Societal Costs of Not Treating Incarcerated Patients with Schizophrenia

Peter Salgo, MD: Why should society care? Why should I care about getting individuals with schizophrenia treated while in correctional facilities. Why should I care about getting them treated well in the community once they’re released?

Richard Jackson, MD: There’s a variety of reasons why we should all care. When patients are not treated in the community, everyone is at risk because they may begin to abuse substances and alcohol and become violent and destabilized. That combination does put the community at risk, as well as having to pay for those illnesses. We hear some payers say, “Well, why pay for their treatment if they don’t function?” But that’s like saying to patients with Alzheimer disease: “Why give them medication for their memory, they can’t remember anyways.” It’s a part of the illness. The better we treat them, the safer they are, and can then be productive and contribute back to society.

Peter Salgo, MD: We’re all paying for these facilities—they’re expensive places to keep and treat people. Doesn’t it make more sense to treat them well and keep them from relapsing? What do you think? Can you put a dollar amount on how much we’d save if we got these folks well treated and they didn’t come back?

Judge Steven Leifman: It’s not only the savings but the avoidance of certain costs. A lot of these individuals, once they’re in recovery, could work and pay taxes and live a productive life. Why do we care about treating people with cancer? Why do we treat or care about people with heart disease? These are just other illnesses and it’s incredibly offensive that they’re not treated this way. I’ve been doing this almost 18 years—if we treated people in this society with primary health care issues the way we treated people with serious mental illnesses, not only would there be a plethora of civil lawsuits, but also an enlightenment of gross negligence.

I don’t understand why it’s acceptable to discharge people in the middle of the night with serious mental illnesses—and then we don’t give them what they need. We then punish them and arrest them because they don’t get what they need. Recovery rates for people with serious mental illnesses are better than those with heart disease and diabetes.

Richard Jackson, MD: Who’s their advocate? When you see someone with schizophrenia on the street, you tend to walk away—no one is really advocating for them, unfortunately.

Peter Salgo, MD: Isn’t that the essence of it? It’s not me, it’s “them.”

Judge Steven Leifman: I think it’s more complicated than that. We know more today than 10 years ago, concerning mental illness. People are afraid of it—there was a big stigma regarding schizophrenia. Now that we’re starting to understand it, the laws and funds have to start catching up. To neglect it is criminal.

Mauricio Tohen, MD, DrPH, MBA: To the judge’s point—it is not actually the cost of the treatment, but the cost of these individuals not contributing to society.

Peter Salgo, MD: That’s what I was getting at.

Peter Salgo, MD: There’s a huge cost.

Mauricio Tohen, MD, DrPH, MBA: Absolutely.

Peter Salgo, MD: It’s enormous.

Richard Jackson, MD: In effect, it’s the cost of not treating them. It’s so much more effective to treat them and keep them out of correctional facilities and back in the workforce—potentially—and part of their families. They quickly get estranged from their families when they’re not being treated.

Judge Steven Leifman: Their hospital costs too, which are even more than the correctional costs. We know that with good treatment-recovery rates, people can live productive lives, and they don’t reach these acute systems.

Transcript edited for clarity.