Emptying the ‘New Asylums’: A Beds Capacity Model to Reduce Mental Illness Behind Bars

In 2016, an estimated 90,000 US jail inmates were pretrial defendants with serious mental illness who had been found incompetent to stand trial (IST). IST services most commonly take place in state hospitals. Most state hospitals maintain waitlists of IST inmates because they do not have enough beds to meet demand. Waits are typically around one month but some are as long as a year. While the inmates wait, typically without treatment, they deteriorate, are often victimized and sometimes die.

Emptying the ‘New Asylums’: A Beds Capacity Model to Reduce Mental Illness Behind Bars reports the findings of a mathematical model built to project whether relatively modest selected changes to the status quo could break this logjam. Data from five sample states were used to model the effect of three specific changes. Eight recommendations for state and federal lawmakers are proposed in response to the findings.

Top Takeaway
Relatively small changes in common policy and practice could dramatically reduce pretrial bed waits and the mass incarceration of individuals with serious mental illness.

Fast Facts
The following examples illustrate what the model found based on 2016 data from the sample states (Florida, Maine, New Jersey, Texas,
Wisconsin).

• In Florida, diverting two mentally ill offenders per month would reduce the average forensic bed wait in the state by 75%, from an average of 12 days to three days.  In Texas, reducing the average hospital stay from 189 days to 186 days would reduce forensic bed waits from an average of two months to three days.
• In Wisconsin, increasing the number of forensic beds from 70 to 78 beds would reduce waits for competency services from nearly two months to weeks.

Behind the Facts
Pretrial inmates represent the largest and fastest-growing segment of the US jail population. At least one in five of these defendants is mentally ill. State hospitals reported having 5.5 forensic beds per 100,000 population in 2016. Of these, about half were reserved for patients found not guilty by reason of insanity. This leaves approximately 8,800 psychiatric beds for all other forensic patients, including the 90,000 pretrial detainees. Historically, state hospitals were called “asylums” because they were associated with long-term care and protection. Mental illness is now so prevalent behind bars that jails and prisons are routinely called the “new asylums.”