Many studies purport that up to 1 in 3 prison inmates suffer from one or more serious mental illnesses.
Incarceration Stats in the US.
Mental health spending in the US- 1996 v. 2014.
Background: How are incarceration rates related to mental illness?
For years, jails and prisons across the United States have been filling with people who have mental illnesses. In the 1950’s, 178,000 inmates were behind bars; of these, only .7% struggled with mental health issues. Today, of the five million people incarcerated in the US, 20% have at least one mental illness.[1] According to the National Alliance on Mental Illness, 25-40% of mentally ill Americans will be incarcerated at some point in their lives. These data seem to suggest an inherent connection between mental illness and incarceration rates.
Contrary to popular belief, however, mental illness is not a precursor for violence. The majority of inmates with mental illnesses are actually non-violent offenders who were arrested on minor charges and apportioned such high bonds that they couldn’t afford to pay for their freedom. Such minor charges are typically ‘crimes of survival’, such as petty food or retail theft, and breaking and entering (often to find a place to sleep).[2] Other times, mentally ill individuals are punished for “failure to obey” oral commands that they simply are not capable of responding to, for “missing counts” they were never appraised of, or for “filing grievances about these and other persistent justices”.[3] These are not violent crimes. Usually, police officers are simply concerned with safety and honestly do not know what else to do with a seemingly belligerent, homeless individual with mental illness.
But there are factors in place that commit people with mental illness (PwMI) to a dangerous cycle of institutionally-supported discrimination. Penal institutions are notorious for keeping the disabled incarcerated ‘for their own good and the safety of society’. Pierre, an inmate at Cook County Jail in Chicago, told The Atlantic that he knew many inmates with mental illnesses that were booked on small, non-violent charges but were being held for over twenty years.[4] Here, he explains how a number of compounding factors like race, comorbid disabilities, lack of housing, employment and freedom, low social and financial support, and barriers to medical and therapeutic resources all work together to keep the disabled institutionalized. Such forces push against PwMI, facilitating noncompliance, additional hospitalization, incarceration and high recidivism rates. While arresting PwMI for violent and non-violent offenses may seem like the only immediate option for regulation, there are alternative options that are ultimately cheaper, safer and healthier for PwMI and the greater population in the long run.
Historical Context
These problematic policies and processes call for a contextualized look at how our mental health policies have developed over time. After World War II, many soldiers returned with severe depression, anxiety, PTSD and other mental disorders. This prompted the passage of America’s first mental health-related law, the National Mental Health Act of 1946. This established the National Institution of Mental Health (NIMH) and provided research funding to states across the country.[5] Thanks to this initial funding, anti-psychotic medications like Thorazine were invented as an initial step in the therapeutic process; this allowed many hospitalized mentally-ill patients to be stabilized and even released.
Over the decades that followed, mental health became a particularly political topic. People became outraged after learning that only 20% of state mental hospitals were up to human rights standards, with many institutions “tending towards locked, barred, prisonlike depositories of alienated and rejected human beings”.[6] The negative zeitgeist surrounding mental institutions was only worsened by its high toll on taxpayer money, the horrifying depictions of ‘insane asylums’ by journalists and pop culture, and the increasing availability of anti-psychotic medicines.[7]
These factors prompted President John F. Kennedy to pass the Community Mental Health Act in 1963, which called for the decentralization of mental hospitals in favor of “a national network of community-based mental health centers…equipped to provide a coordinate range of timely diagnostic, health, educational, training, rehabilitation, employment, welfare and legal protection services”.[8] Although this bill was supported by Medicaid (1965) legislation, construction of such centers was far and few between. Only 26 states offered state-sponsored mental health services during this time, and they were poorly funded. This was only worsened by Reagan’s bold move to cut mental health expenditures in a continued effort to decentralize mental institutions. Because policymakers focused more on emptying the old mental facilities than providing new community-based ones, “many patients went from straitjackets to steam grates”.[9] Although various efforts to remedy these congressional errors have been made in the last few decades (Kendra’s Law, ACT Programs, prison pilot programs), the Great Recession era in the 2000s hampered much of the progress that had started to bloom.
Sociopolitical and legal contexts: Why does this issue matter?
The aftershocks of the slow-moving legislature and depleted funding for mental health resources throughout the 20th century can still be felt today. The process of deinstitutionalization left many PwMI homeless and medically untreated, sometimes causing them to be dangerous to themselves and others. Rather than providing affordable, rehabilitative resources for these individuals, we have used the criminal justice system as ‘quick-fix’ housing and regulation solutions. There is a clear cycle of injustice that is being done to those with mental illness; when PwMI don’t get the care they need, they become symptomatic, engaging in behaviors that appear to be criminal. These behaviors are then criminalized and PwMI are suspended and expelled from school, put into foster care, arrested and incarcerated at rates that far exceed their healthy counterparts.[10] This institutionally-sanctioned process thereby pushes PwMI to the margins of society, deeming them ‘abnormal’.
