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Generally the levels of crime rates in the US have declined since the year 1994. The conducted research credits favorable demographics which show that there are fewer young males than in the years before. Policies have been set in place which allow for community policing and putting up tight measures to deter crime.  The low level of unemployment has ensured that fewer youths engage in crime.

Some of the criminals who break the law are mentally ill or develop mental illness after being incarcerated. Most prisons are obliged to provide mental health care to inmates who are mentally ill. The state prisons are usually overcrowded and with the increase of mentally ill inmates this becomes quite a challenge. Despite being under obligation to provide health services to the mentally ill the states are not fully equipped to perform this task. Most prison administrators and jail officers agree that management of the mentally ill is a big challenge. This is because most of these jails lack qualified staff on this sector and need a well developed program to cater for the mentally ill.

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In the USA it is estimated that 10-15 percent of officer who enter the jail are mentally ill. There is an assumption that mental illness will not present challenges in future. As a result studies and programs have been initiated to cater for the long term needs of the mentally ill. This would most likely generate methods to conduct manage crimes committed by the mentally ill at local level. There are institutions which have a better capacity to cater for the mentally ill as opposed to the prison service. An effective collaboration between these institutions and the prison service would probably identify better solutions that would reduce the influx of the mentally ill into prisons.

The system is particularly under capacitated because prisons do not have treatment beds for the mentally ill. The mentally ill have their rights as it pertains to receiving health care however these prisons do not have the capacity to provide this health care. Mentally ill people require aftercare which may not be available at the local hospital. The health and prison service providers are not coordinated and collaborative enough. It is therefore obvious that there is need for collaboration between local health providers and correction facilities. After care is important in establishing success in mental and substance abuse correction program. Therefore there is need for adequate resources to ensure that the program is continuous. Most of the mentally ill inmates receiving health care are repeat offenders. These offenders have been incarcerated severally due to misdemeanors and small crimes. In addition majority of these offenders do not have a permanent residence. It is understandable that the mentally ill are vulnerable to committing small crimes due to impaired reasoning. These crimes include shop lifting, vandalism; trespassing and petty theft. The mentally ill may also display violent behavior and aggressiveness. In addition these people may have been institutionalized and lack the ability to perform independently in detention settings. These offenders may commit non-violent felonies and misdemeanors before they are diagnosed as mentally ill. They then go through the normal prosecution procedure before they are diagnosed. It is also important to note that the mentally ill may be involved in substance abuse. In the year 1977 the US department of justice reported that 77% of detainees are reported to have been involved in drug and substance abuse. It is difficult to diagnose individuals with chronic mental illnesses.  In criminal justice settings diagnosis of the mentally ill is usually erroneous. Most of the patients end up under-diagnosed often leading to incorrect medication which put the patient in a potentially dangerous situation.

Several countries have diversion programs for the mentally ill. These programs are diverse and range with the country. The success and failure of these diversion programs have not been estimated making it difficult to establish which program is most appropriate. Mentally ill offenders may be linked with treatment providing community services after the charges are dropped. Other proceeds and incarcerated the mentally ill offenders and then provides treatment when they are still in jail. Others sentence the mentally ill to community service with compulsory treatment.

Diversion programs have not been evaluated to view whether they are successful. The major target is usually to rid the jail of excess detainees.  Research that has been conducted reveal that the question as to whether Diversion programs on their own are insufficient to protect the mentally ill preventing the persons from recurring illnesses and more crime. () most mentally ill people stop medication after they feel better. Others revert to drugs while a few stop taking the medication due to fear of their medication. Either way majority of the mentally ill after release find themselves back in jail for petty crimes. Therefore develops to a cycle from jail to clinics and medication then back to homelessness. Women form a small proportion of the detainees however there are more mentally ill women than their male counterparts. A recent study showed that 19% of females and 9% of males admitted to urban jails have diagnosable mental illness. Acute diagnosable mental illness was found in 6 % males and15%females. Post traumatic disorders were found to be very high among the female inmates. In the USA only a few correctional facilities such as in Los Angeles that are equipped well enough to cater for women with co-occurring mental illness. Most women in jails have been incarcerated for illegal drug activity 85% of women in jails have been incarcerated for illegal drug activities.

Provision of mental health services in jails is provided by contracted health service providers which are mainly university hospitals, public or private hospitals. It is important to note that most jails do not offer site inpatient psychiatric services for the mentally ill offenders. In The US only the Los Angeles county jail is able to provide this service.

Medical screening

It is important to note that most of the people who are arrested for petty crimes are released without any screening.  The mentally ill therefore do not understand why they were arrested in the first place because they have impaired reasoning. These criminals are likely to be served with warrants of arrests due to failure to appear. Screening of the non violent felony offenders is done. The jail guidelines on medical and mental health do not specify standards for health screening. These do not specify the level of qualification for these jail screening personnel.  However, most regions provide a basic training level for screening personnel at jail intake.

The jail system does not cater adequately for detainees who have mental disabilities. There is need to improve and rectify the following sectors

Identifying and screening mentally ill detainees at the jail intake.

Establishing the staffing standards for the screening personnel establishing qualifications and training for mental health care personnel

 Efficient monitoring of psychotropic medication.

Establishing efficient retaining place for mentally ill inmates. this can be done through segregation from the rest.

Establishing proper use of mechanical restraints and involuntary medication and 37 mm Guns

Regular maintenance and updating of mental health records and the developing of a health information system.

