Helping a loved one who is experiencing a severe mental illness, especially someone who may not realize they are sick, is one of the greatest gifts you can give. For some, it may mean the difference between life and tragedy. ~ Treatment Advocacy Center
The largest remaining state psychiatric hospital in Tennessee is the Western Mental Health Institute in Bolivar, with 247 patients. The Shelby County Jail, with 6,800 inmates, almost certainly holds more seriously mentally ill individuals than all four state psychiatric hospitals combined. As early as 1997, it was said that 40 percent of the jail inmates were “taking medication for mental illness” (Commercial Appeal, Apr. 13, 1998). And in 1999, a study reported that “about a third of the state’s jail population . . . is mentally ill” (Commercial Appeal, Mar. 3, 1999). The number of mentally ill persons in jail was said to have been “dramatically exacerbated after mid-1996 when the state shifted funding for public mental health programs to managed care” (Commercial Appeal, Mar. 30, 1999). The situation would be even worse if not for the existence of Crisis Intervention Team (CIT) training, which helps police divert mentally ill individuals away from jail; the CIT program started in Memphis in 1988.
The problem in the state’s prisons, where it is said that “one in every three inmates is mentally ill,” is almost as bad as in the jails (News Channel 5, May 9, 2011). The three largest state prisons – at Henning, Tiptonville, and Wartburg – each have more than 2,300 prisoners; each holds more seriously mentally ill prisoners than the largest state psychiatric hospital.
Current Laws Governing Treatment in Prisons and Jails
Tennessee Department of Correction (TN DOC) policies allow nonemergency administration of involuntary medication of an inmate if indicated based on the application of contemporary standards of practice. Authorization of nonemergency involuntary medication is determined through aWashington v. Harper administrative proceeding by a Treatment Review Committee consisting of one psychiatrist and two psychologists who are not directly involved in the treatment of the inmate in question. The policy also specifies that an inmate’s continued need for involuntary treatment may indicate a need to seek the appointment of a fiduciary, who would be empowered to make an informed decision for the inmate.
State law does not prohibit Tennessee county jails from administering medication involuntarily on a nonemergency basis. Therefore, county jails could use a Washington v. Harper administrative proceeding to authorize involuntary medication for an inmate who is suffering from a mental disorder, is gravely disabled, or poses a likelihood of serious harm to himself or others. Based on survey information, if an inmate is refusing medication and needs treatment, Tennessee jails do not administer medication over an inmate’s objection. The only option is emergency commitment to a State Regional Mental Health Institute, which is very difficult.
The Tennessee Department of Mental Health and Substance Abuse Services (TN DMHSAS) posted the following notice on its website:
A change in state law (Public Chapter 531) effective July 1, 2009 allows the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) to delay admissions at state owned and operated regional mental health institutes (RMHIs) until the facility “has the medical capability, equipment and staffing to provide an appropriate level of care, treatment and physical security to a service recipient in an unoccupied and unassigned bed.” This law removes the requirement that RMHIs admit and treat service recipients without regard to whether the RMHI has sufficient resources to do so.