behavior Total
Percentage
24 4 47 25 100
In addition to direct clinical services to the inmates, the mental health project offers recreational and educational services in the jail. The Salt Lake County Jail, like 85% of the jails in the United States, does not provide recreational facilities. The long stays in a confined environment produce the commonly heard fear that the inmate will accrue additional charges because he feels that he may lose control and attack another inmate or guard. In an effort to provide diversions and to lessen the general level of tension, a mental health recreational therapist provides opportunities for outside recreation activities, such as volley ball. Additionally, there are available table games and a jail library, which is largely composed of donated books solicited by the mental health centers. These activities provide opportunities for diversion and methods by which the inmate may effectively cope with his tension. Soon after the project began it became apparent that the average level of education among the inmate population was the 9th grade. Through contracts with the local school district and the local IBM firm, teachers and tutors were obtained. Students are taught individually and can obtain high school degrees. Although education is perhaps not a direct mental health concern, the level of education and individual proficiency in the three Rs certainly has a direct effect on the individuals mental health and his ability to compete successfully in the labor market where a high school degree is a basic requirement. A concerted effort is made by mental health staff to involve inmate patients in school and other recreational activities. Mental health services have been useful to the jail administration as well as the inmates. The Salt Lake County Jail experiences a high turnover rate, 54.9% in 1975, and at any given time over half of the officers have been employed less than 6 months. Consequently, there is a dirth of experience and knowledge among the officers. In efforts to upgrade the skills of the officers, mental health staff have been providing inservice training geared toward helping officers develop skill in identifying problem behaviors and in management of problem inmates. This training proved useful and has now been included in the State Police Officer Academy for Correctional Officers.
32
Community Mental Health Journal
T h e jail a d m i n i s t r a t i o n h a s f r e q u e n t l y r e q u e s t e d m e n t a l h e a l t h staff c o n s u l tation regarding the management of particularly difficult inmates. Suicidal a n d s c h i z o p h r e n i c i n m a t e s a r e t y p i c a l e x a m p l e s of t h e s e r e f e r r a l s . CONCLUSIONS F r o m e x p e r i e n c e w i t h t h e S a l t L a k e M e n t a l H e a l t h Jail P r o j e c t a n d e x a m i n a t i o n of t h e l i t e r a t u r e , s e v e r a l c o n c l u s i o n s c a n b e d r a w n . 1. Jails are perhaps the single most important institution in the criminal justice system, yet the most neglected. This is particularly true regarding mental health services. Jails, and the inmates they house, are a community responsibility. Because jails and prisoners are generally hidden from public view does not change the fact that there are serious mental health problems in these institutions. 2. Inmates of jails need and have a right to mental health services. It is a paradox that so many persons are sentenced to jail because of behavior problems when jails typically do not have the behavioral-change professionals available for the inmates. The curtailment of personal freedoms inherent in jail incarceration should not preclude having mental health services available. 3. The jail staff is frequently faced with extremely difficult management problems. Consultation and education by mental health workers can assist jail officers in effectively working with such problems. Where problems are discovered, mental health workers as consultants are in an excellent position to effect modifications in the jail procedures and environment. 4. Community mental health centers and community hospitals must take an active role in addressing the problems of jails and the inmate population. As the community resources for mental health services, the staffs of these facilities have an ethical responsibility to reach out actively to the jail community. REFERENCES Borgman, R. D. Diversion of law violators to mental health facilities. Social Casework, 1975, July, pp. 418-426. Fox, V. Introduction to corrections. Englewood Cliffs, N.J. Prentice-Hall, 1972. Goldin, G. D. Role of the psychiatrist in the structure of court services. Mental Hygiene, 1965, Jan., pp. 139-142. Menninger, K. The crime of punishment. New York: Viking Press, 1968. National Jail Census. 1970. Washington, D.C.: Law Enforcement Assistance Administration, 1971. Reckless, W. C. American criminology: New Directions. New York: Appleton-Century-Crofts, 1973. Sabot, T. J. Mental health consultation concerning the competency of the criminal defendant. Community Mental Health Journal, 1971, 7, pp. 223-230. Silber, D. E. Controversy concerning the criminal justice system and it's implications for the role of mental health workers. American Psychologist, 1974, April, pp. 239-244. Taft, D. R., & England, R. W. Criminology. London: McMillian, 1964. Task Force Report: Corrections. Washington D.C.: U.S. Government Printing Office, 1967.
ABSTRACT: A frequently neglected group of community residents are those who find their way into jail. Jails tend to be the collecting point for many disturbed persons. This paper briefly describes the problems of the jail population and staff and suggests a policy of mental health intervention. To illustrate these points, the Mental Health Project in the Salt Lake County Jail is described as an example.
