Psychology/Psychiatry

Our Crazy Treatment of the Mentally Ill

Prison cells have replaced mental institutions.

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Credit: Rikke68, Dreamstime.com

A Bronx man died in police custody last week after police responded to a 911 call. An Iraq combat veteran in El Paso, Texas, serving a two-day DWI sentence, died after being subdued by guards. A woman died after being Tasered by sheriff's deputies in a Fairfax, Va., cell. 

What they had in common, besides expiring abruptly while in the hands of law enforcement officers, is mental illness. Denis Reyes was afflicted by bipolar disorder. James Brown reported being diagnosed with post-traumatic stress disorder. Natasha McKenna had a history of schizophrenia. 

We used to warehouse the mentally ill in overcrowded, unsafe asylums—"loony bins"—where they often got crude or ineffectual treatment, if any, and endured violent abuse. But our civilization has moved past that primitive stage. Now we warehouse them in jails and prisons, where their conditions are often even worse. 

It may seem odd that the new executive director of the Cook County, Illinois, Jail, Nneka Jones, is a clinical psychologist, not a career cop or corrections official. It makes more sense when you consider that nearly a quarter of the inmates have mental illnesses. 

Sheriff Tom Dart refers to the facility as the nation's biggest mental institution. But he's got nothing on Illinois prisons, which house six times as many mentally ill inmates as the jail. 

The numbers will only get bigger. One of the grim consequences of Illinois' fiscal insolvency is Gov. Bruce Rauner's proposal for a 15 percent cut in funding for the state's mental health agency—which pays for treatment, housing and other services to help those with psychiatric disorders function in society. 

Last month, Dart told The Chicago Tribune he sees this approach as a mistake: "It doesn't make sense to cut service that prevents people from coming into the criminal justice system, which is a very expensive system to come into." 

Cost aside, it creates hazards for them as well as corrections officers. A new study by Human Rights Watch says, "Persons with schizophrenia may experience prison as a particularly frightening, threatening environment and as a consequence some behave dangerously toward themselves, staff, or other prisoners." 

Many, it says, "refuse to follow orders because hallucinations and delusions have impaired their connection with reality." The mentally ill violate the rules far more often than other inmates, for obvious reasons, and efforts to control them often aggravate their insanity. Some, like the prisoners cited above, end up injured or dead. 

Short term budget needs sometimes take priority over long-term cost-effectiveness. But it's clear that governments need to improve their policies toward citizens who have lost their hold on sanity. 

One reason so many of these people wind up incarcerated is the lack of other places to put them. A 2010 report by the Treatment Advocacy Center noted, "In 1955, there was one psychiatric bed for every 300 Americans. By 2005, there was just one psychiatric bed for every 3,000 Americans." 

Another cause is a shortage of good outpatient care. The idea behind the "deinstitutionalization" of the 1950s and '60s was that the mentally ill could be helped more humanely while living and being treated in community settings. But many of those released from asylums never got the help they needed. 

The results were disastrous, and not just for them. In his book, The Insanity Offense, psychiatrist E. Fuller Torrey notes that a study of 81 cities found "a direct correlation between the decrease in the number of public psychiatric beds and the subsequent increase in homelessness, arrest rates and crime rates among mentally ill individuals in those cities." 

Sally Satel, a psychiatrist and scholar at the American Enterprise Institute, says one remedy is to expand mental health courts, diverting some criminal offenders to non-punitive programs involving medication, treatment and monitoring. 

Another, she says, is for state and local governments to be more active in the use of mandatory outpatient treatment for mentally ill people who repeatedly end up in jail, emergency rooms or homeless because they can't care for themselves or make rational decisions. 

Such measures will require funding. "We're not putting enough into the people who are the most sick," Satel told me. But there is no way for any of us to escape the social and fiscal costs of serious mental illness. 

We're putting a lot into these people, but in all the wrong places—jails, prisons and even morgues. Addressing mental illness differently would be a welcome symptom of sanity. 

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  1. Im not sure that additional funding for state sponsored “mental health professionals” is good news for libertarians. Laws like the Marchman and Baker Acts are among the most terrifying on the books – allowing spouses, coworkers, family or friends to have anyone imprisoned against their will without even the suspicion of a crime being committed. Those so detained are not provided an attorney and often are not allowed to contact their own attorney.
    Massive reform is needed – first and foremost, compulsory mental health treatment has no place in a society of laws.Second, great skepticism must be reserved for psychiatry and psychology’s relationship to the state. The extreme deference given to quacks during sentencing phases of criminal trials and the role that shrinks played in the formation of modern US torture programs should give us all pause that a mental hospital would be a better place than a prison to be incarcerated.
    Heres a shocking idea: leave people the f*k alone and stop imprisoning millions of innocent people.

    1. Your remedy is a good one in theory but we live in the real world here. Homeless people and the mentally ill will be disproportionately arrested because, if they aren’t, businessmen and other powerful people in the community will demand it. That’s not the way it should be but that’s the way it is.

      Between jail/prison and a beefed up mental health and treatment response, the only two realistic outcomes, the treatment response is the lesser, and maybe cheaper, of two evils.

