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Mental Illness and Society: Prisons, Rehabilitation, and Prevention

By Gene Beresin and Steve Schlozman | September 18, 2013 | from PBS’s “Brains On Trial” Science Blog

Over the last 25 years, funding for mental health services in communities, juvenile detention centers, and in prisons has been cut back dramatically. Criminal behavior without question costs more to society than does treating psychiatric illness. Mental health treatment is effective and essential to a sane and modern society, and yet there is deplorable lack of funding or access to these services for huge swaths of our juvenile population.

Shortage of providers:

At this time, there are about 7000 child and adolescent psychiatrists to care for 20-30 million youth who have serious mental illness. There are only about an additional 6000 psychologists trained to work with youth and families. Child and adolescent psychiatry is the number one shortage specialty in the United States (if not the world). And to make matters worse, we graduate only about 320 new child and adolescent psychiatrists a year. The rate of retirement among baby boomers is far exceeding the capacity for our nation to generate new clinical child psychiatrists. The numbers of trained social workers and mental health counselors to help delinquent kids are also exceedingly low.

Poor insurance coverage

Insurance coverage for mental illness is woefully inadequate. While many insurance companies claim there is “parity” for psychiatric problems, what this really means is that a kid with a “biological” condition (like depression, anxiety, PTSD) can have unlimited visits of 15-20 minutes for medications alone. Therapy visits are restricted to at most 24 visits per year. So, what the insurance industry has done is to foster medicating kids and limiting the amount of time given for psychotherapy for kids and families. Virtually all studies about treatment of psychiatric disorders tells us the same thing – therapy combined with medications for many disorders is better than either alone.

Less treatment facilities

In recent years, inpatient and partial hospital (day program) beds have been cut way back. There are fewer treatment centers for aggressive youth, particularly with substance abuse problems. And there are far fewer “wrap around services” that is, services that form a connection between hospitalization, residential care or halfway houses, day programs, and outpatient openings that address the many personal, family and educational problems of these youth.

Given the shortage of trained professionals, the drastic cutback in state and federal funding for mental health, resulting in fewer services and providers, how can we possibly work toward prevention, early intervention and treatment of our youth?

Are we not fostering suffering and possibly delinquent behavior by avoiding a very real and common problem? Understanding how mental illness relates to our system of justice is crucial for reducing rates of recidivism as well as lowering the numbers those incarcerated from the start.

Read the full post on the Brains On Trial website, where you can also find other Neurolaw resources and explore interviews with experts filmed for the show.