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May 16, 2010

"More Mentally Ill Persons Are in Jails and Prisons Than Hospitals"

The title of this post is the headline of a notable and important new report issued this week by the National Sheriffs' Association.  (Hat tip to a helpful reader who forwarded me this item from the Houston Chronicle.)  This press release about the report provides this effective summary:

Americans with severe mental illnesses are three times more likely to be in jail or prison than in a psychiatric hospital, according to "More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States," a new report by the Treatment Advocacy Center and the National Sheriffs' Association.

"America's jails and prisons have once again become our mental hospitals," said James Pavle, executive director of the Treatment Advocacy Center, a nonprofit dedicated to removing barriers to timely and effective treatment of severe mental illnesses. "With minimal exception, incarceration has replaced hospitalization for thousands of individuals in every single state."

The odds of a seriously mentally ill individual being imprisoned rather than hospitalized are 3.2 to 1, state data shows. The report compares statistics from the U.S. Department of Health and Human Services and the Bureau of Justice Statistics collected during 2004 and 2005, respectively. The report also found a very strong correlation between those states that have more mentally ill persons in jails and prisons and those states that are spending less money on mental health services.

Severely mentally ill individuals suffering from diseases of the brain, such as schizophrenia and bipolar disorder, often do not receive the treatment they need in a hospital or outpatient setting. The consequences can be devastating – homelessness, victimization, incarceration, repeated hospitalization, and death.

"The present situation, whereby individuals with serious mental illnesses are being put into jails and prisons rather than into hospitals, is a disgrace to American medicine and to common decency and fairness," said study author E. Fuller Torrey, M.D., a research psychiatrist and founder of the Treatment Advocacy Center. "If societies are judged by how they treat their most disabled members, our society will be judged harshly indeed."

Recent studies suggest that at least 16 percent of inmates in jails and prisons have a serious mental illness. According to author and National Sheriffs' Association Executive Director Aaron Kennard, "Jails and prisons are not designed for treating patients, and law enforcement officials are not trained to be mental health professionals."

Ratios of imprisonment versus hospitalization vary from state to state, as the report indicates. On the low end, North Dakota has an equal number of mentally ill individuals in hospitals as in jails or prisons. By contrast, Arizona and Nevada have 10 times as many mentally ill individuals in prisons and jails than in hospitals.

Among the study's recommended solutions are for states to adopt effective assisted outpatient treatment laws to keep individuals with untreated brain disorders out of the criminal justice system and in treatment. Assisted outpatient treatment is a viable alternative to inpatient hospitalization because it allows courts to order certain individuals with brain disorders to comply with treatment while living in the community. Studies show assisted outpatient treatment drastically reduces hospitalization, homelessness, arrest, and incarceration among people with severe psychiatric disorders, while increasing adherence to treatment and overall quality of life.

The full report is available at this link.

May 16, 2010 at 02:22 PM | Permalink


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lol how true.

But the real headline should be

"More mentally ill individuals in Govt at every lvl than in hospitals!

Posted by: rodsmith | May 16, 2010 8:55:34 PM

must read along this line:


Posted by: will | May 17, 2010 9:51:52 AM

It recalls the early days of proto-prisons when no distinction was made between those who committed crimes, the mentally ill and the direly poor.

Posted by: ohwilleke | May 17, 2010 2:02:34 PM

Prison is inpatient treatment. The pretty good management of the mentally ill, constituting a third of all beds of jails, proves something. Inpatient care can be adequately provided, as it is in most urban jails, for a tenth the cost of hospitalization. The gold plating of inpatient care is to appease oppressive but worthless lawyer driven requirements of accreditation and to prevent second guessing in medmal litigation.

Second, the fact that prohibition of restrictive procedures impairs prison officials less than health care setting officials results in great strides in the reduction of the suicide rate in jails, but not in hospitals.


Some of the same methods can be applied to prison murders and rapes, to markedly reduce them by the same percentage.

Posted by: Supremacy Claus | May 18, 2010 12:30:35 AM

I am a parent of a 24 y.o. schizoaffective son. I can tell you that medication is nothing short of "miraculous" and my son needed it! However, because the illness itself does not recognize that they are ill, they feel good with medication and then go off. What happens next? Possibly another major breakdown, getting hurt, hurting someone, losing an apartment, living on the street, tormented.. and the list goes on. Then what? Our system is indeed "shameful" when it comes to addressing mental illness and implementing laws that actually help people like my son. Civil rights? Really? Do you think a mentally disabled person understands the decisions he's making while in the throes of a breakdown?? Outrageous. I hope people running around calling themselves advocates will speak up and actually help people like my son instead of telling me that "he'll need to fall a few times until he gets it".

Posted by: Joanne Coleman | Jun 22, 2010 4:58:32 PM

By the time people affected by mental illness reach the court system they are generally poor, unable to afford expensive lawyers and suffer at the hands of good hearted but often inexperienced or overworked public defenders. The message is get through the system; don't cost the state lots of money with a trial or the results will be longer sentences; and accept this plea. The fact that the person who has mental illness (diagnosed or not) does not play into the script of the "justice process." So the trail begins, and for many mentally ill people continues on and on through a long series of revolving doors, in and out of the system with no or very poor treatment. THIS COUNTRY CAN DO BETTER. JOAN BARRY

Posted by: Joan Barry | Jan 26, 2011 4:23:08 PM

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