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Agenda Setting: Policies regarding the Treatment of Mentally Ill Inmates inside TDCJ

Lauren K. Webster

Sam Houston State University

CRIJ 6361-01

Dr. Oliver

The past few years have witnessed a considerable rise in awareness about the mistreatment of the mentally ill prison population within the Texas prison system. Politicians, media, advocacy groups, and social media activists have enthusiastically responded to the concerns and stories, making the rounds on mainstream media and social media (Stuckey, 2024; Simpson, 2023). Besides, the research aligns with the alarms raised by media indicating that a considerable percentage of mentally ill inmates fail to receive proper care, which is found to be associated with high recidivism and subsequent burden of cost on the Texas Department of Criminal Justice (TDCJ). These inputs and highlights are largely behind placing the issue on the Senate’s agenda and pushing the demand for a sustainable and workable solution. This paper sets out to overview the factors contributing to the agenda-setting for the mistreatment of mentally ill inmates, applying a range of policy models and concepts.

Recently, State Senator Lois Kolkhorst presented a Bill proposing more transparency in the audits of how mentally ill prisoners are treated. The bill requires the concerned authorities to conduct regular assessments and report the outcomes to take appropriate corrective measures if needed (Stuckey, 2023). The policy agenda is based on the issue raised by Melissa Shearer, director of Travis County’s Mental Health Public Defender Office, spending considerable time with the Texan prison population facing mental health issues. She argues that while 90% of the population has access to mental health services, the outcomes are not visible or poorly understood (Stuckey, 2023). Therefore, there is a need to make efforts to report the outcomes more transparently, allowing policymakers to evaluate the effectiveness of existing interventions and identify the areas requiring further improvement.

Some of the policy models that offer insights into the underpinning factors of the agenda are discussed as follows:

Issue Networks

The issue networks are generally defined as activist groups that collaborate for a common cause. These groups press the government and lawmakers to take appropriate measures that may align with their interests (Farazmand, 2023). In the present case, the role of issue networks cannot be overlooked. It is important to note that dealing with the mentally ill prison population surrounds a contentious debate. Organizations like the National Alliance on Mental Illness and Human Rights Watch advocate for non-punitive measures requiring the justice system to focus more on the rehabilitation of mentally ill prisoners than sentencing (Human Rights Watch, 2023; Sandoval, 2024). This opposition to harshness is rooted in the argument that persons with mental health problems are driven by their psychological issues and not by genuine intent to harm.

Certainly, the issue of mentally ill inmates aligns with the interest of the organizations and groups opposing the hard-on-crime mindset. The problems faced by the mentally ill population making the headlines and finding their path to reputed online sources are instrumental to these networks as they can use them to bolster their advocacy for rehabilitation-oriented interventions (Human Rights Watch, 2023; Sandoval, 2024). Therefore, the issue networks understandably have their roles in exerting pressure on the concerned authorities to improve conditions for the inmates faced with mental health problems within TDCJ.

Issue Attention Cycles

The issue attention cycle also provides a logical understanding of the episodes of rise and fall in the focus on the issue over the past decade. This model assumes that at the pre-problem stage, a problem exists without becoming widely known. An alarming issue, such as a high-profile case or research report, may trigger tension and generate issues around the interest, which gradually wanes as people realize the cost of remedial solutions (Protess & McCombs, 2016). This model is applicable to the public and state’s response to the issue of mentally ill inmates.

For instance, around a few decades ago, the issue mostly remained under the curtains as the search queries related to that time returned no meaningful results. However, research reports began to come out in the past decade indicating that a high percentage of inmates with mental health problems were faced with neglect and inappropriate responses from the concerned department (McCarthy, 2014; Fradella & Smith-Casey, 2014). These reports created considerable enthusiasm, driving the authorities and stakeholders to ponder the options for reform (Fradella & Smith-Casey, 2014). Hence, the issue has already been past its pre-problem stage since then.

However, as the issue came to the agenda, there were divisive opinions regarding the implementation of remedial solutions. The administrative burden and the cost associated with the implementation of holistic care for mentally ill inmates eventually affected the enthusiasm, putting the issue in a state of limbo (Segal et al., 2018; Mongelli et al., 2020). Despite the recurrence of interest in the issue following different incidents and research reports, no concrete measures have yet been directed, and the meager political intent attributable to different trade-offs affects the TDCJ’s ability to make significant breakthroughs.

Three Streams of Policy Process

The agenda-setting in the context of the mistreatment of mentally ill inmates can also be understood from the perspective of three streams of the policy process. This theoretical framework assumes that the policy window or the window of opportunity appears if the three streams, including the problem, policy, and politics, converge into each other (Protess & McCombs, 2016). This convergence involves the confluence generated by the recognition of a problem, the availability of a feasible solution, and the strong political intent to solve the issue. This model is applied to the current agenda as follows:

Problem Stream

The problem of mistreatment of mentally ill prisoners in Texas is now a widely recognized issue. For instance, as reported by the US Department of Justice Bureau, nearly 44% of the prison population is diagnosed with one or more mental health problems (US Department of Justice Bureau cited in Mental Health TX, 2024). Besides, the existing research shows that the recidivism rate is critically high in mentally ill prisoners, attributable to the mistreatment (Dalbir et al., 2022). Besides, the data shows that TDCJ already bears a considerable cost above $585 million for recidivism, placing it among the states in dire need of remedial initiatives (CSG Justice Center, 2023). Furthermore, there are cases outlining the flaws of the existing ecosystem for mentally ill inmates and emphasizing the need for improvement. For example, more than 200 prisoners with mental health problems have been reported to have died in jails since 2012 (Stuckey, 2024). Besides, there are numerous attention-grabbing individual accounts of suffering faced by prisoners due to negligent staff behavior or inadequate response to mental health issues (Simpson, 2023; Edwards, 2024). These findings indicate that the problem is well-established and requires immediate interventions.

