Mental Illness: What Hath Been Wrought

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During the early 1970's in California Ronald Reagan decided to deinstitutionalize persons with mental illnesses. With legislative support that's what happened, and it was supposed to be somehow replaced with some kind of community care system and psychotropic drugs that somehow never fully materialized. Over the years many commentators and researchers have noticed the increased presence of persons with varied mental illnesses or dual diagnoses in prisons and jails.

The Treatment Advocacy Center's latest nationwide study on the mentally ill in confinement notes:

"In historical perspective, we have returned to the early nineteenth century, when mentally ill persons filled our jails and prisons. At that time, a reform movement, sparked by Dorothea Dix, led to a more humane treatment of mentally ill persons. For over a hundred years, mentally ill individuals were treated in hospitals. We have now returned to the conditions of the 1840s by putting large numbers of mentally ill persons back into jails and prisons" (emphasis in original).

Have you been to a local jail lately and checked out how many persons identified as having mental illnesses are there and how many of them are walking around with shackles? It's upsetting to behold, but when you put people in a jail and they don't behave, you do what jailers do. A sad part of this is that there are no bandaid, panacea solutions. Over 30% of women inmates, and a little over half of male inmates, have serious mental health problems, and Los Angeles Sheriff Lee Baca can say with authority, "I run the biggest mental hospital in the country" (cited in the above study, p. 4).

Clearly U.S. priorities and California's in particular are to criminalize problems that belong elsewhere. Criminal justice incarceration, here in the form of local jails, is one of the most inappropriate, expensive and least effective solutions around. The above study suggests that states with the greatest spending on hospitals for the mentally ill spend the least money on mentally ill inmates in prisons and jails. Moreover, mentally ill inmates cost a great deal more to manage than other inmates--and they stay longer (not surprisingly, many have trouble following institutional rules! After all, it is a place of punishment in form if not intent.).

This is one of those areas of criminal justice where it is very clear the form of our structured response to people in trouble (jail and shackles for the mentally ill) is inappropriate. Our society--through our leaders--has put all its money into a criminal justice solution to everything: we're now governing through crime, to use the title of Jonathan Simon's book, Governing Through Crime, a vital way of thinking about the mass incarceration response to crime today.

How can we get out of this mess? It seems advisable to decarcerate the mentally ill with soundly planned and executed community based alternatives designed to keep them out of jails and prisons and which do not infringe on their civil liberties. There are programs that work to do that. Mental health courts appear to have promise, as may other alternatives suggested in the report. The non-help, non-system, let them eat cake solution of Ronald Reagan doesn't work and the current policy of incarceration doesn't work. Moreover, in today's world, throwing psychiatrists at them will do little more than lead to drugs: in today's world, psychiatrists have moved away from talk therapy. (See Talk Doesn't Pay, So Psychiatry Turns Instead to Drug Therapy.) Instead, it's all about drugs and more drugs.

Today it appears that jails and prisons have become for the mentally ill what the juvenile court was in the early 1960's to juveniles having minor run-ins with the police: a solution of first resort. Edwin Lemert's angrily toned (and lengthy) report, Instead of Court: Diversion from Juvenile Justice, drew attention to the overreach of the juvenile justice system and suggested the importance of finding alternatives to formal processing. Since that time diversion programs, which have their own issues, have flourished and many states have decarcerated or completed closed their youth training schools (prisons for young offenders). The important lesson from research on these states' experiences is that with careful planning it is possible to decarcerate young offenders--as California has been doing--without increasing public risk and while providing people with the services and assistance to make them self-sufficient adults. Perhaps similar things can be done with mentally ill persons along lines suggested in the Treatment Advocacy Center report.

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This page contains a single entry by published on June 25, 2010 7:02 AM.

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