A recent article in Psychiatric News highlighted the U.S. Supreme Court’s ruling that California must reduce its prison population due to substandard general and mental health care. The ruling indicated that substandard care violates the Eighth Amendment’s prohibition against cruel and unusual punishment.
The California prison system is overcrowded and financially strapped. It is providing limited mental health services and prisoners are enduring long wait times for mental health care. The Texas prison system is in a very similar situation.
Why? Part of the reason is the criminalization of mental illness. Due to the lack of outpatient resources, poor funding, stigma, discrimination, lack of understanding, poor planning, ineffectual policies and denial, the United States has returned to the conditions of the 1840s. We, as a society, have regressed to a time when individuals with mental illness were more likely to be incarcerated than receive appropriate medical treatment. By de facto, our prisons and jails have become “mental health facilities.”
Is this hyperbole? I wish that it were. In 2000, the American Psychiatric Association estimated that about 20% of prisoners were dealing with a serious mental illness, of which 5% had symptoms of psychosis at any given time.
A report issued by the National Sheriffs’ Association and the Treatment Advocacy Center in 2010 (“More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States”) is even more telling. This report examined the odds of a person with a serious mental illness being in a jail or prison compared to a psychiatric hospital.
The odds for all 50 states were 3.2 to 1 that an individual dealing with a serious mental illness would be in a jail or a prison. Another way to think about this is that for every individual with serious mental illness in a psychiatric hospital, three with serious mental illness are in jail or prison. In Texas the odds were 7.8 to 1, according to the report. In other words, there were nearly 8 seriously mental ill persons in Texas jails or prisons for every person in a psychiatric hospital.
These are disturbing statistics and underscore the important work yet to be done, especially during these austere and financially unstable times. However, Texas has done some critical work to address this very issue, such as establishing mental health courts, jail diversion programs and outpatient competency restoration.
Let us not be short-sighted and allow these projects and programs be undone by fiscal shortcomings. These measures are not only more humane and ethical, but are cost-savers when one analyzes the full societal and systems impact of incarcerating individuals dealing with mental illness. Economic pressures and political inertia are formidable allies of the “criminalization of mental illness.” The reality is, we can save tax dollars and help restore people’s lives by treating mental illness as a health condition, not a crime.