The negative outcomes of this cyclical process are only worsened by the common practice of solitary confinement for PwMI and other disabilities in prison. According to Lewis, “solitary confinement is [often] used as a substitute for the provision of accommodations and protections for [disabled] and incarcerated individuals”.[11] However, various studies have proven that symptoms of mental illness are often worsened by solitary confinement (and incarceration in general). Oftentimes, being placed in a small room with no light or social interaction often provokes further violence by PwMI, thereby reinforcing the caricature of the ‘dumb and disabled prisoner’.[12]
While laws to prevent such abuse have been passed on federal and state levels, they have generally fallen by the wayside in terms of real-life application. Estelle v. Gamble (1976) attempted to address the “critical ethical and security issues” PwMI face in the criminal justice system. This federal case mandates that inmates have a constitutional right to adequate medical resources in prison, per the 8th amendment. Although the law is clear in its intent, the mentally ill are targeted, injured and denied treatment much more often than their healthy counterparts; one national study has shown up to 77% of inmates so severely beaten they needed emergency medical assistance have at least one mental illness.[13] Even when inmates attempt to gain justice for these abuses, only 25% of their legal and medical concerns are even heard – let alone addressed – according to one study.[14] These institutional barriers, along with the complexity of comorbid disorders, high cost of litigating, and ostensible shortage of viable options, work together to silence and marginalize PwMI in our criminal justice system.
Controversies: Why is incarceration of those with mental illness a divisive topic?
While the criminalization of those with mental illnesses is clearly erroneous, many controversial perspectives have emerged in response to such a notion. Those who support eliminating institutionally-enforced biases against the mentally ill contend that nonviolent PwMI are held for excessively long times, for no reason. On average, PwMI are incarcerated for longer periods of time for the same or even lesser crimes than their mentally healthy peers.[15] They also argue that many PwMI only plead guilty to crimes because they don’t fully understand the implications of their arrest; oftentimes the mentally ill are illiterate, poor and do not have access to adequate legal counsel. This inherently puts PwMI at a weakened standpoint for achieving individual justice. As previously discussed, the mentally ill are often wrongfully and unequally arrested compared to other marginalized populations; police officers may see an individual with schizophrenia (or another psychiatric disorder) acting irrationally, and in an effort to curb any ensuing violence, arrest the individual for these actions. This is a process that occurs frequently; according to Prisoner Health, people with mental illness are 4.5 times more likely to be arrested than those in the general population (Prisoner Health). Such state regulation makes the ‘outside’ world a dangerous place for the mentally ill, especially if they’re homeless. Unequal arrest and conviction rates of PwMI also place them at risk on the ‘inside’; studies have repeatedly shown that those with mental illness and other disabilities experience substantially more sexual assault and abuse than healthy inmates (Ford). This, and inaccess to adequate medical and psychiatric services, violates mentally ill inmates’ 8th amendment rights. Lack of unbiased, adequate regulation therefore facilitates the institutional discrimination of the mentally ill.[16] [17]
But not all policymakers, psychiatrists and mental health officials feel this way. Many actors complain that accommodating the mental and physical health needs of their disabled inmates is simply too expensive. Public jails and prisons simply do not have the resources they need to accomplish such goals. Others adopt more of a utilitarian perspective on the issue, arguing that it is more profitable and safe to regulate the mentally ill in a penitentiary setting, than it would be to let them wander, hungry through the streets. This view is mainly born out of the aforementioned misconception that violence is inextricably linked to mental illness. Another point of contention for many is the 1976 ruling of Estelle v. Gamble, which deemed healthcare a right for inmates in the United States. Those who are fiscally conservative often take issue with the fact that their hard-earned taxpayer money is supporting the health and well-being of those behind bars. To many, being a prisoner means conceding the natural rights and privileges that are afforded to the upright American citizen. This belief provides the framework for many right-leaning policies that have cut mental health care budgets in the last few decades. Similarly, many people (both left- and right-leaning) believe such government insertion in health resources in prisons is an overreach of federal power, and should be curbed in order to maintain a healthier balance between one’s Body and the State.[18]
How does this relate to politics of health?
