The National Institute of Mental Health (NIMH) reports that approximately 1 in 5 U.S. adults live with a mental illness and approximately 1 in 25 U.S. adults live with a serious mental illness that “interferes with or limits one or more major life activities” (Serious Mental Illness Among Adults, 2015). It is estimated that approximately two million individuals experiencing a severe mental illness are annually booked into jails. The mass incarceration of mentally ill individuals in our country is deeply problematic; mentally ill inmates struggle to receive decent care and treatment both inside and outside of prison walls. A lack of federal funding for mental health institutions and the prison expansion that occurred throughout the 1980’s and 1990’s contributed to the criminalization of mental illness.
In this paper we will take a closer look at the history of federally funded mental health programs and narrow in on the community mental health funding cuts of the 1980’s and how that, in conjunction with Ronald Reagan’s war on drugs, contributed to and continues to perpetuate the criminalization of mental illness. We will also take a look at prison conditions for mentally ill inmates, including solitary confinement and mental health treatment. We will dive deeper into the measures being taken to decriminalize mental illness and implement higher standards for in prison care and treatment. Finally we will take a look at alternatives to criminalization and learn about the organizations committed to reducing the number of mentally ill individuals in prisons.
Throughout history, our country has been trying to figure out how to provide proper and ethical services for mentally ill individuals. Developing good mental healthcare and support has been a process of trial and error. For centuries, individuals with mental illnesses were treated on a case-by-case basis. Wealthier families would hire doctors to treat mentally ill family members in their homes, while families who were less wealthy would often provide their own care for their mentally ill family members. When families didn’t want the burden of caring for their mentally ill family members, mentally ill individuals lived depressing and lonely lives locked away from society.
Before the 1900’s, mentally ill individuals were contained in jails and often subject to abuse. Society’s objective was to hide mentally ill people from the public eye, so many mentally ill individuals lived in these jails and poorhouses for years and sometimes decades. A reverend by the name of Louis Dwight came across a mentally ill man who was imprisoned for nine years in a Boston jail. He noted that the conditions were bad; the prisoner was found in rags and “sleeping on a filthy pile of hay.” In the 1900’s this treatment was deemed inhumane and state hospitals opened throughout the country.
The campaign to open these asylums and hospitals was spearheaded by Dorothea Dix, a teacher in Massachusetts. “Her advocacy led to the opening of 32 state psychiatric hospitals in 18 states. (Glazer).” In 1949, with the help of Franklin Roosevelt’s New Deal, The National Institute for Mental Health was created to “conduct research, promote training and demonstrate new services (Thompson, p.61).” By the 1950’s state hospitals for the mentally ill were open and running in every state to help accommodate the country's expanding population, but the quality and quantity of these state hospitals quickly declined. State hospitals were costly and overpopulated, ultimately making them hard to maintain and manage.
NIMH pressured the government to devise a plan to introduce federally funded community mental health centers across the nation. Between the 1960’s and 2000’s three different national health care commissions were introduced in the U.S. Though these commissions have all had their fair share of flaws, they have been inherently beneficial to our country.
The first Community Mental Health Commission, titled The Joint Commission on Mental Illness, was introduced during Eisenhower's presidency in 1955. This commission brought forth federal funding to provide nationwide community mental health centers. When John F. Kennedy took office in 1961 he was devoted to furthering federal involvement in community mental health. Kennedy signed into law the Mental Retardation and Community Mental Health Centers Construction Act in 1963. This Act was created to allow Congress a budget of $3 billion in state grants to establish more community mental health centers. But unfortunately our government didn’t follow through with providing these grants and only 754 centers were built, approximately 1/4th of the amount proposed.
Jimmy Carter introduced a second commission called the President's Commission on Mental Health in 1977. In 1980, Carter implemented the Mental Health Systems Act. Carter strived to put a bigger emphasis on healthcare for marginalized populations and better state and federal care, but when Ronald Reagan came into office, he hastily declined the new law. Funding for community mental health programs under Reagan's presidency was cut by 25%. Reagan’s presidency, with the decreased funding for Community Mental Health and increased funding going towards privatized prisons, initiated the criminalization rather than treatment and rehabilitation of mentally ill individuals.
