Mental Health and Mass Incarceration

Are Prisons Becoming The

New Asylums?
By Katherine Zamora

The Growing Demographic Among Prison Inmates

According to Michael Ollove, over 2 million
Americans reside in prisons and jails and of that 2
million, 20 percent of them suffer from mental
disorders. Which would mean over 400,000 people
suffering from mental disorders are imprisoned.
When such a large population of people imprisoned
suffer from a mental illness, one begins to wonder
why the government is not prioritizing this epidemic
facing thousands of prison inmates. Over 30 billion
dollars of government spending goes to sustaining
criminal justice facilities while government health
care plans such as Medicaid are cutting its mental
health benefits. The fact is mental health is
important and in order to reduce the problem of
mass incarceration, United States government
officials need to recognize the problem, promote
mental health awareness, and place those with a
mental illness in a proper institution. If the issue is
left forgotten and disregarded, mass incarceration
will continue to be a problem and grow.
History of Deinstitutionalization
America has not always had such a large
issue of mentally ill people becoming a large
percentage of prison population. Many factors play
into the increase of mentally ill prison inmates, but
the main reason behind the large population of
mentally ill can be made evident by analyzing the
history of deinstitutionalization.

Deinstitutionalization of the psychiatric hospitals is

the removal of the mentally ill of the psychiatric
cares of hospitals to community care. According to
Deanna Pan, writer of Deinstitutionalization and its
Consequences, the number of people in psychiatric
hospitals reached its peak in 1955. In order to reduce
the number of patients, President John. F. Kennedy
signed the Community Mental Health Act and
provided funding for community based mental
health care so that the number of hospital patients
could decrease. When Medicaid was passed in 1965,
there was another burst of patients being released
from state mental hospitals and nursing homes into
normal hospitals because the Medicaid program did
not cover treatment in institutions for mental
diseases. In 1967 the California Legislature passed
Latermen-Petris-Short-Act which resulted in a more
difficult process for involuntary hospitalization of
the mentally ill. After a year the number of mentally
ill in the criminal justice system doubled. By 1984, a
study in Ohio found that 30 percent of those
homeless were thought to suffer from serious mental
disorders. As attempts in reforming the mental
health care system continued to fail, by 2004 there
were three times more mentally ill people in jails
and prisons then there were in hospitals. The
correlation between the deinstitutionalization of
state psychiatric hospitals and the increase of prison
inmates is clear to see. From lack of funding for

mental health care treatment facilities, Americans

found themselves without proper resources to
manage life as a result left them homeless or facing
criminal charges.
Research and Statistics
According to research done by The
Treatment Advisory Center (TAC), a national nonprofit organization that focuses on eliminating the
barriers of mental illness, inmates who are mentally
ill make managing prison institutions more difficult
than regular inmates. These inmates require more
assistance due to the behavior they exhibit from
their mental disorders. For example, in Mississippis
Hinds County Jail, one inmate ate the cover of a
padded cell as well as a Styrofoam container and
paper suit which required him to receive 2
operations and have his stomach pumped 6 times.
TAC also report that mentally ill inmates require
more money to care for than normal inmates. Many
mentally ill patients have a more difficult time
understanding and following jail and prison rules
and are often held for months waiting for an
available bed in the psychiatric hospitals. In
Floridas Orange County Jail, it has been reported
that the average stay for all inmates is 26 days but
for mentally ill inmates, the average stay is 51 days.
From the research, we can conclude that mentally ill
patients are causing more problems due to the
behavior their illnesses are responsible for. Without
proper care, jail and prison systems cannot expect
mentally ill patients to improve and be ready to
enter society.

Figure 1: Solitary holding cells used for treatment of

mentally ill patients
Source: MSBC. Web. June 8, 2001

There has always been controversy

surrounding the correlation between mental health
and mass incarceration. People argue that those who
suffer from mental illness should not be allowed to
blame their actions on their illness. Prevalence of
Criminal Thinking among State Prison Inmates with
Serious Mental Illness is a journal that examines the
criminal thinking of offenders with a mental illness.
Studies have shown that people with serious mental
illnesses are 1.5 more times likely to be put in jails
and prisons rather than being hospitalized for
treatment. The purpose of this study is to question
whether the mentally ill prisoners are imprisoned
because they are mentally ill or because they are
criminals. The study involved 265 incarcerated
males and 149 incarcerated females who were found
to exhibit mentally ill behaviors. Ninety-two percent
were diagnosed with serious mental illness.
Psychiatric diagnoses from 178 of the males show
that 22% had schizophrenia, 12.7% schizoaffective
disorder, 17% bipolar disorder, 15.2% mood
disorders, 4.7% anxiety based disorders, 9.4%
impulse control disorders, and 8.7% with bipolar
disorders. Those with mental illnesses produced
similar criminal thinking scores on the PICTS
(Psychological Inventory of Criminal Thinking
Styles) and CSS-M (Criminal Sentiments Scale
Modified) to non-mentally ill offenders. The PICTS

