Prisons replace Hospitals for Mentally Ill

As many as one in five of the 2.1 million Americans in jail and prison are seriously mentally ill, far outnumbering the number of mentally ill who are in mental hospitals, according to a comprehensive study released Tuesday.

The study, by Human Rights Watch, concludes that jails and prisons have become the nation’s default mental health system, as more state hospitals have closed and as the country’s prison system has quadrupled over the past 30 years. There are now fewer than 80,000 people in mental hospitals, and the number is continuing to fall.

But, Ms. Fellner said, she found “enormous, unusual agreement among police, prison officials, judges, prosecutors and human rights lawyers that something has gone painfully awry with the criminal justice system” as jails and prisons have turned into de facto mental health hospitals. “This is not something that any of them wanted.”

Assuming this study is true - and it seems to be backed up by statistics from the relevent governmental agencies - what should be done about it? Is it just to place the mentally ill in a prison and then systematically deny them treatment?

And what of the more far-reaching implications? Are we seeing a return to a middle-ages style treatment of the mentally ill, where those suffering from psychosis are simply incarcerated, rather than being treated? If this is the natural outcome of destroying federal and state funding for mental hospitals while allowing construction of prisons to explode, what’s the solution?

Thoughts, everyone?

Another report on this subject came out today, focusing specifically on New York City. Has some good information on the new trend towards ‘segregation’ prisons, and how they impact the treatment of mentally ill convicts incarcerated within.

In the association’s 51-page report, the authors paint a grim portrait of the lockdown units in some state prisons. They describe observing one inmate alone in his cell, smeared with his own feces; another inmate sprawled on the floor because his wheelchair was confiscated for security reasons; a prisoner with AIDS, dying and barely able to lift his head; and dozens of others with symptoms of acute psychoses or covered in scars from self-inflicted cuts.

How are the New York State prison authorities dealing with this report? About as you’d expect.

After receiving an advance copy of the Correctional Association’s report, in August, Mr. Goord, the Correctional Services commissioner, accused Ms. Wynn, the report’s principal author, of using the Correctional Association’s privileged status to communicate with a particular inmate, and he banned her from entering the prisons beyond the visiting area. Since then, he has imposed new limits on how many association employees may visit a prison, prohibited association interviews with prison staff and declared access to all segregated housing units off limits.

The logic of solving crime with more prisons will only work when everyone is in prison -from birth.

I am surprised that this required a study. When I lived in NYC I got the impression it was common knowledge that all the mentally ill lived on the street in the summer and in prison for the winter. This came about after all the mental health facilities were closed in the 70s.

Hey, where’s bmulligan? He should be in here saying that since they chose to be mentally ill, they should go to jail. (Troll, troll, troll your boat…)

I thought that it was Reagan that kicked all the mentally ill people onto the streets in the 80s.

Daniel Moynihan, like an idiot, got tricked into going along with a GOP plan to replace the huge mental institutions with small community centers. Funding mysteriously disappeared once they’d gotten them all out of the big centers.

As I recall when it happened, the moves to take the mentally ill out of the big institutions was a very Democratic driven move, in the interest of “humanitarism.” Sounded good, didn’t work. At the time, many mentally ill were being forced into mental institutions, and there was a big debate about how horrible this was. Need to look, but some laws were changed, driven by the Dems, to prevent such forcible institutionalization and to release those who were in the institutions against their will. Lots of TV movies (we didn’t have no DirectTV back then! (hitch pants up) about good hearted mentally ill people being forced into the mental homes, only to, at the end of the movie, be released due to the hard work of Sally Fields and live a wonderful life working with children at a community playground.

Once the laws were changed, however, it became pretty obvious that a lot of people who really need the help don’t want it. They aren’t exactly in the best mental condition to make the decision. Even today, one of the problems is that many/most homeless mentally ill folks refuse to go to mental institutions even when the resource is there.

As much as we’d like to make it out to be a simple Dem/Rep issue, it really isn’t so conveniently simple.

BTW, the best stats I can see say that only about 20-25% of the homeless are mentally ill - so 75-80% aren’t helped by better mental institutions, even if you could force people into them.

What I don’t have good numbers on is the capacity of good shelters and help centers relative to the need. While again it is often difficult to get some homeless to voluntarily go to such shelters, it sure seems like the best short term answer. No one in this country should be without access to good shelter and food - period.

What’s your grand solution to the large number of the criminally insane? Perhaps you’d like to adopt one!


Now to a considerable failure, which is the deinstitutionalization of the mentally ill. I was present when this happened. It was in Albany, the governor’s office, March 1955. Averell Harriman has just been elected governor. His secretary, Jonathan Bingham, brought in his choice for the new commissioner of mental hygiene-that nineteenth century term.

But Paul Hoch was not of that order. He had been head of our psychiatric institute in Manhattan, and he had news, which was that at Rockland State Hospital in the lower Hudson Valley, a Dr. Nathan Kline had synthesized the active ingredient in a Vedic medicine called rauwolfia serpentina. The Vedics just shook this stuff around on patients, and it calmed them down a bit.

It was the first tranquilizer recipe dealing with paranoia. One percent of the population the world over is paranoid at birth and will have the condition for life. We knew this then from protocols, and we now know it now through genetic tracing. Hoch had a proposal. He said they had tested this clinically, believed it worked, and thought it should be used systemwide. The presentation was all very orchestrated, as you can imagine.

“How much will that cost?” asked Governor Harriman. “About $7 million a year,” said Dr. Hoch. The governor turned to the budget director, Paul Appleby, and asked, “Paul, can we afford that?” “Good,” said Harriman. “I’m an investment banker; I believe in this kind of government.”

Well, New York State had ninety-eight thousand persons in mental institutions in 1955. We are now down to a little more than six thousand. The rest are sleeping on the streets or other such places. I came down to Washington with the Kennedy administration. They were awaiting a joint commission study for Congress. This information had spread. We came up with a proposal that instead of having large mental institutions, we would have local community centers where persons were assigned, looked after, medicated, and kept track of.

The last public bill signing that John F. Kennedy had before leaving for Dallas was the Community Mental Health Sector Construction Act of 1963. We were going to deinstitutionalize, build 2,000 community centers by the year 1980, and then add them thereafter at the rate of one for every 100,000 increase in population. We were going to have a new approach to a problem that just cannot be avoided by the species. I was there, and the president gave me one of the pens he used at the signing.

The president did not return from Dallas. Other things came along; we changed the name of the program; we folded it into another program. After we built about 380 of the centers the whole thing stopped. Then along came the problem of the homeless.

In New York City, where we have an unrivaled capacity for getting things wrong, this was described as the consequence of a lack of affordable housing. And indeed, the homeless appeared everywhere. Is there anyone in the room who lives in a large community that doesn’t have some such people? Well, they are mentally ill. They have been turned out of the hospitals and not treated in the community centers. And we cannot get this straight.

It is a huge failure in social policy. No one wants to talk about it, much less do anything about it. We have other explanations, and as a great French theologian once said, “The worst, the most corrupting lies are problems poorly stated.”

I apologize to Reagan; I was going off shoddy memories of reading Came The Revolution back in college.

The thing I can’t figure out is why we don’t have a “one free shot” doctrine for mental health. Get them off the streets, forceably medicate 'em. If they then refuse all medication, ok, but you get into some serious free will/definition of the self issues here if you just assume crazy people who don’t want to be medicated are fully expressing their desires.