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February 9, 2014

Recognizing the modern mental health realities of modern punishment

In today's New York Times, Nicholas Kristof has this poignant discussion of the mental health issues that are often a central aspect of modern crime and punishment matters. The piece is headlined "Inside a Mental Hospital Called Jail," and here are excerpts:

The largest mental health center in America is a huge compound here in Chicago, with thousands of people suffering from manias, psychoses and other disorders, all surrounded by high fences and barbed wire.

Just one thing: It’s a jail. The only way to get treatment is to be arrested.

Psychiatric disorders are the only kind of sickness that we as a society regularly respond to not with sympathy but with handcuffs and incarceration. And as more humane and cost-effective ways of treating mental illness have been cut back, we increasingly resort to the law-enforcement toolbox: jails and prisons.

More than half of prisoners in the United States have a mental health problem, according to a 2006 Justice Department study.  Among female inmates, almost three-quarters have a mental disorder.

In the jail here, some prisoners sit on their beds all day long, lost in their delusions, oblivious to their surroundings, hearing voices, sometimes talking back to them.  The first person to say that this system is barbaric is their jailer.

“It’s criminalizing mental illness,” the Cook County sheriff, Thomas Dart, told me as he showed me the jail, on a day when 60 percent of the jail’s intake reported that they had been diagnosed with mental illness.  Dart says the system is abhorrent and senseless, as well as an astronomically expensive way to treat mental illness — but that he has no choice but to accept schizophrenic, bipolar, depressive and psychotic prisoners delivered by local police forces.

People are not officially incarcerated because of psychiatric ailments, but that’s the unintended effect.  Sheriff Dart says that although some mentally ill people commit serious crimes, the great majority are brought in for offenses that flow from mental illness....

A few data snapshots:

• Nationwide in America, more than three times as many mentally ill people are housed in prisons and jails as in hospitals, according to a 2010 study by the National Sheriffs’ Association and the Treatment Advocacy Center.

• Mentally ill inmates are often preyed upon while incarcerated, or disciplined because of trouble following rules. They are much more likely than other prisoners, for example, to be injured in a fight in jail, the Justice Department says.

• Some 40 percent of people with serious mental illnesses have been arrested at some point in their lives.

In the 1800s, Dorothea Dix led a campaign against the imprisonment of the mentally ill, leading to far-reaching reforms and the establishment of mental hospitals. Now we as a society have, in effect, returned to the 1800s....

In 1955, there was one bed in a psychiatric ward for every 300 Americans; now there is one for every 3,000 Americans, the 2010 study said.  So while more effective pharmacological treatments are theoretically available, they are often very difficult to access for people who are only borderline functional....

Taxpayers spend as much as $300 or $400 a day supporting patients with psychiatric disorders while they are in jail, partly because the mentally ill require medication and extra supervision and care.  “Fiscally, this is the stupidest thing I’ve seen government do,” Dart says.  It would be far cheaper, he adds, to manage the mentally ill with a case worker on the outside than to spend such sums incarcerating them.

February 9, 2014 at 09:09 PM | Permalink

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"It would be far cheaper, he adds, to manage the mentally ill with a case worker on the outside than to spend such sums incarcerating them."

But then what would become of the poor, defenseless prison lobbies/corporations?

Posted by: PDB | Feb 9, 2014 10:10:21 PM

About a third of beds in the jails of the nation are filled by straight state hospital patients.

The Supreme Court took over psychiatry in 1976, and declared people could not be committed without a hearing employing 3 lawyers, without having committed a dangerous act, so the shooters at those schools qualified only after killing dozens of innocent strangers.

So a mental patient makes a nuisance on a bus, is arrested and held on a $1 bond. The family does not want him back out. So they do not post the $1 bail. He stays in jail for a year. There he is made to take meds, is supervised to avoid injury to self and others. He has to bathe more than once a year. He can attend addiction treatment, get counseling, get his medical needs tended. The day cost may be $50, and the treatment cost may another $20 a day.

This is a tremendous government bargain. No wonder families leave them there. Given the betrayal of this population by the Supreme Court, this is the best situation possible.

Jails have also decreased suicide by 90%, a great benefit to the patient. They have done so at no additional cost, just by increasing supervision.

