“America’s new asylums”

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America’s Asylums

The Treatment Advocacy Center in partnership with the National Sheriffs’ Association, released a first-of-its-kind national survey April 8, documenting the treatment and conditions of people with mental illnesses in the nation’s 50 states.

Through dozens of surveys with jail administrators, the report estimated that approximately 356,000 people with mental illness are confined in the nation’s prisons and jails, which the report describes as “America’s new asylums.” This figure is more than 10 times the estimated 35,000 people with similar disabilities in state psychiatric hospitals.

As described in the report, the now decades-long practice of throwing people with mental illnesses in jail, as opposed to providing necessary treatment, represents a reversal of sorts.

Prior to the mid-1850s, people with severe mental illnesses were regularly warehoused in jails and prisons. With the rise of psychiatric hospitals, this population was removed from the criminal justice system, though it still remained segregated from society.

The 1960s brought the start of the deinstitutionalization movement, leading to new opportunities for hundreds of thousands of people with disabilities.

But for many people with the severe mental illnesses, states failed to provide the necessary community services, resulting in the de facto criminalization of severe mental illnesses.

“The practice of putting seriously mentally ill persons into prisons and jails was abandoned in the middle of the nineteenth century in the United States,” the report states. “The reasons behind the abandonment of this practice included the fact that it was widely regarded as inhumane and that it also caused multiple problems for those who are mentally ill, for other prisoners, and for the prison and jail officials.

“In view of these well-known problems, the re-adoption of this practice in the late twentieth century is incomprehensible.”

According to the report, inmates with mental illnesses are far more likely than other inmates to be locked in solitary confinement and be abused in prison.

In addition, people with mental illnesses are disproportionately unlikely to get bail and are more likely to be rule breakers, resulting in far longer sentences. For example, at Rikers Island in New York, the average stay for inmates with mental illnesses is 215 days, compared to 42 days for the rest of the population.

Confining people with mental illnesses is also severely straining state budgets. In Washington State, for example, it cost more than $100,000 per year in 2009 to keep a person with a mental illness in jail, compared to $30,000 for others.

The report provides a variety of recommendations, including increasing the number of beds in psychiatric hospitals, expanding jail aversion and outpatient treatment programs, and improving medical treatment in the facilities, including, when necessary, involuntary medication.

“The lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society,” said Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center and lead author of the study, in a news release. “This is especially true for individuals who – because of their mental illness – are not aware they are sick and therefore refuse medication.”