Inmates who are eligible for parole do not always receive efficient screening to ensure that they eare fit to be released. Some other inmates developmental illness when they are i n hospital. There is always an attempt to help the inmates when they are still under sentence. This effort has not always successful. Unfortunately when these inmates are eligible for parole they do not undergo same stringent measures as those of inmates who were admitted into the facility with mental illness. There is need for heightened supervision for these inmates.

There is need to establish the persons who are mentally ill at the point of entry. This may be easy for repeat offenders.  The current guidelines for correction allow for flexibility in carrying out mental screening procedures. Therefore the counties can use this as a probable method for establishing flexible programs to suit their desires.

There is need to establish in-service training programs for personnel involved i n public safety including detention, police and jail personnel and fire fighters. The counties should also consider contracting mental health services from reputable providers

Integration of mental information with state criminal justice

There is a poor structure for identifying the mentally ill offenders locally. There is notably no coordinated and systematic plan for linking the criminal justice with information relating to health. There is obviously a need for such a system which enables agencies to exchange information relating to mentally ill individuals. The system should ensure that confidentiality issues are well taken care of. The legislature could mandate the county to establish local databases for the mentally ill convicts. This would ensure an efficient method of ensuring that the mentally ill convicts get early treatment and diversion.

After care for the mentally ill is very necessary for reducing crimes fro the mentally ill as well as reducing jail overcrowdings and the justice costs ()

Repeat offenders can be deterred from committing further crime by establishing good and efficient after care programs.

It is estimated that more than 70% of the mentally ill inmates do not receive an equivalent level of mental health care when serving parole.  Development of efficient programs and institutions for handling these paroled inmates may be very expensive and may take a long time before these programs come into action.  Therefore it may be necessary to use the existing community organizations that may be dealing with mental health care to take care of the sick patients. Some mentally ill people who experience mild sickness often do not get the adequate care. It may be necessary to increase funding or work with other organizations in order to provide basic health to these inmates.  Parolees who do not follow the terms of their parole should not be returned to jail but should rather be locked up in a facility that serves their needs best.

Surprisingly very little is known about the impact of mental health services and strategies to the local criminal justice. Existing data from studies and surveys is self administered and cannot count as effective standards for evaluating a program.

The legislature should consider funding evaluation studies for the effectiveness of the programs that have been initiated by criminal justice systems and parole programs.

Case studies and pilot projects should be established to evaluate the feasibility of managing mentally ill convicts through the use of health providers and the probation officers. The outcomes could then be used to establish large scale projects for establishing proper management for the mentally ill. Here is need to establish drug and substance abuse among probationers who are mentally ill. The evaluation could assist deal with drug and substance abuse among these probationers.

Administrative segregation

Administrative removal

Safety cell

Detoxification cell

Developmental disabled inmates

The resources have for quite a while been directed to maintaining the mentally ill in cells and jails. This is misdirecting of the state resources which should be directed in treating the mentally ill rather than incarcerating them. Most of the mentally ill inmates have been incarcerated due to impaired reasoning. Currently the juvenile and adult systems are already housing a significant number of inmates. The society today demands for the provision the necessary medical treatment for the mentally ill. A large number of inmates have notable symptoms of mental illness. Jail diversions could offer a better alternative to incarcerating the mentally ill. Jail diversion will provide better results for the community and the existing judicial system. Mentally ill people will face more incarceration periods if left unattended. The environment provided by the jail and prison setting in general aggravates the mental condition. Stigmatization due to criminal record can further aggravate the condition. Provision of diversion facilities and services will require a larger budget as compared to incarcerating these individuals. Therefore there is need to look for funding from various stakeholders to ensure that the program does not stall. Therefore there is need for research to estimate the efficiency of using these resources. Well designed diversion programs will ensure that these funds are used efficiently.  Research regarding the operating of diversion programs should precede their creation. Long term research must be initiated to ensure that these programs are upgraded in order to remain relevant.  The programs should be holistic. They should include substance abuse programs and should ensure that there is adequate housing.  All stakeholders should be included in creating these programs the society cannot continue to ignore that the medically ill continue being incarcerated without receiving appropriate care.  The adult and juvenile systems provide only basic care to the mentally ill. However the ill do not recover from their mental conditions. This is morally wrong putting into consideration that these crimes were none of their own. It is important to note that what is taking place now is simply trans-institutionalization where the mentally ill leave the prison to hospitals and then get back to prison again. This is a drain of resources considering that most of these mental ill persons can improve with treatment so that they can live with their families who can provide holistic care .

Some of those who are incarcerated were wound up due to having illness which were as a result of mental illness while others is because of disorders that began as a result of their interactions with the justice system. Generally mental illness refers to a wide range of illness mostly psychiatric disorders. It may not be possible to identify the mentally ill just by sight because some look okay. The medical illnesses common in jail include depression, bipolar disorder and schizophrenia. Some inmates may show basic symptoms of mental illness such as aggressive behavior, being paranoid or hallucinations. These disorders are characterized by personality abnormalities which include borderline and antisocial personality disorders.  Some symptoms may not be noticeable even to the experienced police officers,. Mental illness may be confused for alcohol or drug abuse. These criminals are often booked but do not turn up for the actual hearing.  Facilities for providing mental care to the community are not adequate enough to cater to serve the community.

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