      1. Your remedy is a good one in theory but we live in the real world here.

        B+

    2. Point of clarification: It was, IIRC, the psychologists, not MDs that were involved in the torture program.

  2. The idea behind the “deinstitutionalization” of the 1950s and ’60s was that the mentally ill could be helped more humanely while living and being treated in community settings.

    Money shot right there. A lot of controversy surrounding this. There are some in the mental health industry who regret deinstitutionalization and want to return to a system where it’s easier to commit people against their will. This is a hot button topic in libertarian circles because it touches on issues of agency, choice, a dangerously empowered state. Then there’s an ugly reality in the severely mentally ill that allowing them to make their own choices in a highly decompensated state will naturally lead to run-ins with the police who are too often ill-equipped to deal with irrational actors.

    My ex wife who works in an er as a clinical social worker has seen the exact opposite of what this blog post details: police trying to drop off run-of-the-mill criminals into the ER as “mentally ill” because they didn’t want to deal with the paperwork.

    1. There are some in the mental health industry who regret deinstitutionalization

      Yeah, because they lost income from deinstitutionalization. They had to re-purpose themselves and DUI counselors.

    2. I wonder how much mental illness is created by the drug-induced compulsory public education camps. Force children into unhealthy environments, then drug them into social compliance in said unhealthy environments, and you’re probably creating a person incapable of handling life any other way.

      1. [Passes roll of heavy-duty tinfoil to IF]

        And while I totally agree with you, that message needs a bit of framing to effectively reach the general public.

      2. Well, there’s the mentally ill and then there are the mentally ill. I think in this context, we’re discussing the latter. There are certainly forces and incentives to pathologize behaviour that’s quirky, annoying our just plain normal. That’s a discussion of its own.

        But the fact of the matter is that there are people who are just bat shit crazy and are absolutely a danger to themselves and others in the complete absence of medication and care.

        This is one of those issues on the krinkly edge of libertarianism, which is why there’s contention and disagreement on how to deal with it within libertarian circles.

  3. Rid the world of morons, psychopaths, and mental defectives. And put them where they belong – on the force.

  4. Our Crazy Treatment of the Mentally Ill

    Yep. We either make them the Secretary of Energy, or the EPA, or press secretaries.

    1. And the more violent ones get employed as cops.

  5. No time to find a link, but one big factor was the creation of Medicare, which did not pay for people in state mental institutions, so they closed down.

  6. The sheer fact that we are still using terms like “mentally ill” and “mental illness” in 2015 to describe these issues highlights the REAL problem. These folks aren’t merely unhappy, or have a bad attitude. The citizens in question have profound neurological (physical) ailments. Most are no more able to control their illnesses than a one-legged man can run. 50 years ago, neurology was still in its infancy; it isn’t any longer. Everything from drug abuse to depression has been proven to be less about “mentality” and more about brain chemistry, often with a cyclical downward spiral (eg take drugs, they mess with brain chemistry, causes to take more drugs, more chemistry changes). Putting a neurologically-impaired person in a prison system that under no illusion can be said to be actually geared towards “rehabilitation” (instead, biblical-times level punishment) is tantamount to strapping a car-crash victim onto a hospital gurney and telling them to wish real hard for that severed leg to grow back. The future will look back on this generation’s incarceration proclivity with abject horror.

    1. Perhaps scooter confuses “drugs” with opiates–a small subclass, unless you are using the term as an euphemism for demonic possession, which affects only the superstitious.

  7. Local leftists reliably tell me that the problem with America’s treatment of the mentally ill is that Reagan closed down all the mental hospitals. I think it’s pretty amazing that a man who’s been out of office for 27 years and dead for 11 still manages to control our mental health policy. Evidently Reagan’s eldritch puissance was so great that his lich has had the power to compel seven subsequent Presidential administrations and about 13 Congresses.

    1. If you go back far enough, you can always find a Republican to blame.

      I had some people upset on Facebook recently, trying to counter my point that if Democrats have the solutions to poverty, why is it that 50 years of Great Society programs and 100% Democrat rule in Baltimore has obviously failed? Their answers: our tax rates are too low (I said rates and revenue are different), we need to have a European welfare state (I pointed out that that’s what the Great Society was), and that the GOP crashed the economy in 2008 (so things were fine before that?). Their final conclusion: I’m part of the problem, and they aren’t going to talk to me any more.

  8. “We” paleface? I have voted the straight libertarian ticket for decades. Perhaps you were referring to the politicians I voted against.

  9. If I am to pay for social services at all (not that I have a choice), I’d much rather see my money helping those who truly can’t help themselves then those who clearly could; if they had to.

    For years, I have hoped that I would finally lose what’s left of my mind so that I might be set free; but it refuses to go. This leaves me- and only me, responsible for all that I’ve done. I’ve always envied the insane. If you think about it, we are all insane. Leaders of all kinds score high on psychopathic personality tests; and the average person (once you peel back a layer or two) is a mess of anxiety, fear, desperation, and hope. What makes one insane is the unmooring of perception from reality, which is the line that the sane are expected to toe.
    Isn’t madness a kinder fate than failure?

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