To the Editor: Having read the State Mental Health Policy column in the September issue, "Critical Priorities Confronting State Mental Health Agencies," by Mazade and Glover (1), I find it striking that the authors—and apparently state mental health directors around the country—do not consider the vast number of individuals with mental illness in the criminal justice system to be a "priority." Given that there are nearly 300,000 individuals with mental illness currently incarcerated in the United States and about double that number on parole or probation (2), I would think that this ought to be at least one of the priority items listed.
Each of the priorities listed by the authors applies in spades to those of our clientele who find themselves in the criminal justice system. They have a high rate of comorbid medical and addictive diseases, they are perhaps the least empowered of any person with mental illness one can imagine, there are all too few psychiatrists willing to serve this population, and state legislators and administrators are unwilling to spend what the illness burden of this population demands.
Apart from all of that, it is simply morally wrong to think about the priorities of state mental health systems without considering this lost population. But then, once they are incarcerated, they are no longer a problem for the state mental health director, are they?
Dr. Roskes is director of forensic treatment at Springfield Hospital Center, Sykesville, Maryland. The opinions expressed represent those of the author and do not necessarily reflect the views of the State of Maryland Mental Hygiene Administration.
1.Mazade NA, Glover RW: Critical priorities confronting state mental health agencies. Psychiatric Services 58:1148—1150, 20072.Ditton PM: Mental Health and Treatment of Inmates and Probationers. Pub no NCJ-174463. Washington, DC, US Department of Justice, Bureau of Justice Statistics, 1999