Policy Stream

The policy proposals are in place, though the stakeholders and experts are divided on those options, with some arguing for radical investment for improvement, such as staff training, resorting to non-punitive rehabilitation facilities, and placing mentally ill inmates in separate facilities from those dedicated to their mentally healthy counterparts (Hawkes, 2021). Besides, there are also arguments that aggressive investments carry the risk of massive losses, making a case for gradual change based on continuous evaluation (Rukus & Kulkarni, 2019). Similarly, Kolkhorst’s call for more transparency in audits for more robust articulation of the issues remains one of the potential options (Stuckey, 2023). It can help the stakeholders better understand the scope of the problem and underlying issues to help them formulate more targeted interventions.

Political Stream

The political stream intersects the above two streams as the issue has managed to find its path to the Senate and key political debates. Thanks to the media, social media, and activist groups, the government is pressed to pay attention to the problems faced by the mentally ill prison population through appropriate interventions. The aforesaid bill also reflects the recent uptick in the political intent (Stuckey, 2023). Therefore, it is evident that all three streams are poised to converge as the problem has been adequately captured and the improvements are on the political agenda.

To sum up, the mistreatment faced by the prison population suffering from mental health issues is currently on the public and political agenda. Mainstream and social media, along with social activists, advocacy groups, and researchers, have played a vital role in raising awareness of the issue and the cost it causes to the criminal justice system, society, and the state. However, there is a visible divide in the feasibility of different policy options, and it is likely to take considerable time before a solution is finalized and implemented to bring about meaningful change.

References

CSG Justice Center. (2023, April 26). The cost of recidivism: https://csgjusticecenter.org/publications/the-cost-of-recidivism/

Dalbir, N., Wright, E. M., & Steiner, B. (2022). Mental illness, substance use, and co-occurring disorders among jail inmates: Prevalence, recidivism, and gender differences. Corrections, 9(2), 264-286. https://doi.org/10.1080/23774657.2022.2090028

Edwards, J. (2024, June 15). North Texas inmate deaths draw scrutiny and put the spotlight on mental health and jail conditions. Dallas Express. https://dallasexpress.com/metroplex/inmate-deaths-in-north-tx-put-spotlight-on-mental-health/

Farazmand, A. (2023). Global encyclopedia of public administration, public policy, and governance. Springer Nature.

Fradella, H. F., & Smith-Casey, R. (2014). Criminal justice responses to the mentally ill. Criminal Justice Policy, 201-224. https://doi.org/10.4135/9781544302690.n14

Hawkes, J. (2021, January 21). Smart justice: Texas needs more effective alternatives than jail to treat mentally ill – MMHPI – Meadows mental health policy institute. MMHPI – Meadows Mental Health Policy Institute. https://mmhpi.org/topics/policy-research/smart-justice-texas-needs-more-effective-alternatives-than-jail-to-treat-mentally-ill/

Human Rights Watch. (2023, March 27). Callous and cruel. https://www.hrw.org/report/2015/05/12/callous-and-cruel/use-force-against-inmates-mental-disabilities-us-jails-and

McCarthy, M. (2014). US jails hold 10 times more mentally ill people than state hospitals, report finds. BMJ, 348(apr10 1), g2705-g2705. https://doi.org/10.1136/bmj.g2705

Mental Health TX. (2024, January 18). Criminal justice involvement. https://mentalhealthtx.org/populations/criminal-justice-involvement/

Mongelli, F., Georgakopoulos, P., & Pato, M. T. (2020). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States. FOCUS, 18(1), 16-24. https://doi.org/10.1176/appi.focus.20190028

Protess, D., & McCombs, M. E. (2016). Agenda setting: Readings on media, public opinion, and Policymaking. Routledge.

Rukus, J., & Kulkrani, V. S. (2019). Easier said than done: Methodological challenges in exploring the prevalence of mental health illness among rural jail inmates in the United States. International Journal of Rural Criminology, 4(2), 258-272. https://doi.org/10.18061/1811/87907

Sandoval J. (2024, February 7). How solitary confinement contributes to the mental health crisis. NAMI. https://www.nami.org/advocate/how-solitary-confinement-contributes-to-the-mental-health-crisis/

Segal, A. G., Frasso, R., & Sisti, D. A. (2018). County jail or psychiatric hospital? Ethical challenges in correctional mental health care. Qualitative Health Research, 28(6), 963-976. https://doi.org/10.1177/1049732318762370

Simpson, S. (2023, September 21). Texas inmate killed by cellmate during a statewide prison lockdown. The Texas Tribune. https://www.texastribune.org/2023/09/21/texas-prisons-lockdown-inmate-killed/

Stuckey, A. (2023, June 7). Texas could finally collect data on how often jail inmates are denied mental health care. Houston Landing. https://houstonlanding.org/texas-could-finally-collect-data-on-how-often-jail-inmates-are-denied-mental-health-care/

Stuckey, A. (2024, March 18). Nearly 200 people with mental illnesses died in Texas jails. The death toll is getting worse. Houston Landing. https://houstonlanding.org/nearly-200-people-with-mental-illnesses-died-in-texas-jails-the-death-toll-is-getting-worse/