and CSS-M are a series of questions designed to

measure the level of violent and self-gain oriented
thinking. The results showed that although the
patients suffer from mental illnesses they ended up
in jail because they share the same thinking pattern
as criminals.
The journal brings to light the controversy behind
the large size of the mentally ill population in jails
and prisons. Are those mentally ill in jail
committing crimes because of their illness or
committing them because of their own thinking?
The fact of the matter is that a large population of
the inmates in jail do suffer from mental illness. In
the study reported that 95% of the inmates they
studied were serving a sentence of 10 years or less.
This shows that most of the inmates who were
diagnosed with mental illnesses will be released
without proper treatment. Although they may share
the same criminal thinking as other criminals, they
lack the mental skills allowing them to changing
after being released compared to someone who does
not have a mental illness, and therefore is more
likely to be sent back to prison in the future.
A strong factor in mentally ill patients being sent
back to prisons, is their lack of proper outpatient
care due to not obtaining proper medication along
with treatment. According to The Treatment
Advocacy Center (TAC), one of the most likely
reasons people with severe mental illnesses do not
take their medication is because of anosognosia,
which is the unawareness of an illness. Their brains
can be damaged to the extent that they are incapable
of gaining insight into their actions and illnesses.
With the proper medication and treatment, their
ability to become aware and gain understanding of
their situation may improve. According to a journal
written in 2008, patients with schizophrenia in
forensic hospitals were observed for over one and
half years after being discharged in order to study
aggressive behavior among people suffering from
schizophrenia. It was shown that the patients who
gained more insight from their treatments, such as

counseling and consistently taking their medication,

had shown less aggressive behavior compared to the
patients with little or no insight on their illness.
Another journal called Aggressive Behavior studied
60 male patients who were charged with violent
crimes. The severity of violence was concluded to
be strongly associate with poor insight,
nonadherence to medication, and substance abuse
problems. Insight and treatment to ones mental
health is critical in preventing a large portion of
violent behaviors in people suffering from severe
mental illnesses. It is clear that help is needed for
those suffering. Proper treatment and medication is
required in order to prevent violent behaviors in
individual with mental illnesses.
A prison environment is not a proper place for a
person with a mental health disorder to get better
because they are unable to receive the proper
treatment required. Although they may have access
to medication and supervision from prison staff, the
prison environment cannot provide safety from selfharm. According to Treatment Advocacy Center
(TAC), inmates with severe mental disorders are
permitted by law to refuse medication except under
emergency circumstances. Jail officials can be sued
for administrating medication to an inmate without
their consent but can also be responsible for any
harm that comes to the inmates. According to Tom
Lyden on KMSP TV, an inmate in Minnesota who
was psychotic and on methamphetamines refused to
take his medication and proceed to gauge his own
eyes out. He then sued the jail for not providing
proper care for him when he suffers from a mental
disability. In any mental institution, patients would
have the proper nurses and staff who are trained and
capable to care for people who are mentally ill. A
prison guard is not trained or should be held
responsible to provide care for a mentally ill person.
Search for Solution
A solution is needed to decrease the large
population of those incarcerated because those who

are suffering from a mental illness are not getting

the proper treatment required that a prison or jail is
unable to provide. Those who suffer from chronic
mental diseases like schizophrenia, bipolar, and
personality disorders most likely not have been
diagnosed prior to being sent to jail. The police
force and crime agencies are not aware, or educated
enough on mental illness to recognize it or its
impact on criminal behavior. Rather than seeking to
put the inmates behind bars, they should be sending
these people to hospital facilities where they can
learn to manage their disease and have it treated.
Prison environment is not an adequate setting for the
mentally ill because it will just create a cycle of
release and incarceration where no real solution is
ever implemented. The government should enforce
policy on educating their police officers, judges, and
other law enforcements on recognizing someone
with a possible mental illness. So many suffering
from mental illnesses do not get diagnosed. The
longer they go without treatment over time can
make it become more dangerous and life
threatening.
A major problem of trying to help those suffering
from mental health disorders in jails is the resistance
to accept that it is a problem in the first place. Tax
payers already pay so much
money supporting the 5% of Americans doing time,
it is reasonable to understand the resistance to taking
money out of the already limited budget, and putting
it towards mental health. From the large number of
those in jails who suffer from a mental illness, we
can see that mental health is not being prioritized.
The likelihood of the people with behavioral
diseases to become repeat offenders is more than 1.5
times more likely than the average inmate. From
what history shows mental health has been
repeatedly ignored throughout time, one act called
the Mental Health Systems Act was passed to
reconstruct the community mental health center, but
it was quickly repealed a year later. The government
has decided to end their role in providing services to
the mentally ill Americans in order to save money.

If America puts more funding into mental health

institutions the people who need help will be able to
get it before they commit a crime and if not, then
after. Doing this will help keep less and less people
out of the jail and prison system and over time
promote a positive outlook on mental healthcare.
Bringing more funding to mental health institutions
is a great solution for the direct problem at hand.
There are so many people in jails currently who are
suffering from mental health disorders and need
proper treatment. Although this will decrease the
numbers of mentally ill in prisons and jails, this will
not solve the problem of keeping the mentally ill out
of prisons and jails. Not only should there be more
opportunity for Americans to receive the mental
health care they require but we should also focus on
educating public and law enforcement on
recognizing a person who suffers from a mental
health disorder and understanding that they are
suffering from an illness that they may not have the
ability to control at the time. By promoting proper
mental health treatments and good mental health
care, violence and crime rates would continue to go
down and help decrease the issue of mass
incarceration.
In Mathew 25:31-46, Jesus speaks of helping
one of the least of these. He was referring to the
sick, poor, imprisoned, and weak. For what we do
not do for the least of them we are not doing for
Him. He is saying we as Christians have a duty to
helping those that are weaker, poorer and sicker than
us, as a way of serving Him. The mentally ill in jails
are a minority in the country and are suffering
without a voice. The number of people who are
incarcerated are at an all-time high. Twenty percent
of all inmates in the U.S suffer from some sort of
mental illness. There are more people in the United
States in jails who are mentally ill then there are
mentally ill patients in state psychiatric institutions,
and jails and prisons are not a proper place to
receive treatment. The solution to the growing
number of incarcerated mentally ill individuals is to

provide more thorough mental health evaluations for

people in the criminal justice system and increase
funding for mental health institutions while teaching
awareness to state officials and the general public.
With implementation, over time the number of
mentally ill who are categorized as criminals will
decrease.