Our Vanishing National Mental Health Safety Net

Readers Digest (February 2014) reports that in the 1950’s more than a half a million people lived in the U.S. mental institutions – one in 300 Americans. By the late ‘70’s, only 160,000 did, due to the efforts by psychiatrists, philanthropists, and politicians to deinstitutionalize the mentally ill.

Institute of Mental Health 6, Nov 06

Institute of Mental Health 6, Nov 06 (Photo credit: Wikipedia)

Today there’s one public psychiatric care bed per 7,100 Americans – the same ratios as in 1850. Emptying the asylums was going to save money. And who needed hospitals with all of the antipsychotic drugs on the market? Deinstitutionalization was going to restore citizens’ rights and protect them from deplorable conditions. Wouldn’t it be better if the mentally ill were treated at home, given support, therapy, and medication via community clinics? It sounded good, but the reality was quite different.

In 1961, a joint commission of the American Medical and American Psychiatric associations recommended integrating the mentally ill into society. This plan depended on the establishment of local facilities where mentally ill people could receive outpatient care. Congress passed a law providing funding for these “community mental health centers.” In 1963, the states, under pressure from the patients’ rights movement, downsized their psychiatric hospitals faster than anyone had anticipated and between the Vietnam War, an economic crisis, and a lack of political will, adequate funding for community services never came through.

In 1980 the Mental Health System Act was passed to fill the gap. But a year later, Ronald Reagan gutted the act, then decreased federal mental-health spending by 30 percent and shifted the burden to the state and local governments. The crucial community services that the mentally ill were supposed to receive failed to materialize and more and more people ended up on the streets. Collectively, states have cut $4.35 billion in public mental-health spending since 2009.

As of 2006, 1.3 million of America’s mentally ill were housed where they used to be in the late 1800s: in prisons. Between 1998 and 2006, the number of mentally ill people behind bars more than quadrupled. In some county jails, rates of inmates with mental illness have increased by nearly 50 percent in the past five years. It’s not uncommon for individual jails to report that 25 to 30 percent of their inmates are mentally ill or that their mentally ill population rises year after year.

SB 1054-Mentally Ill Offender Crime Reduction Grant Program, To Be Heard April 22nd

Senate Bill 1054 (Steinberg), will renew funding for the Mentally Ill Offender Crime Reduction (MIOCR) Grant Program at $50 million, divided evenly between adult and juvenile populations. The grants are used to create diversion, reentry, and training programs for individuals living with mental illness who are criminal justice involved. In the past, MIOCR grants were used to establish mental health courts, among other productive uses.

The bill will be heard on Tuesday, April 22, 2014, at 9:30 a.m. in the Senate Public Safety Committee, State Capitol Room 3191. This is one of NAMI California’s Tier 1 bills, meaning it’s one of our highest priority pieces of legislation. NAMI California and the Capitol Coalition will be delivering testimony at the hearing.

Please see NAMI California’s support letter HERE.

Bill Summary: Would require the Board of State and Community Corrections to administer and award mentally ill offender crime reduction grants on a competitive basis to counties that expand or establish a continuum of swift, certain, and graduated responses to reduce crime and criminal justice costs related to mentally ill offenders. This bill would appropriate $50,000,000 from the Recidivism Reduction Fund in the 2014-15 fiscal year for the mentally ill offender crime reduction grant program, and require that half of that amount be used for adult offenders and half for juvenile offenders.

— Caliph Assagai, J.D.
Legislation and Public Policy Director, NAMI California

–David Czarnecki
Advocacy Coordinator, NAMI California

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Shameful Numbers: There are 10 Persons with Serious Mental Illness in Jail for Every One In a Hospital

Prison Industrial Complex #occupysanquentin

Prison Industrial Complex #occupysanquentin (Photo credit: @bastique)

From Psychiatric News Alert: Ten times more individuals with serious mental illness are residing in state prisons and county jails today than in the nation’s state psychiatric hospitals, according to a new study released today by the Treatment Advocacy Center (TAC). “The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey” found that in 44 states the largest institution housing people with severe psychiatric disease is a prison or jail. Nationwide, the study reports that there are an estimated 356,000 mentally ill inmates compared with 35,000 public-hospital patients.

The survey provides state-by-state illustrations of how protocols for treating mentally ill inmates who are deteriorating or acutely ill create obstacles that leave inmates without treatment for extended periods or indefinitely, especially in county jails. The report also contains several recommendations, including use of court-ordered outpatient treatment—deemed by the Department of Justice to be an evidence-based practice for reducing crime and violence—to help at-risk individuals live more safely and successfully in the community. 

“The lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society,” said psychiatrist E. Fuller Torrey, M.D., founder of TAC and lead author of the study. “This is especially true for individuals who – because of their mental illness – are not aware they are sick and therefore refuse medication.” 

In comments to Psychiatric News, Torrey said:

Prison doors

Prison doors (Photo credit: rytc)

“It is remarkable that we have let this situation deteriorate to this point. Jails and prisons are not built to be mental hospitals, and corrections personnel are neither hired nor trained to be mental health workers. We have returned to the situation that existed in the 1830s when Dorothea Dix began the reform movement to get mentally ill persons removed from jails and prisons and put into hospitals. The fact that we are where we were almost 200 years ago should give us all pause.” 

To read more on this subject, including strategies to reverse the trend, see the Psychiatric News article, “Judges, Psychiatrists Confer on Handling Mental Illness in Justice System.” Also see “Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review” in Psychiatric Services in Advance.

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Why addressing Mental Health Means Reforming U.S. Prison System

Our mental health system seems highly flawed – currently millions of Americans are unable to access the care they need, instead forced to bear the burden of their illnesses alone and without treatment. Yet little attention has been paid and how the role of our criminal justice system plays in this web of issues.

Over half of the U.S. prison population is mentally ill, and people who suffer from mental illness are represented in the criminal justice system at rates between two and four times higher than in the general population. Given that studies find people with mental illnesses to be no more prone to violence than those without mental illnesses, the root of this overrepresentation in prison clearly lies in our mental health system’s shortcomings. Instead of treating the underlying biological and environmental causes of these disorders, we are criminalizing and incarcerating the mentally ill.

“Most people [with mental illness] by far are incarcerated because of very minor crimes that are preventable. People are homeless for reasons that shouldn’t occur, people don’t have basic treatment and they get into trouble because of crimes of survival.” Bob Bernstein, the Executive Director of the Bazelon Center for Mental Health Law.

Because prisons were never designed to serve as mental health facilities, today they find themselves entirely unprepared to handle the mass quantity of people with mental illnesses that populate the system. Prisons generally fail to address the underlying issues that confront people with mental illness, often even exasperating these conditions.

Moreover, our broken prison system is a huge drain on America’s economy. The government currently spends over $70 billion per year on corrections.

February 8, 2012
by Rachel Howard
For full text see http://thinkprogress.org/health/2013/02/08/1561341/mental-health-prison-reform/