A third commision was put forth by president Bush Sr. titled the President's New Freedom Commission on Mental Health. Bush’s commission was built on the concept of “compassionate conservatism.” This commission was active between 2002-2003 and was put forth to focus on implementing career opportunities for individuals suffering from a disability, inspire mentally ill individuals to strive for recovery, and provide mental healthcare and early intervention for children. Bush Sr.’s commission was relatively progressive, but the resources to put them into action weren’t available.
In 2008, President Obama focused more on behavioral health and addiction. In October of 2008, Congress passed the Mental Health Parity and Addiction Act. The goals of this act were to provide recovery centers for individuals suffering from substance addiction and to create more accessible care and treatment for mentally ill individuals. Though actions taken during Bush Sr. and Obama’s terms have reversed some of the negative effects of Nixon's and Reagan’s legacies, the criminalization of the mentally ill in the 1980’s created a harsh stigma that continues to influence the way our country treats our mentally ill population both in and out of prison. In other words, the damage was already done.
President Nixon announced a war on drugs in 1971 and rehabilitation programs were replaced with harsher and longer prison sentences. In 1973, the Rockefeller drug laws were enacted in New York; these laws included mandatory sentences for people caught in possession of drugs (Glazer). In 1978, Michigan followed New York's lead by adopting the “650-Lifer Law. This law made it acceptable to imprison individuals caught in possession of more than 650 grams of cocaine for life, without parole. Many other states followed these anti-drug laws and adopted versions of their own. Currently 28 US states still have the Three Strikes Law, a law that can incarcerate people for life if they receive a third felony. While these laws vary by state, they put mentally ill individuals, who may be repeat offenders, in vulnerable positions.
Community mental health centers began to face massive overcrowding, and medication and other forms of treatment became less accessible. This left many mentally ill individuals and individuals suffering from addiction vulnerable and exposed, especially those who didn’t benefit from economic privilege and security. Many mentally ill individuals were arrested and incarcerated for nonviolent crimes. The majority of these nonviolent crimes were “survival crimes,” also known as crimes of self-preservation. These crimes included prostitution, trespassing, obstruction of justice, disturbing the peace, and resisting arrest. In the article “Prisoners and Mental Illness” by Sara Glazer, Glazer describes how during the 1980’s, community mental health centers and low-income housing both were subject to huge decreases in funding, leading to a growth in the homeless population.“The homeless are especially vulnerable because they're peeing in the street, panhandling, sleeping in the subway,” says Michael Jacobson, president of the Vera Institute of Justice at City University of New York. According to NAMI “The vast majority of the individuals are not violent criminals—most people in jails have not yet gone to trial, so they are not yet convicted of a crime. The rest are serving short sentences for minor crimes.”
As psychiatric hospitals began to close down, community mental health centers shifted their focus to outpatient programs, that, while beneficial, weren’t sufficient for mentally ill individuals who needed the care and treatment of inpatient programs. The majority of mentally ill offenders who could have benefited from psychiatric stays were being incarcerated instead at alarming rates, and thus the population of mentally ill individuals in prisons began to grow exponentially. Growth in prison populations subjected many prison facilities to overcrowding. An article titled “The Prison Industrial Complex” written by Eric Schlosser for the Atlantic outlined some of the devastating results of overcrowded prison populations. In the 1980’s California’s Folsom State Prison was overpopulated; Schlosser stated that “Folsom became dangerously overcrowded. Fights between inmates ended in stabbings six or seven times a week.”
President Reagan, taking up the call of Nixon’s original declaration for a War On Drugs, brought us into an era of mass incarceration and prisons for profit. To this day, our country systematically criminalizes people suffering from a mental illness, especially those who are economically, racially, and sexually underprivileged. Our country contains 5% of the world's population and 25% of the world's incarcerated populations (13th). This proportion demonstrates that our country is still stuck in an era of mass incarceration, and mass incarceration has many consequences. A study published by the Treatment Advocacy Center in 2014 revealed that in 44 states there were more people suffering from severe mental illness in prison or jail than in psychiatric facilities. In 2015, a sheriff by the name of Thomas Dart proclaimed that Cook County Jail is Chicago's largest psychiatric hospital (Glazer, 2015).
