Mentally Ill Inmates Win Right to Discharge Planning

Without follow-up care, many of these inmates would have a difficult time accessing treatment services after discharge, since a substantial portion were homeless and dependent on Medicaid at the time of their arrest. “As a result of the abrupt termination of their treatment, many inmates experience a relapse of symptoms [and] an increased risk of suicide, and frequently wind up in a ‘revolving door’ of successive periods of hospitalization and reincarceration, interrupted by periods of release in which their psychiatric treatment is suspended and their symptoms recur,” the amicus brief points out.

The plaintiffs’ arguments centered on several issues including that U.S. jails have become de facto mental health care facilities filled with people who would probably not be there if they had received care in the community or psychiatric hospitals. They also emphasized that mental illnesses can be successfully treated, that almost all major mental health organizations, including APA, insist that discharge planning is an essential part of care for incarcerated individuals, and because inmates lose Medicaid coverage and other public assistance, it is unlikely that they have the resources to restore all these benefits without help prior to discharge.

Among the arguments upon which the city relied in defending itself against the charges are that jails, by their nature, house a transient population, thus presenting an “insurmountable barrier” to comprehensive discharge services. The city also said that a mandated discharge-planning system could not work because many inmates leave jail before jail officials have the chance to arrange evaluations by mental health professionals. Addressing all inmates’ crucial mental health care needs would require financial investment whose dimensions make it prohibitive, the defendants maintained to no avail.

The terms of the settlement, in which the city did not admit liability, require that all inmates receive an assessment of their need for continuing mental health treatment, public benefits, housing, and transportation to that housing. Inmates have the right to decline the services mandated under the agreement.

City officials are also to “create a mechanism to allow significant others and other members of the community who have clinical information. . .relevant to the mental health treatment” of an inmate to relay that information to a jail’s discharge-planning staff. In addition, every inmate is to receive a medical assessment within the first 24 hours of incarceration and, if a need is identified at that time, a mental health care assessment with three days.

A discharge plan for those who are found to need mental illness treatment while in prison is to be completed within seven days of the mental health assessment for those in segregated mental health units, and 15 days for those in the general population. Jail officials are to provide these inmates with a written discharge summary at the time of release from jail.

The settlement also mandates that the city release prisoners during daylight hours, addressing a contention of the plaintiffs that inmates are often left at bus stations at all hours of the day and night.

The agreement also requires that discharge planning include an assessment of the need for medication, case management, substance abuse treatment, and psychiatric rehabilitation services. In addition, appointments for and referral to these services are to be arranged prior to discharge, and the city is to inform the inmate orally and in writing of the time, date, and place of such appointments. Within three days of such appointments, jail officials are to contact the treatment or service program to find out whether the released inmate showed up.

If continuing medication is needed, jail staff are to provide the inmate with a seven-day supply and a prescription for 21 additional medication days. If there is a reason an inmate is denied such medication, officials are to document it in writing.

The city is now also required to help inmates apply for Medicaid or, if they were on it previously, to help them get it reinstated.