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U.S. Prisons and Mental Illness
October 22, 2003 10:16 AM   Subscribe

Prisons have become America's default mental health system. According to a new study by Human Rights Watch, between two and three hundred thousand men and women in U.S. prisons are seriously mentally ill, about three times more than the number of mentally ill who are in mental hospitals. [Via TalkLeft.]
posted by homunculus (23 comments total) 1 user marked this as a favorite

 
Hmm, the NYTimes says "as many as one in five of the 2.1 million Americans in jail and prison are seriously mentally ill," while the HRW press release says it's one in six. Either way, it's far too many.
posted by homunculus at 10:34 AM on October 22, 2003


Well, first Nixon impounded federal funds for mental health hospitals, then Reagan converted it all over to block grants, and then slashed funding of mental health programs to pay his tax cuts.

What, did anyone expect the result would be different?
posted by Cerebus at 11:22 AM on October 22, 2003


It's probably only gonna get worse. In my state they are consolidating the two public mental hospitals, which will result in fewer beds. (It seems that one happens to be sitting on some very primo real estate in our state's capitol.) Meanwhile more and more pressure is being placed on local facilities...many of the mentally ill cannot work because of their illness, so they can't obtain private insurance that would permit them to get decent medical treatment so they could get better...the county system is overloaded...

Stigma, ignorance, lack of training for police, etc....it's so depressing. And heaven help someone who has a public manic episode or psychotic break then acts in a perceived threatening manner toward law inforcement. Lots of people suicide by cop that way.

If I think about it too much....well, let's just say I couldn't bring myself to click the link.
posted by konolia at 11:55 AM on October 22, 2003


The economist ran a similar piece last year and well, its not surprising anymore its just pathetic. The larger issue here, of course, is can a wealthy western nation with 300 million+ people sustain itself without some form of universal healthcare? Arguably, mental illness causes crime as a dysfuntional person is unable to hold a job or maintain normal relationships, thus theft and violence.

Interesting to note that the main reason cited for bankrupcy in the US is healthcare bills. I think this is really just a symptom of a much larger healthcare issue in the US. Unfortunately, powerful groups like the AMA will fight tooth and nail to avoid socialization.

On top of this, we have a "popular" backlash against the cheapest and effective mental illness treatment known: anti-depressant pills. The media is rife with "experts" and "studies" attacking what is really the only affordable salvation in this country for many mentally ill people.
posted by skallas at 12:05 PM on October 22, 2003


Arguably, mental illness causes crime as a dysfuntional person is unable to hold a job or maintain normal relationships, thus theft and violence.

That's kind of a stretch. The study said 1 in 5 inmates was mentally ill. That leaves 80 percent of the prisoners perfectly sane. People commit crimes for all kinds of reasons. And who's to say you can't be mentally ill and still be held accountable? Obviously, say severe schizophrenics or bipolars might be non compos mentis, but you can suffer from depression and still know what's right and wrong.
posted by jonmc at 12:14 PM on October 22, 2003


>And who's to say you can't be mentally ill and still be held accountable?

Very true, but there is a correlation, that's why I used the word arguable. Also the correlation exists with homelessness and a myriad of other social problems.

It would seem treatment, for free, would make *huge* difference.

>but you can suffer from depression and still know what's right and wrong.

Well, sure, but a suicide victim's family might disagree with you on that. Let's just assume a broken brain can lead to real harm.
posted by skallas at 12:23 PM on October 22, 2003


There's a hella big gray area between "perfectly sane" and ill enough to be dysfunctional. And how about knowing what's right and wrong and being beyond caring?
posted by alumshubby at 12:25 PM on October 22, 2003


Let's just assume a broken brain can lead to real harm.

Absolutely. The building where I work is across the street from an outpatient mental health clinic, and I see the poor sad sacks, and I feel for 'em.

However, for example, there's a guy who, when he's not caressing parking meters likes to get right up in passing womens faces and stare in their eyes like a panther, until someone tells em to lay off. Obviously, the guy is sick, but that ain't much comfort to those of us who have to deal with him day in and day out. There are also several mentally ill people who loiter around my neighborhood, who are perfectly harmless, just so I'm not applying the brush too broadly

Plus there needs to be clear dilineations of what "mentally ill" actually means. Does it include alcoholism? drug addiction? I sympathise with the plight of addicts, but that dosen't mean I want the junkie who robbed my father (and a number of other people) at knifepoint to get a free ride. It's ultimately (like a lot of crime issues) not so much a public health issue as a public safety issue. Obviously, people like parking meter boy don't necessarily belong in prison, but I can sympathize with people who might not want him in front of their house either.

There's a hella big gray area between "perfectly sane" and ill enough to be dysfunctional.

Just about everybody in prison qualifies as dysfunctional, otherwise they wouldn't be there. Like I said, clear definitions needed here.
posted by jonmc at 12:37 PM on October 22, 2003


I sympathise with the plight of addicts, but that dosen't mean I want the junkie who robbed my father (and a number of other people) at knifepoint to get a free ride.

