Health care costs of jail inmates may compel Texas counties to consider alternatives to incarceration for mentally ill and drug addicted defendants


The Texas Tribune reported this week that jail inmates in Texas are dying at nearly the same rates as inmates in Texas prisons, despite the fact that jails house approximately half as many inmates as prisons, and for significantly shorter periods of time. Many of these jail inmates enter the county jails, said Gregg County Sheriff Maxey Cerliano, with “conditions that have been neglected for years because of poverty, substance abuse, or mental illness.” According to the article, these health care problems only become worse upon incarceration because jails are strapped for resources and staff, only able to provide the least costly medications and treatments.

Just as importantly, the article noted, health care costs have been rising significantly in recent years. In counties with populations of 1 million or more, the average jail health care expenditures leaped from approximately $5 million in 2005 to $15 million in 2009. Given the declining budgets facing most counties, such increases in health care costs are particularly onerous.

Although there are no simple or easy answers to these problems, it is possible to lessen the enormous number of non-violent, non-dangerous inmates who cycle through jail doors, and thereby decrease health care costs borne by jails. The majority of jail inmates are there awaiting trial, but many of these individuals are ""manageable risk"" individuals and may be suitable for supervised release, or some kind of community or diversion program, rather than incarceration or prosecution. As indicated by the article, a number of the inmates who consume health care resources have mental health or drug addiction issues. However, these issues place enormous strains on jail health care systems, and illustrate the value that pretrial supervisory services and diversion programs can provide to local criminal justice systems. Counties with high-functioning pretrial services and diversion programs can make early identification of individuals with mental health or drug addiction problems who could be safely released into supervision or treatment alternatives. Many times, such individuals have access to health care through their families or jobs, and can best receive treatment while awaiting trial outside jail without posing significant risks of re-arrest or flight. By preventing the unnecessary incarceration of non-violent, non-dangerous individuals, jails can avoid assuming the associated high health care costs and funnel those resources into the detention and care of individuals who do in fact pose serious risks. As Scott Medlock, director of the prisoner’s rights program at the Texas Civil Rights Project noted, counties “should find ways to keep fewer people behind bars, releasing those awaiting trial who are nonviolent, and finding appropriate treatment for the mentally ill.” Pretrial service programs and diversion programs provide these alternatives, and hopefully more counties will consider them as they evaluate ways to reduce costs.

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