Deinstitutionalization and the criminalization of mental illness

Reference: Friends of Justice

September 6, 2011

By Melanie Wilmoth

A recent NPR story sheds light on the growing number of people with mental illnesses residing in America’s prisons and jails. Rather than treating mental illness with therapy and treatment programs, the government uses the criminal justice system as a warehouse for people with mental health issues. With little capacity to provide mental health services, U.S. prisons and jails struggle to treat these individuals.

The increasing “criminalization of mental illness” dates back to the 1950’s when the federal government first began its push for deinstitutionalizing individuals with mental illnesses. There were two main aspects of deinstitutionalization: individuals would be taken out of state-run mental institutions (many of which had a reputation for inhumane treatment) and then treatment would be provided through community mental health programs. In theory, deinstitutionalization sounded promising. People would be moved out of restrictive state institutions and moved into community-run programs. However, deinstitutionalization backfired when community mental health services lacked funding. Thus, people were removed from institutions and received no support services or treatment for their mental illness. As a result, those who were deinstitutionalized ended up homeless or in prison.

Deinstitutionalization has largely been a failed policy, and the responsibility for treating people with mental health issues has shifted from mental institutions to correctional institutions. Today, over 350,000 individuals with mental illness are incarcerated in the US.

Similar to the push for the deinstitutionalization of people with mental illnesses, recent budget crises throughout the U.S. have resulted in bipartisan support for the closure of costly prisons and jails. As deinstitutionalization has taught us, however, if states are to be successful in closing prisons (and, ultimately, in ending mass incarceration), well-planned and well-funded alternatives to incarceration need to be in place.

Take a look at the transcript of the NPR story:

LAURA SULLIVAN, host: This is WEEKENDS on ALL THINGS CONSIDERED, from NPR News. Guy Raz is away. I’m Laura Sullivan.

Half a century ago, mentally ill people were often locked away in insane asylums – places built like castles, with grand staircases and large gardens.

CHRISTOPHER PAYNE: The asylums of the 19th century, some of them were the largest buildings of their time.

SULLIVAN: Chris Payne photographed these now-decrepit buildings for his book “Asylum.”

PAYNE: They thought that the architecture and the buildings in this lush landscape, this almost utopian environment, could actually transform people and help them feel better.

SULLIVAN: Instead, many asylums became houses of horror. We’ll hear more from Payne in a few minutes. But what happened to all of those people? Many states shut down their mental hospitals in the 1980s. Six hundred thousand former residents were supposed to find support in community mental health centers. But those centers rarely had enough money, and they still don’t.

Now, three decades later, more than a million people a year with mental illness are finding a home in the two places that can’t turn them away: jail and prison.

Judge STEVE LEIFMAN: We have a criminal justice system, which has a very clear purpose: You get arrested. We want justice. We try you. And, you know, justice hopefully prevails. It was never built to handle people that were very, very ill.

SULLIVAN: That’s Steve Leifman. He’s a judge in Miami, Florida, and he says the result has not been good for the mentally ill, the taxpayers or the criminal justice system. That’s our cover today: the nation’s courts, jails and mental illness.

Judge Leifman has seen the problem firsthand for a decade. People often stand before his bench with no sense of where they are or who they are. And for years, he wasn’t able to do much to help them.

LEIFMAN: What we used to do – which I tell people was the definition of insanity because we kept doing the same thing again and again, and expected a different outcome – they would commit an offense; the police would arrest them; they’d come to court. They’d be acting out so we would order two or three psychological evaluations, at great expense.

We would determine that they were incompetent to stand trial. And we’d re-release them back to the community – and kind of held our breath and crossed our fingers and hoped that somehow, they’d get better and come back, and we could try them. But they would just disappear and get re-arrested.

SULLIVAN: How soon would you often see some of the same people come back?

LEIFMAN: Sometimes within minutes.

SULLIVAN: You’re kidding. Minutes?

LEIFMAN: Yeah. They’d walk out the door. They were floridly ill; they’d act out. Because it’s next to the courthouse, there are several officers out there, and they’d get re-arrested. And just to give you a clear picture in your mind of what I’m talking about is, we did a sampling, and we asked one of our institutions, University of South Florida, to look at who our highest utilizers of criminal justice and mental health services were in Miami-Dade County.

And they were able to narrow it down to 97 people who, as it turned out, were primarily diagnosed with schizophrenia. But over a five-year period, these 97 individuals were arrested almost 2,200 times, and it cost the taxpayers $13 million.

SULLIVAN: Thirteen million dollars for 97 people?

To read the complete NPR transcript, click here.