Academic journal article Journal of the Institute of Justice and International Studies

Legitimacy of Corrections as a Mental Health Care Provider: Perspectives from U.S. and European Systems

Academic journal article Journal of the Institute of Justice and International Studies

Legitimacy of Corrections as a Mental Health Care Provider: Perspectives from U.S. and European Systems

Article excerpt

Large numbers of seriously mentally ill persons are being incarcerated because their disturbed behavior is criminalized. The criminal justice system is struggling to manage the needs of these mentally ill persons in correctional settings. This article examines the problem of the incarcerated mentally ill in terms of whether or not the correctional setting is an ethically legitimate place to house and treat these persons. First, it briefly summarizes how we arrived at this problem in the U.S. Then, it examines the problem today in the U.S. and comparatively in European nations. Finally, it closes with recommendations for establishing treatment outside correctional settings and how to best address the issue of mental illness within correctional settings.

The public system for responding to serious mental illness in the United States is in a state of dysfunction. The largest psychiatric institutions in the nation are not hospitals, but instead correctional facilities (Torrey, 2008). This is not a new state of affairs in America. Some one hundred and seventy-five years ago the United States was faced with a similar situation, as the majority of poor mentally ill persons found themselves confined to poor houses at best, and to jails or prisons at worst (Grob, 1966, 1973). The situation seemingly has come full circle today. In the intervening time the United States witnessed the development and widespread establishment of large public psychiatric institutions for mental health care. More than a century of medical and social change led to the disbandment and deinstitutionalization of these large institutions in favor of communitybased mental health services, and subsequent implementation problems led to the failure of these community-based services to meet the demands placed on them. After both past successes and failures, the seriously mentally ill are once again frequently confined to jails and prisons. In order to understand how we arrived at the present situation, it is necessary to review what led us here. The following is a short historical description of American mental health care and is not intended to be a comprehensive study of it. Elaborate discussions can be found in the works of Grob (1973, 1983, 1994) and Torrey (1997, 2008, 2014), among others. Subsequently this paper will look at mentally ill inmate populations in U.S. prisons and jails by introducing estimates on this particular inmate group and how correctional facilities deal with them. Then a comparative analysis of mentally inmates in European penal institution will follow before concluding with a discussion of findings and formulation of possible solutions.

A Brief Review of U.S. Public Mental Health Care

Mental illness in colonial American society was not a substantial problem. As the overall population of the colonies was relatively small, the numbers of the population with mental illness was similarly small (Grob, 1966). People with financial means often took advantage of care in private settings or their own homes when mental illness occurred, while the poor and indigent mentally ill needed to seek out public care (Grob, 1973). In the seventeenth and early eighteenth century those persons with mental illness who could not provide for their own care were most often placed in households subsidized by the government to provide care, as there were few institutions of any kind. Although many existed in Europe, it was not until 1773 that colonial America saw its first public psychiatric institution when the Virginia Colony opened one in Williamsburg that year because the presence of the mentally ill in communities was becoming a social problem (Dain, 1971). The hospital at Williamsburg represented only the most rudimentary beginning of institutionalized psychiatric care in America, and it was usually the local almshouses and jails that confined disturbing persons away from society (Grob, 1973). Not until the 1840s would the development of model public institutions for the care of the mentally ill take place. …

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