The Cautionary Instruction: Prison and Mental Illness--An American Tragedy

The Pittsburgh Post-Gazette/Ipso Facto
June 10, 2011

Earlier this year, a 20-year-old Utah man starved himself to death after spending four months in the Salt Lake County Jail. The young man was diagnosed with schizophrenia and bipolar disorder. The delusions caused by his illness could be directly linked to his death.

He came to jail weighing approximately 180 pounds. When he died on February 27 he weighed just 77 pounds. His autopsy confirmed he had no prescribed psychiatric drugs in his system.

Why was this young man in prison and not in a psychiatric hospital? The reason is clear and troubling.

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 compared the number of seriously mentally ill people in prisons to those in hospitals on a state-by-state basis.

In Pennsylvania, the ratio of seriously mentally ill in prison as compared those with serious mental illness in hospitals is 2:1. In West Virginia, the ratio is 2.1:1. In Ohio, the ratio is 4:1-- the tenth highest in the nation.

The survey also found that 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. Today, about four out of every ten individuals with serious mental illness will spend some time in jail or prison.

Unfortunately, if states wanted to even out the ratios listed above it would be difficult. In 1955 there was one psychiatric hospital bed for every 300 Americans. Today, there is one bed for every 3,000 Americans. Those numbers are reminiscent of the 19th century.

Twenty-four percent of local jail inmates have serious psychotic disorders, such as delusions or hallucinations. Fifteen percent of state inmates and 10 percent of federal prisoners have serious psychotic disorders.

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.

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