The “treatment” of the mentally ill in America has taken a step backwards, about 200 years backwards, according to a new report released by the Treatment Advocacy Center. The report questions how much we’ve really learned about treating the mentally ill in the last 200 years, pointing out that people with mental illness were routinely confined in prisons and jails from 1770 to 1820.
“Because this practice was regarded as inhumane and problematic, until 1970, such persons were routinely confined in hospitals. Since 1970, we have returned to the earlier practice of routinely confining such persons in prisons and jails.”
Public psychiatric hospitals in the early 20th century came to be criticized for inhumane and disturbing treatments. Then in the 1950s a movement began to de-institutionalize mental health in favor of treating patients in more community-based treatment centers. Out-patient and “mainstreaming” the mentally ill gained popularity. Today, mental illness is rarely mentioned except in the context of gun control, keeping guns out of the hands of the mentally ill, or occasionally in relation to homelessness. So, where are all of the mentally ill in America? According to the Treatment Advocacy Center report, if they are not homeless on the streets, then they are in jails and prisons.
Before de-institutionalization, patients in mental hospitals peaked in 1955 at 558,922 patients institutionalized. According to the report, today’s mental hospital patients only number about 35,000. However, American prisons and jails housed an estimated 356,268 inmates with several mental illness in 2012 or Ten Times as many as are being treated in mental hospitals. Of course, jails and prisons in many cases are poorly equipped to deal with mental illness and such inmates are more likely than others to be held in solitary confinement, many are raped, commit suicide or hurt themselves. The anecdotal cases in the report include, a man in New York with schizophrenia who spent 13 years of a 15-year prison sentence in solitary confinement. A Minnesota county jail where a man with schizophrenia stabbed out both of his eyes with a pencil in his cell. A study of 132 suicide attempts in a county jail in Washington found that 77 percent of them had a “chronic psychiatric problem,” compared with 15 percent among the rest of the jail population.
The community treatment approach proved inadequate for a variety of reasons, leaving many of the mentally ill homeless or in jail. According to the Department of Justice, about 15 percent of state prisoners and 24 percent of jail inmates report symptoms that meet the criteria for a psychotic disorder. Few of these inmates get any treatment and the treatment provided to those that get it is minimal. At the end of the day we are left with untreated or “treated and streeted” mentally ill people, many of whom are homeless or upon serving their time in jail or prison are released back into our communities. Institutionalizing the mentally ill was deemed inhumane, now it seems that we are imprisoning them or abandoning them on the street with little if any treatment. Is this progress? Is this somehow more “humane” than the mental institutions of the past?