The MAD the BAD and the Abandoned: THE MENTALLY ILL IN PRISONS AND JAILS
Sigurdson, Chris, Corrections Today
Editor's Note: The following is an edited version of an article that originally appeared in Public Service Psychology Division 18 Newsletter, Vol. 24, No. 3, Fall 1999. Opinions expressed in this article are those of the author and do not necessarily reflect the opinions of the Federal Bureau of Prisons (BOP) or the US Department of Justice (DOJ).
Imagine that our government deliberately began to cut funding for the chronically mentally ill. Instead, prisons and jails were built to provide public psychiatric care. Therapists and hospitals were replaced with police and the criminal justice system. Thirty years ago, I would have dismissed this as an Orwellian fantasy -- but I would have been wrong. We currently have alarmingly high numbers of mentally ill men and women in our prisons and jails and exponential growth in the number of people we incarcerate. We also have eliminated more than 90 percent of our former state psychiatric hospital beds.  Jails in most major cities contain a larger number of severely mentally ill people than the local mental health hospitals. For example, the Los Angeles County Jail houses the largest single population of mentally ill men and women in the United States.  This criminalization of mental illness has become an unrecognized crisis in mental health care.
Two hundred years ago, families cared for their mentally ill relatives. Those whose families were unable or unwilling were housed in prisons and poor houses.  Effective treatments were not available. Two centuries of mental health reform eventually led to the development of large public hospitals designed to care for the mentally ill in more humane and effective ways. During the past 50 years, we have radically increased our medical understanding of the causes and treatment of mental illness. We know that severe mental disorders are not the product of moral weakness, poor parenting or demonic possession. They are chronic medical illnesses, such as diabetes, hypertension or asthma.
Following the development of anti-psychotic and antidepressant medications in the 1950s, and the use of lithium in the 1960s, life outside the confines of a mental hospital became possible for the vast majority of men and women with severe mental illnesses. In the current decade, new anti-psychotic and antidepressant medications and the use of anti-convulsant medications for manic depressive illness have further advanced the medical treatments of these illnesses. These newer medications are better-tolerated, have fewer side effects and, in some cases, are more effective than the medicines they replace.
Our most recent mental health "reform" movement, deinstitutionalization, was theoretically designed to improve the lives of severely mentally ill men and women by bringing them, and their care, out of state hospitals and into their communities. This practice has led to important improvements in mental health care. However, there also have been devastating and unexpected consequences. One such result is the incarceration of large numbers of mentally ill individuals. The United States currently has more mentally ill men and women in jails and prisons than in all state hospitals combined. [3,50] Further, mental health professionals familiar with both settings recognize that mentally ill inmates have the same illnesses and symptoms as past and present state hospital patients.  We also have seen a large homeless population emerge during the past 40 years, and approximately 30 percent of homeless men and women have severe mental illnesses. [41,46] For many of these people, there is a revolving door between the streets and jail.  We have essentially turned the clock back 200 years. We again are housing the severely mentally ill in prisons and poorhouses.
I am a psychiatrist at a federal medical center -- one of four psychiatric referral hospitals within the BOP. Ironically, this medical prison occupies the site of a now-defunct state psychiatric hospital. …