The Mentally Ill and the Prison System of America
Hailey Walker
Salt Lake Community College
As someone who struggles with mental illness, the issue of the mentally ill in prison is
one with which I am concerned. Unfortunately, many of the prisoners currently in the system are
mentally ill, according to the Bureau of Justice Statistics (James & Glaze, 2006). The question
the United States currently faces is what to do with our mentally ill prisoners, especially now that
we are also facing an issue of prison overcrowding. For this paper, I have undertaken to research
the history of incarcerating the mentally ill, whether in prisons or in hospitals; the present
situation of the mentally ill in the prison system; and finally, what steps could be taken to better
treat the mentally ill that find themselves within the criminal justice system.
This paper is far too short to engage in a complete discussion of the history of restraining
and imprisoning the mentally ill (or “insane”, as they used to be called). However, a summation
of this history is still necessary to lay the foundation to understand our current problem.
Pennsylvania Hospital, located in Philadelphia, was one of the first hospitals to treat
those who struggled with “lunacy”. It opened in 1753, and “six of the first people treated were
psychiatric patients” (Sudak, 2013). Eventually, a trend grew: people who had family members
with unusual behavior took to sending them to these asylums, believing it was for their own
good. While some, like Dr. Benjamin Rush, believed that lunacy and mental illness could be
cured, others thought that there was no cure and took extreme measures to keep the insane
locked up. Many of us are familiar with anecdotes of mental patients being abused, chained up,
left in solitary confinement, or otherwise mistreated in these asylums; the problem stemmed from
overcrowding, because as the population of the U.S. grew, the population of those struggling
with mental illness grew with it. “Asylums changed from treating patients to just housing
them…fewer and fewer people were released from the asylums” (Tartakovsky).
Dorothea Dix brought in the first wave of reform for the asylums. She toured many of the
country’s jails and asylums and “she saw people with mental illnesses who had been treated
inhumanely and neglectfully” (Parry, 2006). Her reports to the state legislature highlighted “the
horrendous treatment of the mentally ill in prisons, almshouses for the poor, and asylums”
(Parry, 2006) and funding was made available by the state to improve conditions for the mentally
ill. The rest of the country began to make reforms as a result of her influence, and care for these
people did improve for some time. Asylums began again to treat their confined mentally ill
instead of simply housing them.
These improvements did not last for long, however. A second wave of reform occurred in
the 1950s and 1960s that again highlighted inhumane conditions within the mental health
asylums, this time concerning treatments used to “better” the ill, such as lobotomies (usually
performed by shoving an ice pick through the frontal lobe) or electric shock therapy. According
to Vitiello (2011), this wave of reform was also accompanied by an “anti-psychiatry” movement
that “challenged the most fundamental assumptions and practices of psychiatry”, including the
controversial treatments for mental disorders. Both of these movements were paralleled by a
third movement to expand civil rights for those viewed as “oppressed”, and this including the
mentally ill.
The end result was that many asylums were closed in favor of releasing the mentally ill
back into communities, many of whom had been involuntarily committed under two principles:
“the power and authority of the police to protect the safety and welfare of the community and the
state's paternalistic authority (parens patriae) to protect citizens with disabilities” (Lamb, 2006).
Many viewed involuntary commitment instead as a way to strip a person of liberties, and thus
fought for the mentally ill to be treated in their local communities instead. Regrettably,
“development of the community-based programs lagged far behind the demand created by the
release of the mentally ill” (Vitiello, 2011). Without access to treatment, a significant percentage
of the mentally ill population “often engage[s] in behaviors that capture the attention of law
enforcement and lead to arrests” (Unknown, 2004); according to Vitiello (2011), a “general
public fear of those with mental illness” leads to pressure on police officers to arrest the mentally
ill on the streets that are homeless. We learned from one of our recent discussions in class that
police are always under pressure to “clean up” the streets to reduce fear of crime, and this type of
situation is no exception.
According to statistics compiled by the U.S. Department of Justice, “more than half of all
prison and jail inmates had a mental health problem” in 2005 (James & Glaze, 2006). Young
people, women, and white people are the highest effected. A report by the Human Rights Watch
released in 2003 noted that “prisons hold three times more people with mental illness than do
psychiatric hospitals” (Unknown, 2004). A case study of a class action suit in California that
targeted poor conditions for mentally ill prisoners established that mentally ill prisoners of the
California penal system were experiencing similar conditions to the ones exposed by Dorothea
Dix and the anti-psychiatry movement (Specter, 1994). It is clear, then, that the supposedly
humane closing of the confinement centers such as asylums was not so humane at all, for it lead
to many of the mentally ill being funneled instead to a different confinement center known as jail
or prison.
In addition, prison is certainly not an ideal environment for the mentally ill. These
prisoners can exhibit bizarre behavior which can lead to further confinement in medium or
maximum security prisons, or even solitary confinement. These types of conditions only serve to
exacerbate mental illnesses, especially depression and schizophrenia. Finally, the mentally ill
prisoners are more likely to be “disorganized” criminals within the prison system, unable to be a
part of prisonization. Thus, they are more likely to be taken advantage of by other inmates.
