Old 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