The multivariate relationship between mental health and incarceration directly relies on the politicization of health. While psychiatric and legislative processes in the 20th century invited public actors to take meaningful roles in health policy, it did not come without consequences. The initial presentation of PwMI and mental hospital pre-1950’s shaped public discourse and opinion; the belief that the mentally ill are dangerous, bizarre, and lack morality is so pervasive that it remains today. The mediatization of the ‘dumb and disabled criminal’ excludes PwMI from sites of production and consumption, pushing them into the margins of the community. While we did see a cultural shift in the United States in terms of media portrayal and incarceration rates of PwMI in the mid-20th century (thanks to JFK’s active policies), such efforts were short-lived and ultimately contributed to the marginalization of PwMI by putting them out on the streets with nowhere to go. The police’s tendency to simply arrest those with mental illness, rather than helping them access the resources they need, further demonstrates institutional discrimination towards this marginalized population. The system is constructed in a way that supports able-bodied, mentally-healthy individuals – criminal or otherwise–, letting everyone else fall by the wayside. In this way, the State provides institutionalized standards of normativity- and thus, abnormality. Discriminatory policies that arrest and keep PwMI in prisons unnecessarily allows the State to control mentally ill bodies. When considered with racism, sexism and other discriminatory forces that are inherent to our system of law in the US, State control over the mentally ill is compounded. We can even understand these processes as an elimination of therapeutic citizenship, through its intentional embrace of political body over the individual one. Because PwMI are unable to challenge the political systems that control them through activism and legal means, the mentally ill become susceptible to institutions of biopower, ultimately leading to therapeutic pacifism.
Bibliography
Ben-Moshe, Liat. “Disabling Incarceration: Connecting Disability to Divergent Confinements in the USA.” Critical Sociology 39, no. 3 (2013): 385-403.
James, Doris J., and Lauren E. Glaze. “Mental Health Problems of Prison and Jail Inmates.” Manual of Mental Disorders 4. Accessed April 13, 2017. doi:10.1037/e557002006-001.
Ditton, Paula M. “Mental Health and Treatment of Inmates and Probationers.” US Department of Justice, July 1999. Accessed April 13, 2017. doi:10.1037/e387772004-001.
Ford, Matt. “America’s Largest Mental Hospital Is a Jail.” The Atlantic. June 08, 2015. Accessed April 13, 2017. https://www.theatlantic.com/politics/archive/2015/06/americas-largest-mental-hospital-is-a-jail/395012/.
Lewis, Anisha. “Incarceration and Mental Health.” The Center for Prisoner Health and Human Rights. 2017. Accessed April 13, 2017. http://www.prisonerhealth.org/educational-resources/factsheets-2/incarceration-and-mental-health/.
Lewis, Talila A. “In the Fight to Close Rikers, Don’t Forget Deaf and Disabled People.” Truthout. 2017. Accessed April 13, 2017. http://www.truth-out.org/opinion/item/40136-in-the-fight-to-close-rikers-don-t-forget-deaf-and-disabled-people.
Schwirtz, Michael and Michael Winerip. “For Mentally Ill Inmates at Rikers Island, a Cycle of Jail and Hospitals.” The New York Times. April 10, 2015. Accessed April 13, 2017. https://www.nytimes.com/2015/04/12/nyregion/for-mentally-ill-inmates-at-rikers-a-cycle-of-jail-and-hospitals.html.
[1] Talila Lewis, “In the Fight to Close Rikers, Don’t Forget Deaf and Disabled People”, Truthout, 2017, http://www.truth-out.org/opinion/item/40136-in-the-fight-to-close-rikers-don-t-forget-deaf-and-disabled-people.
[2] Matt Ford, “America’s Largest Mental Hospital Is a Jail”, The Atlantic, June 08, 2015, https://www.theatlantic.com/politics/archive/2015/06/americas-largest-mental-hospital-is-a-jail/395012/.
[3] Lewis, In the Fight to Close Rikers, 1.
[4] Ford, “America’s Largest Mental Hospital”, 1.
[5] Ibid., 1.
[6] Michael Schwirtz and Michael Winerip, “For Mentally Ill Inmates at Rikers Island, a Cycle of Jail and Hospitals.” The New York Times. April 10, 2015. Accessed April 13, 2017. https://www.nytimes.com/2015/04/12/nyregion/for-mentally-ill-inmates-at-rikers-a-cycle-of-jail-and-hospitals.html.
[7] Ford, “America’s Largest Mental Hospital”, 1.
[8] Ibid., 1.
[9] Ibid., 1.
[10] Lewis, In the Fight to Close Rikers, 1.
[11] Ibid., 1.
[12] Liat ben Moshe, “Disabling Incarceration: Connecting Disability to Divergent Confinements in the USA.” Critical Sociology, 385-403.
[13] Michael Schwirtz and Michael Winerip, “For Mentally Ill Inmates at Rikers”, 1.
[14] Ford, “America’s Largest Mental Hospital”, 1.
[15] Ibid., 1.
[16] Ibid., 1.
[17] Paula Ditton, “Mental Health and Treatment of Inmates and Probationers.” US Department of Justice, July 1999.
[18] Anisha Lewis, “Incarceration and Mental Health.” The Center for Prisoner Health and Human Rights. 2017. Accessed April 13, 2017. http://www.prisonerhealth.org/educational-resources/factsheets-2/incarceration-and-mental-health/.
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