It is a commonly accepted fact that crime is a major growing social problem in the United States. In response to this growth there is an ever-increasing number of persons arrested and placed in local jails. Thus the community jail becomes an institution through which passes a variety of people, many of w h o m are in need of mental health intervention. WHAT IS A JAIL? There are between 15,000 and 41,000 jails in the United States (Fox, 1972). These institutions range in size from cage or tank type, sometimes found in smaller cities to the large city jails, housing thousands, such as the Los Angeles Jail. The 1970 Jail Census surveyed 4,037 jails and found that on the date of the survey 160,863 persons were incarcerated in them (National Jail Census, 1970). Although m a n y such persons are awaiting trial, it is interesting to note that commitment of convicted persons to jail exceeds commitment to prison by about 10 to 1 (Taft & England, 1964). There is a wide range in the size of jails, and there is also a wide variance in their quality. Many authors have described the difficult and often deplorable conditions found in jails (Menninger, 1968; Reckless, 1973). The 1970 Jail Census reported that of the facilities surveyed 13.6% had recreational facilities, 10.8% had educational facilities, 51.0% reported medical facilities, 74.0% reported visiting facilities, and 98.6% reported having toilet facilities (National Jail Census, 1970). Even the more modern facilities tend to be custodial in nature, with maximum emphasis on security. The result is a harsh, depriving environment in which a variety of persons are confined for varying lengths of time. The typical jail is run by the local sheriff and his staff. It is interesting to note that an agency geared toward the detection of crime and apprehension of offenders is also responsible for institutions to which more persons are sentenced, for corrective purposes, than prison. This arrangement points out the *Mr. Nielsen is a dinicaI social worker with Granite Community Mental Health Center, 156 East Westminister Ave., Salt Lake City, Utah 84115. Community Mental Health Journal Vol, 15(I), 1979 00i 0-3853/79/1300-0027500.95 ~) 1979 Human Sciences Press
27
28
Community Mental Health Journal
poorly defined role of the jail in the criminal justice system. Because of the large numbers processed through the jail, it is apparent that it is the most important institution in the criminal justice system; however, it is often the most neglected. WHO COMES TO JAIL? Jails detain three general groups of persons: those awaiting trial, those convicted and awaiting sentencing, and those serving sentences. Among these persons, three general types of inmates have been identified. The largest group is comprised of persons frequently described as chronic offenders. These persons have developed persistent maladaptive behavior patterns that regularly lead them to incarceration. The second group is best defined as crisis offenders. These persons have generally functioned in a socially appropriate fashion, but in response to some precipitating stress have decompensated and acted out in such a manner as to come to the attention of law enforcement personnel. The third group is comprised of those persons who are innocent of any crime. Persons in each of these groups may frequently lose, as a result of incarceration, not only freedom, but also family, friends, and job. In general, the jail is the community depository for unwanted, frightened, and marginally functioning persons. A PHILOSOPHY OF MENTAL HEALTH SERVICES IN JAIL The mental health professional is interested in antisocial behavior as a form of psychopathology not because it is antisocial and so labeled by society, but because it is maladaptive (Goldin, 1965). Clearly, the vast majority of persons who find their way into jails are exhibiting maladaptive behavior. In view of the foregoing, it appears that there is a logical basis for hospital and mental health center involvement in local jails. When considering services for local jails, three factors seem to form the basis of a mature agency policy. First is the fact that the jail is in the community. It is a community agency that deals with large numbers of community residents. The fact that the individual is charged with or convicted of a crime should not preclude him from mental health services. In fact, the arrest is frequently a very sound indication of need for mental health services. While incarcerated, the inmate is entitled to adequate health care. This should include provisions for adequate mental health care. An analogy can b e found in mental health services for residents of nursing homes. Many nursing-home patients are also patients of community mental health centers and community hospitals. These patients are not denied services on the basis of their involvement with another agency, that is, the nursing home. Clearly, the residents of local jails are in much the same situation as nursing-home residents. Both groups of patients are involved with other agencies. Both require outreach by the treatment staff. Both are community residents and are entitled to communitybased mental health services.