This was one of the points that we went over for almost an hour in my psychology class in college: the general public thinks that individuals who are committed to mental institutions by the courts are "getting a free ride," or not getting some sort of punishment they "deserve."

If someone is found to be mentally ill, then they're put in a locked institution for treatment where they must undergo therapy. This is unlike prisons, where education programs and the like are optional. Mental patients are only released when a board certifies them sane, not at the end of a court-issued sentence. Stays in these institutions can be much longer than jail sentences, and often are.

For some reason people think that sentencing someone to an institution is like a slap on the wrists. The stereotype that someone will be sent to an institution and "rehabilitated" within months is false.

To use a bad metaphor, sending a mentally ill person to jail is like having your car repainted when the engine is bad. Sure, it may keep up appearances, but it's going to break down as soon as you get it back. If someone is mentally ill, going to jail isn't going to fix it.
posted by mikeh at 2:54 PM on October 22, 2003


so they can't obtain private insurance

...and for some silliness, the only way for many mentally ill to receive state sponsored health insurance is to sign up for public assistance.

Admittedly I know very little about mental illness but wouldn't locking someone up for years on end in an ultra violent society with all of the Very Best People drive a normal person over the edge?
posted by soren at 3:33 PM on October 22, 2003


Plus there needs to be clear dilineations of what "mentally ill" actually means. Does it include alcoholism? drug addiction?

Unfortunately there is something called "self-medication." Many bipolars medicate themselves with drugs or alcohol, which makes a proper diagnosis even harder to make than it was to begin with. And when you put these folks in rehab, it won't do much good unless the underlying illness is addressed.

It's all a tangled mess. Add to it that a lot of schizophrenics and bipolars don't like to take their meds. Sometimes because of side effects, which can be pretty bad, and sometimes because that is part of the disease process-denying that anything is wrong.

Now there are people who do fall in the grey areas. Most mentally ill people do have it together enough to tell right from wrong, at least most of the time.
posted by konolia at 5:02 PM on October 22, 2003


After a long day at work reading about 100 letters from prisoners most of whom are, obviously, mentally ill I am dismayed to read the comments in this thread. People who are mentally ill are disproportionately represented in the prison population, and then, once incarcerated they are disproportionately represented in the punishment units.

People who are mentally ill in our society are sometimes incapable of holding a straight job, and they are sometimes incapable of wading through the bureaucracy that we call social services. So, some people who are mentally ill commit crimes so that they can get money so that they can eat. Maybe it's petty drug sales, maybe its a half baked attempted robbery, then these non-violent offenders are put in prison, with REALLY inadequate healthcare, and very poor coping skills, and they have a miserable time in prison. Their psychiatric issues are not dealt with and then they are released without public assistance only to repeat a similar crime and be given a harsher sentence.

When we are talking about mentally ill people we are talking about people who might write suicide notes in crayon, or who basically cannot read or write, or who have other severe problems.

I'm not saying that some of the people who are imprisoned who are also mentally ill are not violent offenders, I'm just trying to paint an accurate picture of the people who are being referred to in the article.

Nobody would argue that a violent offender should get 'a free ride' (I'm not sure what that means...). But, anyone who has worked with the justice system would understand that there should be more social services to deal with mentally ill people so that they aren't forced into a life of crime.

Also, as an aside, a lot of the self-medicating homeless men that you see on the street are Vietnam Era Veterans. New York City is closing another veterans hospital that basically serves that same group of duly diagnosed (mental health and addiction problems) adult males as the prison system will now in the future.
posted by goneill at 6:16 PM on October 22, 2003


Not to mention that putting young males convinced of possession or other non-violent offences in that environment likely causes, if not mental illness, at least strong antisocial habits.
posted by Nothing at 10:52 PM on October 22, 2003 [1 favorite]


(I say males because the environment reinforces a typically masculine brand of antisocial behavior. I realize it's not just a male problem, though.)
posted by Nothing at 10:54 PM on October 22, 2003


Surely, it's time you guys instituted some form of involuntary euthenasia. I know your government isn't for people offing themselves if they want to be killed, but they seem ok with it if profit margins increase, so maybe you guys could write your local congressman and ask that your local loonies get put through the grinder and fed to livestock.
posted by The God Complex at 1:32 AM on October 23, 2003


TGC -- That certainly sounds like a modest proposal.
posted by Civil_Disobedient at 3:01 AM on October 23, 2003


It sounds to me like mad cow disease.
posted by konolia at 4:10 AM on October 23, 2003


TGC - that is what I like the sweet sound of progress, don't give me problems I want solutions. In one swift stroke the mentally ill can be disposed of whilst their processed caracasses can be used for rearing some prime beef, ingenious.
posted by johnnyboy at 6:48 AM on October 23, 2003


Nobody would argue that a violent offender should get 'a free ride' (I'm not sure what that means...).

What I meant by that is that even though the guy who held a knife to my father's stomach, has an illness -addiction- that he still should answer for what he did. Meaning that yes he should probably get some treatment for his addiction, but also that he should be punished.


I am dismayed to read the comments in this thread.

