"We are literally drowning
running around trying to put our fingers in the bursting dikes,
while hundreds of men continue to deteriorate psychiatrically
before our eyes into serious psychoses…
The crisis stems from recent changes in the mental health laws
allowing more mentally sick patients to be shifted
away from the mental health department into the department of
- Nowhere in our
society is the debacle of deinstitutionalization felt more than in our
criminal justice system. Major cost-shifting by the states to the
federal government following the advent of Medicare and Medicaid and
the radical actions of civil libertarians in the name of
"freedom" proceeded in rapid order, leading to the largest
component of today’s health crisis: The criminalization of Americans
with severe psychiatric illnesses. In fact, America’s jails and
prisons are now surrogate psychiatric hospitals for thousands of
individuals with the severest brain diseases.
- According to a 1999 Department of Justice report, at least 16
percent of the total jail and prison population, or 283,000 people,
have a serious mental illness – more than four times the number in
state mental hospitals.
- The costs of such
incarceration are enormous. According to the Department of Justice
(1996 Source Book: Criminal Justice Statistics), it costs American
taxpayers a staggering $8.5 billion per year to house individuals with
psychiatric disorders in jails and prisons ($50,000 per person
individuals with severe psychiatric disorders costs twice as much as
assertive community treatment programs – some of the most effective
plans to treat the severely ill. Community treatment programs cost
roughly $60 per day, compared to the costs of jails and prisons which
are approximately $137 per day.
- While some jails
and prisons provide adequate psychiatric services to ill inmates, many
do not. And, many corrections officers receive very little training in
the special problems of caring for psychiatrically ill inmates.
Assertive Community Treatment teams provide patients with the same
individualized 24-hours-a-day services that are furnished in
psychiatric wards of hospitals. The difference is that the ACT team
travels to the patient in his or her chosen environment, essentially
serving as a ‘hospital without walls.’ On their own, continuous
treatment teams such as ACT must be complemented by the use of
conservatorships or outpatient community treatment orders to ensure
individuals actually get the medications they need for recovery. If
some mechanism for treatment compliance is not incorporated into the
outreach efforts, patients are no more likely to take their medication
than in a hospital inpatient setting.
- A 1992 study of
American jails reported that a shocking 29 percent of the jails
acknowledged holding ill individuals with no charges against
them. These individuals were being held awaiting psychiatric
evaluation, the availability of a hospital bed, or transportation to a
psychiatric hospital. These jailings were done under state laws
permitting emergency detentions of individuals suspected of being
mentally ill and were especially common in rural states such as
Kentucky, Mississippi, Alaska, Montana, Wyoming, and New Mexico.
- This same study
found that the vast majority of U.S. jails do not provide adequate
psychiatric services to inmates with serious brain disorders. More
than one in five jails have no access to mental health services of any
kind. Corrections officers in 84 percent of jails receive either no
training or less than three hours training in the special problems of
people with severe mental illness.
- The vast majority
of jail inmates with serious brain disorders who do have charges
against them have been arrested for misdemeanors such as trespassing.
Studies also have shown that these inmates are four times more likely
to have been incarcerated for less serious charges such as disorderly
conduct and threats than non-ill inmates. Police, in fact, frequently
use disorderly conduct charges to arrest an ill person when no other
charge is available. Alcohol and drug related charges also are common
because alcohol and drug use among this population frequently occurs
as a secondary problem among those with serious brain disorders.
- In examining
police arrest records, researchers often find a direct relationship
between the person’s brain disorder and the behavior that led to
apprehension. For example, a woman with schizophrenia in New Mexico
was arrested for assault when she entered a department store and began
rearranging the shelves because she had a delusion that she worked
there; when asked to leave, she struck a store manager and a police
officer. People who suffer from paranoid schizophrenia are likely to
be arrested for assault because they may mistakenly believe someone is
following them or trying to hurt them and will strike out at that
bookings" by police who are trying to protect people with the
severest forms of psychiatric illnesses also are surprisingly common.
This is especially true for women, who are easily victimized, even
raped, on the streets.
- Local businesses
often exert pressure on the police to get rid of
"undesirables," including those suffering from untreated
psychosis. This is especially true in tourist towns such as New
Orleans, where the police have a well-known reputation for
"cleaning the streets" by arresting all vagrants and
Another Route to Much Needed Treatment
- People with
severe mental illnesses also are sometimes jailed because their
families find it is the most expedient means of getting the person
into needed treatment. As the public psychiatric system in the United
States has progressively deteriorated, it has become common practice
to give priority for psychiatric services to persons with criminal
charges pending against them. Thus, for a family seeking treatment for
an ill family member, having the person arrested may be the most
effective way to accomplish their goal.
inmates with schizophrenia or manic-depressive illness is relatively
common. For example, data collected from New York State jails between
1977 and 1982 showed that half of all inmates who committed suicide had
been previously hospitalized for treatment of a serious brain disorder.
successful suicide in jails, there are many others that are
unsuccessful. According to a chief psychiatrist in the Los Angeles
County Jail, the ratio of failed suicide attempts to deaths by people
with untreated brain disorders is about 20 to 1.
Individuals with Psychiatric Illnesses More at Risk
thinking, delusions, auditory hallucinations, and severe mood swings
often lead to bizarre behavior by individuals with severe brain
disorders who are in jails and prisons. Such bizarre behavior is
disquieting to other non-ill inmates who frequently react with violence
against those with brain disorders, thereby making life in jail a brutal
experience for them.
form of assault that sometimes occurs behind bars is attempted or actual
rape. All inmates in jails or prisons are at risk for such attacks, but
inmates who are confused by their illness and less able to defend
themselves are more vulnerable.
major problem for those with severe mental illnesses in jails and
prisons is exposure to infectious diseases and neglect of their medical
problems. Tuberculosis, some varieties, which are resistant to
medications, spreads rapidly among the incarcerated. AIDS and venereal
diseases can be a consequence of rape. People who suffer from severe
brain diseases frequently cannot describe their physical symptoms to
officials, and if they are able to do so, they are often ignored. Either
way, the results can be fatal.
with serious brain disorders, the effects of being in jail or prison are
occasionally positive, but more often negative. Interestingly, many of
those who claim that it was positive, do so because they found being
incarcerated was the only way they could get psychiatric treatment.
- Such cases are the exceptions, however. Jails and prisons usually
exacerbate psychiatric symptoms, both because individuals with serious
brain disorders are frequently placed in solitary confinement and
because they often are not given the necessary medication to control