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Report: Jails House 10 Times More Mentally Ill Than State Hospitals

By Jenny Gold

April 8th, 2014, 5:00 AM

In 44 states and the District of Columbia, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to a report released Tuesday by the Treatment Advocacy Center and the National Sheriffs’ Association.

Across the country, an estimated 356,268 people with mental illnesses including bipolar disorder and schizophrenia are in prisons and jails, compared to just 35,000 in state hospitals — a tenfold difference.

That’s similar to the mental health system in 1830, before Dorothea Dix and other advocates pushed to shift people with mental illnesses out of the prisons and into hospital care instead, says Dr. E. Fuller Torrey, a psychiatrist and lead author of the report.

“We’ve basically gone back to where we were 170 years ago,” says Torrey, a prominent critic of the widespread effort to deinstitutionalize psychiatric patients beginning in the 1960s. “We are doing an abysmal job of treating people with serious mental illnesses in this country. It is both inhumane and shocking the way we have dumped them into the state prisons and the local jails.”

The report includes a survey of each state’s mental illness treatment laws in prisons, as well as background on the percentage of prisoners with mental illnesses in each state.  Since 1970, Torrey says that percentage has risen from an average of about 5 percent to 15-20 percent.

“There is not a single state in the United States where you want to go to a jail or prison and be severely mentally ill,” says Torrey.  He adds that many jails and prisons are trying to improve their care of prisoners with mental illnesses, but they are hampered by state laws that make forced treatment difficult.

In 31 states, prisons can administer treatment over a prisoner’s objections by requesting a special treatment review committee, but the process is often difficult and the report calls such efforts “grossly underutilized.” Some people with mental illness refuse treatment, often because they are not aware that they are sick.

“This causes major problems,” the authors write in the report. “Jail officials can thus be legally sued in many states if they forcibly medicate mentally ill prisoners without their consent, yet can also be held legally responsible for the consequences of such prisoners’ psychotic behavior,” including suicide.

Torrey adds that there is often a fundamental mismatch between guards and prisoners with mental illnesses. “People who work in jails and prisons signed up because they wanted to take care of bad people. So you get some personality types that are not compatible with taking care of people with serious mental illnesses,” he says.

Prisoners with mental illnesses often are put in seclusion for long periods of time, remain incarcerated longer than other prisoners, and are disproportionally abused, beaten and raped by other inmates. In addition, prisoners with mental illness who are not treated often become sicker.

The solution to the problem, according to the authors of the report, is to create a public mental health system that helps people with serious psychiatric problems “before they are so disordered they commit acts that result in their arrest.” This includes court-ordered outpatient treatment and jail diversion programs such as mental health courts.

The authors also recommend reforming jail and prison treatment laws to more easily allow staff members to administer involuntary medication for inmates with mental illnesses who are gravely disabled, deteriorating or pose a likelihood of serious harm to themselves or others.

The issue of court-ordered outpatient treatment divides the mental health community with organizations like The Bazelon Center for Mental Health Law and Mental Health America  opposing it on the grounds that it violates the civil liberties of people with serious mental illnesses.

5 Responses to “Report: Jails House 10 Times More Mentally Ill Than State Hospitals”

  1. Killroy71 says:

    Mentally ill people are in jail because it’s easier to raise taxes for jails than for mental health care. We pay either way, but apparently as a society we are more punitive than sympathetic. It’s a pretty sad and ugly statement about who we are as a country.

  2. evan says:

    Thanks to President Ronald Reagan, mental hospitals all across America were closed and mentally ill patients were sent out into the streets in droves to fend for themselves. Couple that with the fact that the National Rifle Association has always defended the right for people (with no criminal record) to own guns, including the mentally ill, and you have the perfect recipe of the Republican Party platform regarding the mentally ill in America. Thank you President Reagan! In my opinion, the only President to show serious signs of Alzheimer’s disease while in office. On second thought, maybe we should be saying thank you to President Nancy for closing the mental hospitals?

    Don’t believe me? If not, do a web search for the words…

    “Ronald Reagan’s shameful legacy: Violence, the homeless, mental illness”

  3. Spencer Graf says:

    Perhaps we should substitute the term “Super Scary Terrorist Lockdown” for “Mental Hospital” in order to boost funding?

  4. evan says:

    Boost funding? With a tea party caucus in Congress that does not believe anyone in America is mentally ill? The same way the Congressional tea party caucus believes that global warming is a contrived left-wing hoax? I’m beginning to believe that most of the folks that make up the tea party are, in reality, the exact same people that President Reagan flushed out of the mental hospitals back during his administration. Gun-toting survivalist wackos!

  5. R. E. H. says:

    Dr. Torrey and his organization want to turn back the clock and undo the progress we’ve made in treating mental illness and providing mental health services. They want to return to the coercive model that forced people into treatment and often resulted in over-medication. Granted, the current system of mental health services is far from perfect–and the concentration of people with mental illness in jails and prisons is striking evidence of what is wrong with the system. But the answer is not forcing people into restrictive inpatient or outpatient treatment as the first choice. Treating mental illness requires sensitivity to the nuances that characterize mental illness in different people and the enhancement of community-based services. Surely, we do not need to return to the huge mental hospitals of the 1940s and 1950s and the “once-size-fits-all” style of treatment that was all too prevalent then. People with mental illness have hard-won civil rights and civil liberties that need to be respected in any treatment choice.

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