Many references and resources for suicide prevention here:

http://www.usmarshals.gov/prisoner/suicide_prevention.htm

These prisoners are actually the lucky ones to be in prison.

The article is a propaganda hit piece to generate more social worker jobs on the outside of jail, at 10 times the cost.

Posted by: Supremacy Claus | Feb 9, 2014 10:19:45 PM

PDB --

"But then what would become of the poor, defenseless prison lobbies/corporations?"

They'd meld themselves into the already rich, well-fortified and tax-eating social welfare lobbies/agencies.

Hey, they might even get Obamacare.

Posted by: Bill Otis | Feb 9, 2014 10:30:24 PM

This article is about the eight millionth re-tread of, "Criminals Aren't Victimizers, They're Victims."

If Kristof ever wanted to actually investigate why people wind up in prison, he might trouble himself to go down to his local courthouse and sit in on a few cases. What he'd see is what anyone else would see: That by a huge margin, the reason people get sentenced to prison is GREED.

They want a quick buck, don't want to work like everybody else, and think rules are for suckers. That's the recipe.

Posted by: Bill Otis | Feb 9, 2014 10:37:45 PM

There is a fine line between the criminalization of the mentally ill and crime as a manifestation of a mental illness. Many modern mental illness have such a strong social component that they would be better characterized as "social illnesses" rather than "mental illnesses" which results in the truth that the difference between a "social illness" and a "crime" has a large gray area. Is it "greed" or is it "illness"? Not an easy answer.

Having granted that point, there isn't much interest in figuring which is which, though. Most of what drives the mentally ill to prison is the public's NIMBYism. They want the mentally ill treated--just not around them. Same as we do for pedophiles...they can live...just do it somewhere else....preferably under an overpass. Both are forms of banishment. So we de-institutionalize the mentally ill (again) and what is that going to achieve that prior attempts haven't? Until the public becomes serious about mental illness, nothing will change.

Posted by: Daniel | Feb 9, 2014 11:18:32 PM

Daniel --

"Many modern mental illness have such a strong social component that they would be better characterized as "social illnesses" rather than "mental illnesses"..."

The truth of what you say here first got through to me when I heard about "urban survival syndrome." For a long time, I couldn't figure out what it was, except that it tended to get invoked by the defense when some relatively big person beat the daylights out of some relatively small person in order to get the latter's purse (or wallet).

Then it dawned on me. A person "afflicted" with "urban survival syndrome" = "thug."

Posted by: Bill Otis | Feb 9, 2014 11:31:15 PM

Social illness. I prefer the more honest, revealing, and useful word, bastardy.

Bastardy is the policy of the feminist lawyer as one of many paths to the destruction of the patriarchal American family. Try asking an amoral bastard female to slow the rate of spawning of multiple bastards by multiple male bastards, you will be fired from your child welfare job. All those bastards require massive government services. Any slowing will threaten Democratic Party voter jobs and will never be tolerated.

In order to reduce the rate of bastardy, you will first have to step over the bodies of the feminist hierarchy and its male running dogs. The government jobs are so entrenched, nothing short of death will pry them from their sponsors.

So whites do not feel too smug, bastardy is headed toward the white population at a high rate of speed, now up to 40%. Bastardy has reached the White House, with the devastating effects of the Bastard in Chief on the economy of the nation. It is ironic that the groups that voted him in are the most victimized by his policies.

Posted by: Supremacy Claus | Feb 10, 2014 5:54:47 AM

There is a place between institutionalization of the mentally ill and putting them in the typical prisons around today. It has been noted that on average a guilty by reason of insanity judgment will not get you less time confined. But, the nature of the confinement is likely to be different. This includes how society and specific groups involved in dealing with them think about them.

The subset of mentally ill criminal is seen (rightly) as less blameworthy than those not mentally ill who commit crimes. "Less" in many cases (since they still have been convicted of crimes in most cases) is not "none" but it matters. Also, it affects the proper way to treat them in prison. This also can be much cheaper since various types of treatment can be much less costly than typical confinement. Since the public or legislatures often focus on money -- greed indeed -- that's pretty useful to point out.

Urban survival syndrome = thug? There are various types of thugs. I think it should be applied more often than it is now to those outside of the stereotypical urban slum context who abuse their power to hurt others.

