Tuesday, December 2, 2003
Seattle Post-Intelligencer - November 26, 2003
These two are not alone. The American Psychiatric Association has estimated that as many as one in five of those behind bars has a serious mental illness.
Some 300,000 people in U.S. prisons suffer from mental disorders ranging from major depression and post-traumatic stress to schizophrenia - three to four times more than the number in mental- health hospitals. In a recent report, Human Rights Watch argued that the penal system is "not only serving as a warehouse for the mentally ill but is also acting as an incubator for worse illness and psychiatric breakdowns."
Fifty years ago, says HRW, more than half a million Americans lived in public psychiatric hospitals. Today, proper hospitals house fewer than 80,000 people.
This is largely a sign of progress. The development of new drugs has made it possible for the mentally ill to be treated outside a hospital. And there is far better legal protection to prevent people from being locked up against their will.
Nevertheless, things have not gone according to plan. When many of the country's mental-health hospitals were shut down in the '60s, the idea was that patients would be looked after by local health systems. Instead, the mentally ill often have little access to treatment, and many have ended up on the streets. According to the National Resource Center on Homelessness and Mental Illness, up to one in four homeless people has a serious mental illness.
Once on the streets, and with only meager health care, it is often only a matter of time before a mentally ill person commits a crime and is sent to jail.
For instance, the number of mentally ill in Santa Clara County's jails jumped by 300 percent in the four years after a nearby California state hospital closed down. Another study showed that the arrest rate of mentally ill people rose fivefold in the first eight years after the rules tightened about who was allowed into mental hospitals.
Tougher sentencing policies are also pushing mentally ill people toward prison. The United States' prison population has more than quadrupled over the past 20 years, largely because of the war on drugs.
The minor misdemeanors for which mentally ill people get arrested increasingly draw prison sentences: Three-quarters of the new arrivals in state prisons are there for non-violent offenses. And the famous "not guilty by reason of insanity" plea is increasingly rarely used.
Shocked by the fact that John Hinckley used this defense to escape punishment for shooting President Reagan in 1981, many states restricted a defendant's right to plead insanity. Utah, Montana and Idaho abolished it.
There is a perverse economic logic in the mentally ill ending up in prison rather than hospitals. U.S. prisons, after all, have been far more successful than mental-health systems at protecting their budgets from cost-cutting politicians. It is also cheaper to house the mentally ill behind bars than in a state hospital.
On the other hand, the prisons are not designed to treat the mentally ill. They are bad at rehabilitating "normal" prisoners, and they usually make mentally ill people more ill.
The problem is bad enough for some politicians to reconsider the current tough policy and to try to divert non-violent mentally ill offenders away from prisons. There are now 90 special mental health courts in more than 20 states; they can sentence minor offenders to treatment programs rather than prison.
A bill is being considered in Congress that would provide money for such courts, as well as more cash for treatment and housing. It will cost money; but U.S. Rep. Ted Strickland, a Democrat from Ohio who has sponsored the bill, says that the alternative is accepting "incarceration and homelessness as part of life for the most vulnerable population among us."
Copyright 2003 Economist Newspaper Ltd. Distributed by The New York Times Syndicate.
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