I thought my concerns were fairly reasonable. I am not without compassion for those with mentall illness or addictions, since many people close to me have suffered from both, but at the same time ordinary people have every right to be concerned when these people (many of them potentially dangerous) are loitering in front of our homes and businesses. I agree that most of them don't belong in prison, but they dont belong on my front stoop either. And I'm not some kind of fascist ogre for thinking so.
posted by jonmc at 7:24 AM on October 23, 2003


jonmc, I don't believe that I called you a fascist ogre anywhere in the thread. What I tried, and obviously failed to do, was explain the situation to you. I am very sorry that your father was robbed at knife point. My roommates were recently robbed at gun point.

What I tried to explain in my very long post is that the mentally ill people are hanging out on your stoop until they commit a violent or non violent crime and then are shipped off to prison. They are in prison for some time and then they are let out and then they are back on your stoop until they committ another violent or non violent crime. It's a horrible cycle, and it is becoming more and more frequently the solution that the United States Penal System is advancing.

Obviously the man who is addicted to drugs who robbed your father ostensibly to purchase more drugs should not but put immediately back on your stoop. Individuals who are incarcerated who committed of drug related crimes do have to attend drug counseling sessions, but the are often inadequate.

The human rights watch book about prisons details extensively the definition of 'mentally ill.' The definition does not include simple addiction.

Psychiatric prisons are horrible places to spend time. I don't think anyone who has had any involvement with them would believe that the people in them are getting 'a free ride'.
posted by goneill at 8:44 AM on October 23, 2003


And until the public at large understands that "mental illnesses" are real physical illnesses, I doubt it will change.
posted by konolia at 9:06 AM on October 23, 2003


jonmc, I don't believe that I called you a fascist ogre anywhere in the thread.

OK, that was an overreaction. Sorry. But the "dismayed" implied that you were shocked by my previous comment. All I was trying to advance is that ordinary, non-criminal, non-mentally ill, citizens have every right to be concerned and even afraid about the mentally ill on their streets. And also that one can have mental problems and still be cognizant of what they are doing.

Just as the mentally ill should have a right to adequate treatment, taxpaying citizens have at least some right to feel safe on city streets, and that the women who are scared by parking meter guy have every right to be scared.

Obviously the man who is addicted to drugs who robbed your father ostensibly to purchase more drugs should not but put immediately back on your stoop. Individuals who are incarcerated who committed of drug related crimes do have to attend drug counseling sessions, but the are often inadequate.

Agreed. But at the same time any drug treatment therapy worth it's salt will emphasize the importance of taking responsibility for the things you did in the course of your addiction. The men who robbed my dad and your friends decided that their desire for dope or money was more important than innocent peoples safety. The perpetrators probably wouldn't have committed these crimes were it not for enviornmental factors, but still, they made a decision and along with the help they get, they should also pay a penalty.
posted by jonmc at 9:10 AM on October 23, 2003


The way that we care for the mentally ill is the true definition of insanity.

My younger sister is a paranoid schizophrenic. For a long time, she was subject to religious delusions. At various times, she thought that she was Jesus, and that she talked to Jesus, that the voices that she heard was Jesus and the Devil shouting at her, and that it was necessary for her to die so that the world could be saved. She is better now, thank God, but for several years she refused to believe that there was anything wrong with her and there was nothing we could do to get her into psychiatric care. Any attempt to do so only fed into her intense paranoia and delusions.

Finally, we had to put her in jail after she came at my father with a knife. The main reason that we prosecuted was so that we could get her off the streets and give us the time process the paperwork to get guardianship of her. She was in jail for four months, refusing treatment and in the throes of a full fledged schizophrenic break in one of the worst environments possible. It was the only thing we could do at the time – at least we had some guarantee of her physical safety.

Despite all the best efforts, it was a period of three years of heartache and fear before we could get her into treatment. During that time, she lived homeless on the streets - she is a small girl, no taller than five feet and about sixty pounds in weight and to this day I am scared when I think of what could have happened to her. And yet, her mental illness is so profound that I don't think that anything she could have experienced in the real world could compare to the torment within her mind.

The sad thing is that we do have some money to help her and in my family there is a lawyer and a nurse to help us navigate through the courts and the mental hospitals.She is in treatment now, but it took a lot of money and a lot of time and expertise to get her to this point. I think about other people who might not have the money or the resources that we had and it breaks my heart.

But still, for us it came down to the fact that we had to put her into prison before we could get any treatment for her. Before that, we had taken her several times to facilities where she was turned away because she was not an immediate danger to herself or to others and that she was not deemed to be “sick enough” to warrant care. After some research, I have to believe that her case is one of the more extreme cases of paranoid schizophrenia out there, and if they were not accepting cases like her I can't imagine who they would have accepted.

This entire experience has left me with some antipathy for Jeb Bush and the paltry healthcare system in Florida. I am very glad that he is willing to do the political grandstanding to protect a woman who's been in a vegetative state for the last decade but can't seem to bring himself to care about the fact that there are walking, talking, living people who need our care even more. There's some sort of equation going on that the worth of a human life is so much greater before birth or close to death, but not at any point in between. That is also pretty crazy to me.
posted by rks404 at 9:39 AM on October 23, 2003


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