- Written by Tatiana Alba, 9th Grade Springhouse Learner -
American society has always had a complicated relationship with people who have mental illnesses. Mentally ill individuals have historically been viewed as subhumans incapable of feeling, idiotic lunatics, dangerous, morally corrupt, and much more. In this paper, I will be going through the history of incarceration of the mentally ill through many different forms leading up to the present day incarceration of individuals with mental illness in prisons and jails and the relation of recidivism for previously incarcerated individuals with a mental illness.
The incarceration of people with mental illness in America goes back many centuries. In colonial America, people would confine the mentally ill in horrendous conditions at local jails to be abused if the family could not or did not want to care for them, or if they were a public disturbance1. Other times, those with mental illness were segregated from the rest of society for their odd behavior and left to fend for themselves. People at that time believed that mental illness was caused by demonic possession or punishment by God, therefore leading to social stigma and social isolation in a heavily religious society. Americans have long held a “not in my backyard” mentality that has resulted in the confinement or banishment of the mentally ill and increased suffering throughout American history.
In the late 18th century America there was a shift in attitudes toward the mentally ill called the “moral treatment” initiated most noticeably by Benjamin Rush in the United States and others around the world4. The idea behind the movement was that mental illness was a disease of the mind caused by disruptions in the blood circulation in the body and should be treated, not punished. The intentions of this may have been well-meaning but the little understanding of mental illness at the time made the forms of treatment at best unsuccessful and at worst deadly. The first hospital in the United States that provided moral treatment for the mentally ill was the Pennsylvania Hospital in Philadelphia5. Benjamin Rush was the lead physician whose forms of treatment were bleeding and purging his patients endlessly and bringing them to the brink of death in an attempt to shock them back into sanity and begin normal blood circulation. Rush also believed in the use of sensory deprivation and incorporating constraints in treatment. Many other asylums that were created after the Pennsylvania Hospital were inspired by the practices of Benjamin Rush and therefore not providing better care. However, this shift in thinking about the origins of mental illness set the groundwork for modern psychiatric treatment.
The first state hospital in America was established in Virginia in 1773, called the Eastern
State Hospital.4. Fifty years later, other states started to follow in the lead of Virginia. Starting In 1822, Kentucky opened a state mental asylum for paupers and indigent insane persons in Lexington, Kentucky. In 1833, Worcester State Hospital in Massachusetts was opened, followed by the Utica Asylum in New York State. Between 1836 and 1842, nine new public hospitals were opened4. In this time was the beginning of a societal shift from putting incarcerated individuals with mental illnesses in prisons and jails to mental hospitals as a result of Dorothea Dix’s 40 year-long campaign to get and keep people with mental illness out of prisons and into State hospitals1. Dorothea Dix was a teacher who took a job at a Boston jail where conditions were so abysmal and the treatment of mentally ill inmates so inhumane that she began campaigning at once for their improvement. Dix visited hundreds of jails and prisons, documenting the conditions she found and presenting her findings to state legislatures, demanding that officials take action toward reform. As a result of Dix’s efforts, funds were set aside for the building of the state mental hospitals. This marked the period of institutionalization for the treatment of mental illness that lasted until 1960 when incarceration of the mentally ill began to replace institutionalization.
In the 1960s began the era of deinstitutionalization. The endeavor to deinstitutionalize treatment of mental illness from hospital-based care to community-based care in an effort to stop the abuses within state mental hospitals that the mentally ill had to endure for what was presumably a more humane and cheaper means of treatment6. There were three phases to deinstitutionalization: the development of alternative community-based facilities, the release of psychiatric patients to community-based facilities, and the diversion of new patients to the alternative community-based facilities6. These initiatives were poorly planned and neglected by the government halfway through despite having already started the closure of state hospitals that had left the mentally ill with little places to go and few means of treatment6, 1, 2. At the height of state institutionalization in 1955, there were 559,00 people in state mental hospitals, in 1999 this number was fewer than 80,0007. In total, between 1955 to 2010, the U.S. closed 92% of its state hospital beds2.
The people that once filled the hospital beds did not disappear with the closure of state mental hospitals. Instead, many found themselves receiving inadequate treatment in nursing homes, local hospitals, homeless shelters, on the streets, or in penal institutions8, 2. This phenomenon is what experts call “transinstitutionalization”8, 9. The diversion of individuals who would have otherwise gone to state psychiatric hospitals being diverted to other public institutions8, 9, 10. Most notably, patients went from psychiatric institutions to prisons and jails. For example, the United States has three times more individuals with severe mental illnesses in prison than in psychiatric hospitals. By the mid-1990s, the largest institutional provider of mental health services in the United States was not a state or private psychiatric hospital, but the Los Angeles County Jail13. Research estimates that perhaps as many as one in five prisoners are seriously mentally ill15. Almost 300 years of science and medical discovery, and we are back to where we started; incarcerating the mentally ill.