Sadly, any change forced by litigation or appeals to the courts is slow to occur for these
prisoners. Once plans for change are set by agreement of judges and officials of prisons, “it often
takes five to 10 years before they are fully implemented” (Specter, 1994). In addition, states are
constantly pressured by budget constraints to reduce costs, and mental health services are often
the first to go. Specter (1994) in his case study stated that the CDC often avoided diagnosing
mentally ill prisoners “because they knew the fiscal implications”, meaning that they knew that
they would have to fund mental health care for these prisoners.
It seems like a dire situation. With change slow to occur and states in financial straits, it
almost looks impossible to revolutionize the prison system for the mentally ill like Dorothea Dix
or the anti-psychiatrist movement did. “Anyone who comes forward with a proposal for reform
must demonstrate that it will save the state money,” says Vitiello (2011). Change must also
happen much faster than its current rate for the mentally ill if it is to be truly effective.
With that in mind, several proposals have been made to change the situation for those
who are mentally ill; these proposals are meant to help both the mentally ill who are not yet
imprisoned because of an arrest or conviction (but may be at risk to be so in the future because of
the nature of their illness) and those who are already incarcerated for whatever reason. Vitiello
(2011) proposes that the community-based programs originally meant to replace institutions for
the mentally ill be expanded and funded so that those incarcerated because of their mental illness
leading them to commit an offense can get treatment after they are released. “The state needs to
stop releasing the mentally ill back into the community without resources” (Vitiello, 2011); the
resources of which he thinks are those community-based treatment programs. He also proposes
that conditions be set on the mentally ill after release to ensure that they continue treatment for
their illness, much like the conditions of parole.
In 2007, the journal for Psychiatric Times released a summary of results from a study
done by the RAND Corporation on diverting nonviolent mentally ill offenders to mental health
courts. These courts are similar to drug courts and juvenile courts meant to divert juvenile or
drug offenders from the harsh life of prison; they divert mentally ill offenders in the same way.
This also helps reduce the problem of recidivism among mentally ill offenders. According to
Bureau of Justice statistics, those without a mental health issue were less likely to have served a
previous sentence than those with a mental illness. By giving those who struggle with mental
health a chance at diversion from prison life and into real treatment, recidivism is less likely and
more people are kept out of prison, also solving the overcrowding problem. Finally, the RAND
Corp. found that costs upon the taxpayers for incarceration were greatly reduced, and treatment
seemed to be more effective than the prison environment (not a great surprise).
To be quite blunt, many of the problems that we face in dealing with the mentally ill,
especially those in prison, stem from a stigma about mental illness. Much of the world,
especially the United States, has no idea how to deal with those who struggle with mental health
problems. I myself have faced the stigma against depressive disorder and anxiety; even though I
do not find myself likely to end up in prison, I am less than comforted by how our mentally ill
population is currently treated if they do find themselves in prison. While it does look as though
some reforms are slowly making their way to our criminal justice system, we are still slow to
lose the stigma from which many of our problems stem.
Nevertheless, there is always hope. We know that this problem is getting more attention
once again, and more wardens and prison officials are realizing that their mentally ill inmates
should not be simply shunted to prisons and jails, but should be better treated by all. Solutions
are forthcoming, and even if they are slow, we can still hope that they will one day be effective
enough to solve our overcrowding, our mistreatment of the mentally ill, and our financial straits
in which we so often find ourselves in these times of recession.
References
James, D. & Glaze, L. (2006). Mental health problems of prison and jail inmates. Bureau of
Justice Statistics. Retrieved from http://www.bjs.gov/content/pub/pdf/mhppji.pdf
Lamb, H. R. (2006). Involuntary treatment and the use of jails to treat the mentally ill.
Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/articles/involuntarytreatment-and-use-jails-treat-mentally-ill
Parry, M. (2006). Dorothea Dix (1802-1887). American Journal of Public Health, 96(4), 624625.
Specter, D. (1994). Cruel and unusual punishment of the mentally ill in California’s prisons: a
case study of a class action suit. Social Justice/Global Options, 21(3), 109-116.
Sudak, H. (2013). A remarkable legacy: Pennsylvania Hospital’s influence on the field of
psychiatry. Penn Medicine. Retrieved from
http://www.uphs.upenn.edu/paharc/features/psych.html
Tartakovsky, M. (U.k.). The birth of the mental asylum. PsychCentral. Retrieved from
http://psychcentral.com/blog/archives/2011/02/17/the-birth-of-the-mental-asylum/
Unknown. (2004). Guilty of mental illness. Psychiatric Times. Retrieved from
http://www.psychiatrictimes.com/forensic-psychiatry/guilty-mental-illness/page/0/1
Unknown. (2007). Mental health courts reduce incarceration, save money. Psychiatric Times.
Retrieved from http://www.psychiatrictimes.com/articles/mental-health-courts-reduceincarceration-save-money
Vitiello, M. (2011). Addressing the special problems of mentally ill prisoners: a small piece of
the solution to our nation’s prison crisis. Denver University Law Review, 88(1), 57-71.