Eric D. Nielsen
29
Second, 10 times more offenders are sentenced to jail than to prison. This is, ostensibly, for the purpose of changing their behavior. Yet, most jails in the United States are custodial institutions, with no treatment staff employed. Throughout correctional facilities, the professional is not minding the store. The Task Force on Corrections (1967) estimated that the ratio of treatment staff to prisoners is 1:179 nationally. In 1971 a survey noted that for 230 adult correctional facilities only 60 full-time psychiatrists were employed (Silber 1974). These figures point out the difficulty of prisoners having access to treatment staff. The situation in jails is generally much worse, yet more persons are sentenced to jail than to prison. Mental health treatment opportunities should be made available to persons sentenced to jail in order to rectify this situation. Third are the apparent needs of the jail as a community agency. Mental health consultation and education are services that jail staffs require. Jail staffs nationally tend to be inadequately trained in human behavior and frequently are composed primarily of individuals new to the job. Emphasis is on security and management of inmates. Officers typically are ill prepared to recognize and manage difficult inmates, such as psychotic and potentially suicidal inmates. Training that includes mental health concepts and frequent consultation with mental health professionals can serve to reduce the number of offensive incidents and encourage the identification and referral of decompensating inmates to mental health staff. The establishment of such consultation and education services also provides the vehicle by which the system may be influenced. Jail facilities and procedures can and frequently do aggrevate psychological conditions and can contribute to the appearance of psychiatric symptoms where none were evident prior to incarceration. Where unhealthy conditions exist, a mental health staff used as outside consultants and advocates is in an excellent position to encourage modification of the jail environment and procedures. MENTAL HEALTH SERVICES IN A JAIL: AN EXAMPLE Salt Lake County is served by three community mental health centers. Over the last 2 years a mental health project in the Salt Lake County Jail has been developed by the Granite and Salt Lake City Community Mental Health Centers. The Salt Lake County Jail is a maximum security facility capable of detaining 350 persons. The average inmate census is around 280 persons. Yearly, there are between 16,000 and 20,000 persons booked into the jail. The average stay awaiting trial is 34 days. Originally the mental health services offered were on a crisis basis and typically involved hospitalization. This has gradually grown to include a wide range of services. As the scope of the project has grown, many other agencies involved with the public offender have come to rely on mental health staff for treatment and evaluation. Currently the mental health project receives between 90 and 100 referrals per month. Below is a breakdown, by agency, of the referrals received.
30
Community Mental Health Journal
Referral Source
Courts: City, District, and Justice Attorneys: prosecutors and defenders Department of Court Services Jail Administration Public health physician and nurses Self Family Other Total
Percentage
13 6 7 18 27 22 2 5 100
The data suggest that a large number of agencies, as well as the inmate himself, frequently see mental health evaluation or treatment, or both, as beneficial. Although many inmates are not seen beyond one interview, many others engage in a therapeutic alliance that continues beyond their period of incarceration. Approximately 50% of those inmates who are offered treatment contracts while incarcerated continue with this contract when released into the community. Many advantages accrue to this voluntary treatment system. It eliminates the problems of forced treatment, which generally tends to produce poor results (Borgman, 1975). This service makes treatment available to persons w h o are in a transitional state and generally feel a more intense need. The process of arrest and confinement frequently produces anxiety and personal discomfort that is otherwise lacking in the more chronic-offender types. Mental health intervention during this key time can result in psychological movement not possible otherwise. Those inmates who do not continue in treatment u p o n release are often back in jail a few months later and again psychologically and physically available for intervention. Experience with a large number of these persons shows that there is a cumulative effect that is evidenced by (a) longer intervening periods between stays in jail, (b) movement to less serious offenses, and frequently (c) there comes a time when these persons do continue in treatment on their release. Many forms of treatment have been used with inmates. These models have included chemotherapy, hospitalization, crisis intervention, long-term individual psychotherapy, and family and group psychotherapy. The project averages four hospitalizations per month. Of those hospitalized, inmates who are charged with relatively minor crimes are hospitalized at local facilities. Usually this process involves requesting that the charges be dropped in lieu of a civil commitment. Occasionally some inmates become voluntarily hospitalized via a similar process. Other inmates charged with more serious offenses are initially evaluated in the jail and subsequently sent to the Utah State Hospital. Most of these cases involve extended evaluations to determine competency. Initial evaluation in the jail provides a valuable screening device and eliminates inappropriate hospitalizations. Such evaluation frequently leads to consultation with attorneys about how to work with their clients (Sabot, 1971). Family therapy has frequently been the treatment of choice. Particularly where the identified patient is a young man whose attempts to separate from
Eric D. Nielsen
31
