Appropriate Treatment for Incarcerated People with Schizophrenia - Episode 9

Inhibitors to Schizophrenia Management Streamlining

Peter Salgo, MD: I hear unanimous agreement that medication and transition planning works—it saves money and jail time and gives people better lives.

Steven Leifman: And hospital time.

Peter Salgo, MD: This is my simple question with a complicated answer: Huh?

Steven Leifman: Exactly. Why aren’t we doing it?

Peter Salgo, MD: What’s the problem here?

Nneka Jones Tapia, PsyD: Some of it is money. Not many correctional institutions have the financial wherewithal to maintain all these systematic parts. That is where community collaboration comes in. At Cook County, where we had a lessening budget every day, we were able to engage the community and mental health providers to come into the facility and offer those treatment modalities that we’ve been talking about; then the person was more likely to continue care. We were able to develop alumni programs in which inmates voluntarily came back to the jail and had peer-support programs with their fellow inmates.

Mauricio Tohen, MD, DPH, MBA: We need seamless collaboration.

Nneka Jones Tapia, PsyD: Yes.

Mauricio Tohen, MD, DPH, MBA: That is between law enforcement and the mental health services.

Steven Leifman: But the cause is money and ignorance.

Peter Salgo, MD: I think your answer is correct, but my question was how come we don’t do it? And the answer is money and ignorance.

Steven Leifman: I’m optimistic.

Peter Salgo, MD: It’s a bad combination.

Steven Leifman: It’s a terrible combination. But I will say that Congress over the last couple of years has allocated significant funding under the CARES Act. States are finally starting to wake up to this issue because they don’t want to spend the money on the correctional side. Politically, you have this interesting coalition between the Koch Brothers and the ACLU [American Civil Liberties Union], who don’t want to keep spending money on correctional costs or treatment. We’re at the beginning of a real sea change on how we should be doing things.

Nneka Jones Tapia, PsyD: Steven, you also spoke about educating our law enforcement professionals and the judiciary. I think we also need to educate our legislatures.

Steven Leifman: Absolutely, and our physicians.

Nneka Jones Tapia, PsyD: Yes.

Peter Salgo, MD: Good luck educating politicians.

Steven Leifman: Doctors aren’t easy either. There’s a lot of stigma among psychiatrists and primary health care doctors for people who have been arrested; they think they’re violent and dangerous and should be in jail.

Transcript edited for clarity.