One might assume that when people with serious mental illnesses are locked up by the state it is in specialist psychiatric institutions – but all too often they end up in the prison system instead.

Writing from a US perspective for the City Journal, E Fuller Torrey argues that the policy of ‘care in the community’ (or ‘deinstitutionalization’ in the American terminology) has become one of care in the penitentiary – not that ‘care’ is really the word:

“A study done between 2002 and 2006, covering inmates in three New York county jails, reported that 15 percent of the males and 31 percent of the females suffered from a current serious mental illness, narrowly defined to include schizophrenia, bipolar disorder, and major depressive disorder. These percentages are almost certainly low, moreover, since 31 percent of the inmates refused to participate in the study, and their ranks would have included many mentally ill people, especially those with paranoid schizophrenia, who’d be suspicious of such surveys.”

This represents a massive reverse on the progress made by the social reformers of the 19th century:

“A broad social movement of that era, led by activist Dorothea Dix, among others, succeeded in building the first state psychiatric hospitals and in getting mentally ill prisoners transferred en masse to the new institutions. When Worcester State Hospital opened in Massachusetts in 1833, more than half of the first-year admissions arrived from jails, prisons, and poorhouses. The movement of the mentally ill into mental hospitals proceeded over the next several decades, so that by 1880, a national census of mentally ill individuals—still the most complete such survey done in the United States—found that less than 1 percent of jail and prison inmates were ‘insane persons.’”

This situation persisted for most of the 20th century – “studies of prisoners regularly reported low rates—usually 3 percent or less—of serious mental illness among them.”

Ironically, the return to mass imprisonment was precipitated by a medical breakthrough:

“…during the 1960s, effective medications for treating mental illness became available, and the deinstitutionalization of state mental patients got under way. Deinstitutionalization’s fundamental flaw was not its shifting of patients from hospitals to living in the community but its failure to ensure that those patients would keep taking the medication they needed to remain well once they left the hospital.”

Torrey attaches some of the blame to civil liberties lawyers who made it difficult for the authorities to hospitalise individuals against their wishes. There is, of course, a long and shameful history of people being confined to asylums for the most spurious and abusive reasons. But can we really claim that fewer individuals are wrongly institutionalised these days, when so many vulnerable people end up in jail – an institution that might have been designed to worsen their condition?

“The mentally ill are less likely to make bail and more likely to break jail rules, thus failing to get their sentences reduced for good behavior…

“Mentally ill prisoners are three times more likely to be raped or otherwise victimized by other prisoners. As noted by [Matthew] Spina, who has written passionately about this injustice, a mentally ill individual in prison ‘is like a lamb or a zebra to a lion—easy pickings.’”

Then there’s the painfully obvious fact that “psychotically induced behavior can also be extremely disruptive to daily life behind bars”:

“Such behavior often results in solitary confinement for mentally ill prisoners, which usually produces a further deterioration of their psychiatric condition… Studies in some states have reported that half or more of the prisoners in solitary confinement are mentally ill.”

Tragically, the downward spiral can become a death sentence – “suicide attempts occur, as one might expect, disproportionately among mentally ill prisoners.”

In Britain, the 2009 Bradley Review (which was commissioned by the Government in 2007) called for a policy of early intervention to divert mentally ill offenders from the criminal justice system. Five years on, far too little progress has been made.

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