The incarceration of the mentally ill happens when individuals who have not been able to receive help through psychiatric hospitalization begin to disturb their communities either because they engage in survivalist behaviors (e.g., loitering, stealing, or trespassing) or through their unusual behaviors that are related to their mental illness that end up with these individuals coming in contact with the criminal justice system8. Mentally ill persons who are homeless oftentimes have a substance abuse disorder that leads to even more run-ins with the law2. According to the National Homeless Coalition, 38% of homeless people are dependent on alcohol and 26% abused other drugs and 20 to 25% of the homeless population in the United States suffers from some form of severe mental illness. In comparison, only 6% of Americans are severely mentally ill11, 12. Furthermore, America's federal and state adoption of a zero-tolerance approach to deviant behavior and drug policies beginning in the 80s increased the likelihood of conviction for a crime resulting in incarceration and increased the length of time served for minor crimes (e.g. mandatory minimum sentencing, “three strikes” laws)9 and increasing the rates of incarceration for people with mental illness. Additionally, those with a major mental illness are four times as likely to be charged with minor crimes as those without a mental illness2. All of these factors have created the disparities of individuals in prisons and jails with mental illnesses that we have not seen in America since the 18th century. E.g. 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates qualify for having a severe mental illness14.
Incarcerating individuals with a mental illness leads to what experts call “the revolving door syndrome”. This term refers to the higher rates of recidivism for previously incarcerated individuals with a major mental illness than those without. According to a study by the Bureau of Justice statistics, of the 56% of State prisoners, and 64% of jail inmates that have/qualified for a major mental illness, nearly a quarter of both state prisoners and jail inmates had 3 or more prior incarcerations compared to a fifth of those without a mental illness15. In another study that examined data on all people released to parole in California during 2004, researchers found that people on parole with mental illnesses were more likely to return to prison for a parole violation within one year of release, compared to people without mental illnesses16.
Without adequate planning to transition inmates with mental illness back into the community, many will quickly return to jail or prison; recidivism rates for inmates with mental illness can reach over 70 percent in some jurisdictions15. These are shocking numbers but if we look to how these individuals end up in prison, it is not hard to see why the rates of recidivism for persons with major mental illness are high. People who have a serious mental illness tend to be homeless or poor and have a substance abuse disorder. All three of these increase the chances of coming into contact with the law. Furthermore, we do not address the issues that lead these individuals into prisons and jails while they are incarcerated (e.g. receiving sufficient treatment and support for their mental illness, substance abuse, and homelessness). In addition, the American government doesn’t provide adequate support post-release. Leaving these unfortunate individuals to be more vulnerable to the criminal justice system than they were before and thus creating the revolving door syndrome.
America has, in one form or another, always incarcerated people with mental illness. Either if that was in jails, mental hospitals, nursing homes, or jails and prisons once again. Among other things that have consistently been present in America's historical treatment of people with mental illness was a lack of understanding about the complexities of having a mental illness, sufficient treatment for said illness, and ample support in the community for these individuals. If Americans ever want to learn from our past mistakes, we must completely change the ways in which we approach mental illness, addiction, homelessness, and incarceration.
1Torrey, Fuller E., Zdanowicz, T. Mary, Kennard, D. Aaron, Lamb, H. Richard, Eslinger, F. Donald, Biasotti, C. Michael. The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey. Treatment Advocacy Center, 2014.
2Slate, N. Risdon, Buffington-Vollum, K. Jacqueline, Johnson, W. Wesly. The Criminalization of Mental Illness: Crisis and Opportunity for the Justice System: Second Edition. Carolina Academic Press, 2013
3Carron, A. Michael, Saad, Hanna. Treatment of the Mentally Ill in the Pre-Moral and Moral Era: A Brief Report.Jefferson Journal of Psychiatry, 2012.
4Roberts, R. Albert, Kurtz, F. Linda. Historical Perspectives on the Care and Treatment of the Mentally Ill. Journal of Sociology and Social Welfare, 1987.
5Dain, Norman. From Colonial America to bicentennial America: two centuries of vicissitudes in the institutional care of mental patients. Bulletin of the New York Academy of Medicine, 1976.
6Lamb, Harry, Bachrach L. Leona. Some Perspectives on Deinstitutionalization. American Psychiatric Association, 2001.
7Council of State Governments. Criminal Justice/Mental Health Consensus Project. Council of State Governments, 2003.
8Primeau, Ashley, Bowers, G. Thomas, Harrison, A. Marissa, XuXu. Deinstitutionalization of the Mentally Ill: Evidence for Transinstitutionalization from Psychiatric Hospitals to Penal Institutions. Sage Journals,2013.
9Human Rights Watch. ill-equipped: U.S. Prisons and Offenders with Mental Illness. Human Rights Watch, 2003.
10Lamb, R. Harry, Weinberger, Linda. Persons With Severe Mental Illness in Jails and Prisons: A Review. Psychiatric services, 1998.
11The National Coalition for the Homeless. Substance Abuse and Homelessness.The National Coalition for the Homeless, July 2009.
12National Coalition for the Homeless. Mental illness and homelessness. July 2009.
13Kopel, B. David, Cramer, Clayton. Reforming Mental Health Law to Protect Public Safety and Help the Severely Mentally Ill.
14Osher, Fred, Steadman J. Harry, Barr, Heather. A Best Practice Approach to Community Reentry From Jails for Inmates With Co-Occurring Disorders: The Apic Model. 2007.
15Al-Rousan, Tala, Rubenstein, Linda, Sieleni Bruce, Deol, Harbans and Wallace, B. Robert. Inside the nations largest mental health institution: a prevalence study in a state prison system. BMC Public Health, 2017.
16James, J. Doris, Glaze E. Lauren. Mental Health Problems Of Prison And Jail Inmates.
Bureau of Justice Statistics, 2006.
17Jacob, Seth, and Draper, P. Laura. Improving Outcomes for People with Mental Illnesses Under Community Corrections Supervision: A Guide to Research-Informed Policy And Practice. 2009.