While mental health courts have been put in place to oversee the treatment of some mentally ill inmates, the mental health courts are not very successful in preventing those inmates from reoffending later in life. Mental health courts are beneficial, but the majority of mentally ill offenders are in need of more than just psychiatric support. Additionally, mental health courts don’t have the resources to serve a big proportion of mentally ill inmates. Former New York City corrections commissioner stated that “even when mental health courts work well, they handle only a fraction of the thousands of people with mental illness who end up in a big-city jail.” The other complication with mental health courts is that the quality of the court can vary from state to state. Nicole Waters, principal court consultant at the National Center for State Courts commented that “A court might be very effective in one state and not another, and we don't know why.”
According to the National Alliance on Mental Illness published in 2016, about 20% of all state and federal prisoners suffer from a mental illness. Once mentally ill individuals are locked up, they are all too often improperly cared for. Mentally ill prisoners often face legal barriers. In the book Criminalization of Mental Illness: Crisis and Opportunity for the Justice System, NAMI legal director Ronald Honberg sheds light on some of the legal complications that individuals suffering from a mental illness are subject to. Some of these difficulties include determining whether the prisoner is competent enough to stand trial, whether or not they can declare insanity, and what the prisoner's rights are regarding their choice to receive or refuse treatment. Many mentally ill inmates also face poor mental health treatment and sometimes even solitary confinement. Though solitary confinement has been deemed unconstitutional by multiple courts, it’s still practiced, especially on mentally ill inmates. Solitary confinement is a method of imprisonment designed to isolate an inmate from other inmates. Often times inmates in solitary confinement are alone for almost 24 hours a day, only receiving contact when interacting with correctional officers. Aside from solitary confinement being unconstitutional and immoral, the mental health and well being of inmates in solitary confinement often declines. For an individual who is already struggling with mental illness, solitary confinement can do serious damage.
The story of 19-year-old Kevin DeMott is an example of how unjust the treatment of mentally ill inmates can be. Kevin DeMott was diagnosed with bipolar-disorder when he was just 11-years-old (Glazer, 2015). At age 13, DeMott was incarcerated in a juvenile detention center for trying to rob a pizza joint with a toy gun. When DeMott was 15, he was transported to an adult prison in Michigan, where for years he exhibited signs of depression and suicidal ideation. DeMott acted out by shredding bed sheets to tie a noose, and breaking light bulbs to cut himself (Glazer, 2015). While in prison, he assaulted a correctional officer, further extending his sentence. Instead of proper care and support for his depressed state, DeMotts’ actions landed him in solitary confinement where he was shackled to a bed and denied privileges that other inmates received. DeMott was often distressed and would be found banging his head on the wall. Images of DeMott chained to his bed in solitary confinement show him with bandages wrapped around his head and blood stains on the wall of his cell. DeMott refused to stop when correction officers asked him to and eventually he was pepper sprayed for refusing to comply and stripped of more privileges (Solitary Watch, 2014). Many mentally ill prisoners, like DeMott, are subject to cruel and excessive punishment for acting out in prison.
It is common for correctional officers to use pepper spray, stun guns, and physical force to gain control of inmates. 29-year-old Prisoner James Burns stated that in solitary confinement “you begin to turn on yourself.” Burns was kept in solitary confinement for nearly five years for committing an armed robbery. In order to “feel something” Burns would often punch the walls of his cell until his knuckles bled. The story of Jose Guadalupe is another example of how mentally ill inmates are held in solitary confinement and brutalized by correctional officers. In 2015, Guadalupe was staying in solitary confinement at Rikers Island Prison Complex. On September 2nd, Guadalupe was pulled into his cell and beaten unconscious by four correctional officers. Guadalupe, now an inmate at the Fishkill Correctional Facility in Beacon, N.Y., has since sued Rikers Island for the beating he received. Other instances similar to Guadalupe's have been reported. Video footage was found of a prisoner staying at Rikers Island by the name of Tracy Johnson, beaten so badly that you could see blood and cuts on his head and face. Rikers Island has been under scrutiny over the years for using excessive force on inmates. In 2014, Correction Department data released recorded that guards had used excessive force on on inmates 4,074 times. More than half of these incidents resulted in broken bones and 62% of these beatings resulted in head injuries (Cite).