the family have involved criminal acts. Time-limited contracts for treatment of these families have assisted the identified patient to find a healthier w a y to separate from the family. It has also provided an avenue to do primary prevention work with younger brothers and sisters. The clinical work in the Salt Lake City Jail has revealed a fairly consistent set of diagnostic categories for the inmates receiving service. Of the referrals seen in treatment or evaluation, the following breakdown shows the type and percentage of problem area: Problem Area
Psychosis Organic brain syndrome Narcissistic personality disorder Other symptoms, i.e., anxiety states and suicidal behavior Total
Percentage
24 4 47 25 100
In addition to direct clinical services to the inmates, the mental health project offers recreational and educational services in the jail. The Salt Lake County Jail, like 85% of the jails in the United States, does not provide recreational facilities. The long stays in a confined environment produce the commonly heard fear that the inmate will accrue additional charges because he feels that he may lose control and attack another inmate or guard. In an effort to provide diversions and to lessen the general level of tension, a mental health recreational therapist provides opportunities for outside recreation activities, such as volley ball. Additionally, there are available table games and a jail library, which is largely composed of donated books solicited by the mental health centers. These activities provide opportunities for diversion and methods by which the inmate may effectively cope with his tension. Soon after the project began it became apparent that the average level of education among the inmate population was the 9th grade. Through contracts with the local school district and the local IBM firm, teachers and tutors were obtained. Students are taught individually and can obtain high school degrees. Although education is perhaps not a direct mental health concern, the level of education and individual proficiency in the three Rs certainly has a direct effect on the individuals mental health and his ability to compete successfully in the labor market where a high school degree is a basic requirement. A concerted effort is made by mental health staff to involve inmate patients in school and other recreational activities. Mental health services have been useful to the jail administration as well as the inmates. The Salt Lake County Jail experiences a high turnover rate, 54.9% in 1975, and at any given time over half of the officers have been employed less than 6 months. Consequently, there is a dirth of experience and knowledge among the officers. In efforts to upgrade the skills of the officers, mental health staff have been providing inservice training geared toward helping officers develop skill in identifying problem behaviors and in management of problem inmates. This training proved useful and has now been included in the State Police Officer Academy for Correctional Officers.
32
Community Mental Health Journal
T h e jail a d m i n i s t r a t i o n h a s f r e q u e n t l y r e q u e s t e d m e n t a l h e a l t h staff c o n s u l tation regarding the management of particularly difficult inmates. Suicidal a n d s c h i z o p h r e n i c i n m a t e s a r e t y p i c a l e x a m p l e s of t h e s e r e f e r r a l s . CONCLUSIONS F r o m e x p e r i e n c e w i t h t h e S a l t L a k e M e n t a l H e a l t h Jail P r o j e c t a n d e x a m i n a t i o n of t h e l i t e r a t u r e , s e v e r a l c o n c l u s i o n s c a n b e d r a w n . 1. Jails are perhaps the single most important institution in the criminal justice system, yet the most neglected. This is particularly true regarding mental health services. Jails, and the inmates they house, are a community responsibility. Because jails and prisoners are generally hidden from public view does not change the fact that there are serious mental health problems in these institutions. 2. Inmates of jails need and have a right to mental health services. It is a paradox that so many persons are sentenced to jail because of behavior problems when jails typically do not have the behavioral-change professionals available for the inmates. The curtailment of personal freedoms inherent in jail incarceration should not preclude having mental health services available. 3. The jail staff is frequently faced with extremely difficult management problems. Consultation and education by mental health workers can assist jail officers in effectively working with such problems. Where problems are discovered, mental health workers as consultants are in an excellent position to effect modifications in the jail procedures and environment. 4. Community mental health centers and community hospitals must take an active role in addressing the problems of jails and the inmate population. As the community resources for mental health services, the staffs of these facilities have an ethical responsibility to reach out actively to the jail community. REFERENCES Borgman, R. D. Diversion of law violators to mental health facilities. Social Casework, 1975, July, pp. 418-426. Fox, V. Introduction to corrections. Englewood Cliffs, N.J. Prentice-Hall, 1972. Goldin, G. D. Role of the psychiatrist in the structure of court services. Mental Hygiene, 1965, Jan., pp. 139-142. Menninger, K. The crime of punishment. New York: Viking Press, 1968. National Jail Census. 1970. Washington, D.C.: Law Enforcement Assistance Administration, 1971. Reckless, W. C. American criminology: New Directions. New York: Appleton-Century-Crofts, 1973. Sabot, T. J. Mental health consultation concerning the competency of the criminal defendant. Community Mental Health Journal, 1971, 7, pp. 223-230. Silber, D. E. Controversy concerning the criminal justice system and it's implications for the role of mental health workers. American Psychologist, 1974, April, pp. 239-244. Taft, D. R., & England, R. W. Criminology. London: McMillian, 1964. Task Force Report: Corrections. Washington D.C.: U.S. Government Printing Office, 1967.