Posted by: Joe | Feb 10, 2014 10:26:44 AM

Supremacy Clause, I think you have no understanding of who most of the mentally ill in prison are. I have never seen someone held on a $1 bond or had a family unwilling to post it. Most of the mentally ill have committed jailable offenses so they have appointed counsel who will fight to get them out regardless of the family's wishes because it's their job (and I doubt any bail would be required on an offense that can't carry the possibility of jail time).

Most cases involving the mentally ill generally involve one of two situations. The first is a situation where the mental illness contributed to their actions, but it doesn't meet the legal definition of insanity. The second are cases that meet the legal definition of insanity, but the cost to the defendant of a successful NGRI defense outweigh the costs of incarceration. I think both of these have shown the problems caused by the law's restriction of mental illness evidence in courtrooms either as an affirmative defense or as evidence creating reasonable doubt as to an element of the offense.

That being said, this article seems to be dealing more with the issue of where to hold individuals with mental illness who are convicted. There are two issues there. One is whether the law even provides for it (or, if it does allow the transfer of those convicted to a mental institution instead, if there's a preference against it). The other is whether there's sufficient funding in mental hospitals or if, due to lack of space or resources, jails and prisons are used as a backstop to insure there's at least something (since jails are obligated to accept those convicted, while hospitals are generally not obligated to accept everyone with a mental illness). Overall, I think there are a lot of interwoven questions that need to be addressed, but there's no simple narrative for what the problem is.

I do agree with Bill Otis that, in my experience, the majority of defendants do not have a mental illness as it is traditionally defined. That being said, it is a substantial minority and, I suspect, an even larger proportion of repeat offenders (because they need treatment in order to be rehabilitated).

Posted by: Erik M | Feb 10, 2014 11:29:11 AM

Speaking only from my experience at the state court level in a rural community, most of the mentally-ill that we dealt with on a regular basis suffered from ADHD or bipolar or a similar disorder. Their mental illness did not rise to the level to support either an involuntary civil commitment or a defense based on their mental disease. Instead, it was just one of a constellation of factors that steered them toward criminal conduct (typically with self-medication through controlled substances and alcohol being the intermediate way station).

Should their mental illness be considered in the disposition of their cases? Probably, but the vast majority of our offenders got probation during which help with their mental conditions was available for those who wanted it. Once you get to the repeat offenders and the violent offenders, I am not sure that the reason for their criminality is as significant as is the need to protect the public from future criminal conduct.

Posted by: tmm | Feb 10, 2014 2:02:34 PM

Prisons are just places where correctional programs are carried out. Those programs may be bad or good, given the State's objectives in each case.

Posted by: Tom McGee | Feb 10, 2014 3:21:31 PM

I appreciate Erik M's comments.

Posted by: Joe | Feb 10, 2014 4:03:45 PM

tmm, I agree that we need to be careful with categories. ADHD is a mental disease in some sense of the word, but it's not something that a hospital necessarily needs to handle (same, generally speaking, with bipolar disorder). Schizophrenia, on the other hand, is a completely different story. The tone of the author's article suggests we're talking about something closer to the latter rather than the former. The former might be mitigation, but I don't think it warrants hospitalization as opposed to incarceration.

Posted by: Erik M | Feb 10, 2014 4:51:14 PM

| In 1955, there was one bed in a psychiatric ward
for every 300 Americans; now there is one
for every 3,000 Americans, the 2010 study said. |

Has anyone followed the history? Nicholas Kristof is old enough to recall it.

Any good of the / “far-reaching reforms and the establishment of mental hospitals” / were undone by even more radical reforms and law suits
of the not-the-greatest generation of such as Leary, Fonda, and Brennan, who also managed to ban the death penalty nationwide for a time.

[ Anyone older than 40, who grew up in the rust belt or NE, should have seen the tail end of this revolting development ending in the late ‘70s-early ‘80s.]
----- ----- -----
To characterise this issue as politically as need be:
-- liberal Dr. Frankensteins created this monstrous situation, and won’t allow the answer, i.e. return to the policies of the dreaded, conservative ‘50s.
Thereby, dangerous maniacs could be forcibly committed without an act of the Almighty, which is nearly required today.

Posted by: Adamakis | Feb 11, 2014 4:01:23 PM

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