The book Addicted to Incarceration: Corrections Policy and the Politics of Misinformation in the United States recognizes a disturbing and credible theory about the way our society favors social control over social support. The war on drugs quite clearly reinforced that ideology. While some countries, like Portugal, for example, were focusing more and providing resources to people struggling with addiction and mental illness, the United States was funding more prison complexes and filling them with nonviolent offenders. Prisons don’t have the resources to support this control over support dynamic and this leaves prisons overcrowded and unqualified to treat mentally ill inmates. The prison industrial complex is far from a myth. Though crime rates have gone down by 20% since the 1990’s, both left wing and right wing politicians use fear mongering tactics to scare society into thinking prison expansion is a valuable use of taxpayer dollars, making prisons for profit a marketable commodity. Our country is capitalistic and privatized prisons for profit are still on the rise, but many scholars have argued that our country would spend less money on the treatment of mentally ill persons than the incarceration of the mentally ill.
Fortunately our country has been exhibiting more awareness around the struggles faced by mentally ill persons without access to quality care. States such as Montana, New Jersey, and New Mexico have been contemplating legislation that would keep mentally ill prisoners out of “long term solitary confinement (Glazer).” Fred Osher, director of health systems and services policy at the Council of State Government’s Justice Center has proclaimed that “The pendulum in funding has swung in the negative territory for a while; a deep hole needs to be filled.” More mental health professionals are recognizing the high numbers of mentally ill individuals behind bars and police departments are receiving mental health training. Frederick J. Frese, Ph.D., former Vice President of the national board of directors of National Alliance on Mental Illness states that “Laws governing the ability to treat persons who have mental illness and are resistive to treatment have arguably been improved.”
Mental health advocates like the National Alliance on Mental Illness, criminal justice attorneys, and other organizations are putting the pressure on politicians to reform a criminal justice system that is outdated and immoral. NAMI believes that it is our responsibility to prioritize “helping people get out of jail and into treatment.” NAMI created a document called “The Guide To Mental Illness and The Criminal Justice System” designed to help mentally ill individual's family members understand their constitutional rights. In their introduction they state “We hope the guide will assist by raising issues that should be considered in a criminal case involving mental illness and will offer comfort by detailing the likely progress of a criminal case.” They go on to provide different scenarios on topics, such as arrest, booking, jail diversion, court, and more.
NAMI has also taken important action towards prison reform and mental health advocacy by teaming up with The Stepping Up Initiative; an initiative that “challenges counties” into decreasing the number of mentally ill individuals in their prisons. The Stepping Up Initiative provides a toolkit on their website introducing six different questions that county leaders should be asking. These questions include the following: “Is your leadership committed? Do you have timely screening and assessment? Do you have baseline data? Have you conducted a comprehensive process analysis and service inventory? Have you prioritized policy, practice, and funding? Do you track progress? (The Stepping Up Initiative). Through posing these questions, The Stepping Up Initiative hopes to achieve a way to measure and track progress made to decriminalize mentally ill inmates and get them out of incarceration.
NAMI also supports jail diversion and re-entry programs across the country. Re-entry programs help make the transition from incarceration to society smoother by helping inmates set up treatment plans, secure housing, and find jobs. Crisis intervention teams are helping police officers learn to recognize when mental health treatment is a better option than incarceration. The internet also provides a great collection of resources through mental health advocacy sites and forums. Organizations like The Center For Prisoner Health and Human Rights and The AVID Prison Project provide helpful information and resources for mentally ill inmates and their families. These sites also help spread awareness and inform society of the ways mentally ill individuals are stigmatized and treated unjustly.
It is our responsibility as a society to provide adequate care and treatment to our mentally ill individuals and to address the ways in which people suffering from a mental illness are criminalized and incarcerated for committing crimes in a society that fails to set them up for success. Our money and our motives have been misdirected for too long, and it’s time for our country to prioritize prison reform and health care for mentally ill individuals. We can speculate how our treatment of mentally ill individuals could have been more progressive if the War on Drugs and prison industrial complex never came to be, but we have to address the ways we have failed the mentally ill population. It is time to correct our wrongdoings by making reparations to the mentally ill individuals our nation has let down and criminalized. We can only achieve this by actively working towards more accessible care and resources for all people experiencing mental illness, pushing politicians to reform our deeply flawed criminal justice system, and spreading awareness about inhumane methods of incarceration.
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