Criminalizing Mental Illness

Seriously mentally ill people are 3.2 times more likely to be incarcerated than hospitalized. A survey conducted by the Treatment Advocacy Center and the National Sheriffs’ Association, More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States, compared the number of seriously mentally ill in prisons to those in hospitals on a state by state basis.

The survey also found that at about 16-percent of inmates in jails and prisons have a serious mental illness. In 1983 the seriously mentally ill accounted for only 6.4 percent of all incarcerated offenders. The survey also found that 4 in 10 individuals with serious mental illness have spent some time in jail or prison.

The alarming number of seriously mentally ill in prison is the result of a cultural shift that has its origins in the 1960s. The idea of deinstitutionalizing the mentally ill had wide support. The expanded use of psychotropic medication encouraged policymakers to shift from institutionalization to community treatment. However, the psychiatric hospitals were prematurely dismantled and community treatment underfunded.

Has the incarceration of the seriously mentally ill had an impact on prison crowding? A comparison of the Sheriffs’ Association survey and a recent Pew Center report is instructive. The Pew Center report found a nationwide decrease in prison population for 2009. However, 24 states had some increase in prison population. Below are the nine worst states when it comes to prison to hospital ratio for seriously mentally ill.

State --M/I Ratio --Prison Population
Nevada ... 9.8 to 1 ... -1.6
Arizona... 9.3 to 1 ... +2.4
Texas... 7.8 to 1... -0.7
South Carolina...5.1 to 1... -1.0
Georgia ... 5.1 to 1... +1.6
Florida ... 4.9 to 1 ... +1.5
Louisiana... 4.6 to 1 ... +3.6
Michigan ... 4.3 to 1 ... -6.7
Ohio ... 4.0 to 1 ... -0.2

Five out of the nine states listed had a decrease in prison population in 2009. North Dakota has the nation's best 1 to 1 ratio (that means for every seriously mentally ill person in prison there is one in a hospital), yet they had a 2.3 percent increase in prison population in 2009. In fact, none of the states with the largest increase in prison population (Indiana, West Virginia, Vermont, Pennsylvania) are in the top 10 of the mental illness ratio.

There does not appear to be a correlation between increasing prison population and incarcerating the seriously mentally ill. However, there is a connection between incarcerating the seriously mentally ill and cost savings. In these difficult economic times states can save on the bricks and mortar of psychiatric hospitals, the cost of staffing those institutions and the expenditures for meaningful treatment.

Unfortunately, if states wanted to even out the ratios listed above they couldn’t. In 1955 there was one psychiatric hospital bed for every 300 Americans. Today, there is one bed for every 3,000 Americans. The numbers are reminiscent of the 19th century.

The criminalization of mental illness is an American disgrace. Locking up the seriously mentally ill does nothing more than pump-up law enforcement statistics, prey on the homeless and eradicate neighborhood nuisances.

Not everyone is taking the incarceration of the seriously mentally ill sitting down. According to the USA Today, Summit County, Ohio Sheriff Drew Alexander threatened to stop accepting violent mentally ill people at the county jail. "We don't want to be a dumping ground," Alexander told the paper. "Everybody knows we need someplace other than a jail for these people."

E. Fuller Torrey, a psychiatrist who founded the Treatment Advocacy Center told the USA Today that the Ohio sheriff is the first he has heard rebel, "but I think it's a harbinger of what's coming.”

To read full report: http://www.treatmentadvocacycenter.org/storage/tac/documents/final_jails_v_hospitals_study.pdf