Prison Replaces Community Mental Health

lunatic-asylumOld lunatic asylum

This final post concerns the third main driver of high US incarceration rates: the warehousing of the mentally ill in America’s prisons and jails. It’s the one I’m most intimately acquainted with, after campaigning for 14 years, alongside the National Alliance for the Mentally Ill, to end this medieval barbarism. Federal and state lawmakers are perfectly aware that 1) this 40 year old practice constitutes a crime against humanity under international law and 2) that imprisoning the mentally ill costs taxpayers two to three times as much as community treatment. Yet our elected representatives remain unwilling or incapable of rectifying this problem.*

According to Health Affairs, 20 percent of US prison inmates have a serious mental illness and 30 to 60 percent have substance abuse problems. Between 50 and 70 percent have mild to moderate mental disorder.  Al Jazeera reports that people with severe mental illness are 10 times more likely to be in a jail or prison than in a mental health facility and 40 percent of individuals with a severe mental illness will have spent some time in their lives in either jail, prison, or community corrections.

Aside from the absolute barbarity of warehousing vulnerable mentally ill offenders with violent psychopaths, locking them up costs the taxpayer far more than providing them outpatient mental health services: adding up to $150 billion annually

I see two main factors behind the American practice of using correctional facilities to warehouse the mentally ill. Number one is the systematic defunding of America’s mental health system. Number two is the systematic defending of federal housing programs that initially provided shelter for the mentally ill when they were first released from state mental hospitals in the sixties, seventies and eighties.

The Movement to Close State Mental Hospitals

The movement to close state mental hospitals and “deinstitutionalize” the mentally ill began in 1963, after President John F. Kennedy signed the Community Mental Health Center Act. The goal of the new law was to replace institutionally based mental health treatment with community based care, by funding outpatient community mental health centers, group homes and residential facilities. In the early seventies, the discovery of effective pharmaceutical treatments for schizophrenia and manic depressive disorder facilitated this process.

As anticipated, state legislatures all over the country jumped at the opportunity to shift the cost of mental health care to the federal government. Because they provided 24/7 care, state hospitals had monstrous labor costs and lawmakers were only too happy to close them.

Unfortunately this federal funding dried up when Johnson created Medicaid for low income Americans in 1968. From this point on, the only federal mental health funding states received was from the individual entitlement of the Medicaid patients they served. Any non-Medicaid patients they treated had to be funded by private fees and charity.

Reagan Slashes Medicaid

Mental health funding deteriorated even further when Reagan replaced Medicaid funding with social service “block grants” that provided 25% less funding than the programs they replaced. Federally subsidized housing programs experienced comparable funding cuts.

Faced with steep funding cuts, states had no choice but to turn away thousands of mentally ill clients in genuine need of treatment. It was during the early eighties, under the Reagan administration, that large numbers of mentally ill Americans first made their appearance on the streets and in jails and prisons.

As funding continued to deteriorate, community mental health centers reduced costs even further by replacing labor intensive counseling and psychotherapy with “drugs-only” treatment and “case management” – and master’s degree social workers and counselors with “case workers” with no mental health training.

George W Bush Makes Further Medicaid Cuts

America’s mental health system would take a further hit in 2006 when Bush further slashed federal Medicaid funding to help finance the wars in Iraq and Afghanistan. States responded with further service cutbacks and, as always, jails and prisons took up the slack.

America’s mental health system would enter its death spiral when the economic recession hit in 2008. A study by the National Alliance on Mental Illness reveals the states slashed an unprecedented $1.8 billion from their mental health budgets between 2009 and 2011.

Continuing a well-established trend, mentally ill patients unable to access community treatment would end up in jail or prison.

To fully appreciate the unspeakable horror of this inhumane policy, listen to this excellent BBC World Service documentary America’s New Bedlam**


*The total indifference of our elected representatives to our prison system’s crimes against humanity is well illustrated by this post on solitary confinement (which also violates international law):  Oh, Just Stop It

**Bedlam refers to the Royal Bethlem Hospital in London, the first to specialize in the treatment of the mentally ill.

photo credit: danmillerinpanama

6 thoughts on “Prison Replaces Community Mental Health

  1. Dr. Bramhall, this is an abomination and an outrage! It is no wonder that so many people have crossed that thin line that separates what is considered sane into what is considered lunacy. Life for many is so hellish that it is no wonder that they develop a mental illness of some sort. And shall we not forget that many homeless people are veterans and that is an atrocity in and of itself. What is wrong with us that we do not look out for our weakest and our most vulnerable?

    How can we allow so many people to be locked up over something that they have no control over? Why is it that we care more for our pets than we do for human beings?

    Here in my neck of the woods, or as close to my neck of the woods as is possible, HUD is attempting to place the mentally ill into senior housing. Now the seniors are complaining that the mentally ill are causing them no end of grief. A major newspaper printed a story on its front page about this issue. It was stated that the mentally ill are running through the halls screaming and brandishing knives to “keep the devil away.” They are engaging in illegal drug use and threatening the seniors and the seniors do not feel that the answer is to house the disabled with them. Unfortunately, there is just not enough housing for the disabled and there is more housing available for seniors especially those in the higher income brackets and the disabled of course are low income.

    Incarcerating the mentally ill still should not be the answer, I suggest that more housing for the mentally ill and others with disabilities would help but as you’ve pointed out, the funding is just not geared to that when we’d rather just incarcerate them in for profit prisons.

    We could do better but we don’t want to because we’d rather fund the war machine and leave vulnerable people homeless or locked up and if they are locked up in for profit prisons, well all the more better for those who make a killing from convict labor and by locking them up, when they are released, they do not qualify for public housing. Not unless some charity is funding its own rent assistance program and there are usually long waiting lists to get into those programs. HUD hasn’t been fully funded for years and I don’t see that changing at all especially since we’re more into war than ever. Sigh! I despair of us!

    ..and like Jeff, I thank you for posting this series. It was very informative and eye opening to those who did not know that the problem was this urgent. You do indeed deserve award after award for you are a knowledge powerhouse, a veritable fountain of knowledge and in information clearinghouse.

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    • It’s a horrible problem, Shelby. It’s not simply a matter of inadequate funding. Ironically prison is one of the most expensive places to house the mentally ill. If we could move them out of prison, there would be plenty of money to fund disabled housing for them and adequate treatment so they’re not running up and down the hall screaming at their hallucinations.

      Coming to New Zealand has shown me that the US is incredible backward in their approach to treating the mentally ill. There are some incredible halfway houses in Malaysia where residents are encouraged to start a business (one example was a secondhand shop) in order to become self-supporting. The opportunity to contribute to the community is far more therapeutic than sedating them with heavy medication.

      I’m afraid I don’t have the answer to how to bring about this and other desperately needed changes in the US. There is such immense suffering, not only in prisons and jails, but in the public schools, and in family homes where there isn’t enough money for nutritious food, heating and doctor bills. I think there are millions of politically active Americans with a genuine desire to change these things. But they are blocked by a few powerful individuals whose blind greed (the Koch brothers and the Walton family come to mine) makes them callously indifferent to the suffering around them.

      Thank you for your very flattering comments. You are most kind.

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  2. my brother is bipolar and schitzoprenic…he is locked up in county jail on his way to prison,
    because he is very ill. if there is anyone that can help this family keep their brother, father, and son
    from going to prison instead of a mental hospital, please please email me…maid396@sbcglobal.net

    Like

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