Vol. 2 No. 2 Specials

Over the past thirty years, prisons have become de facto treatment facilities for thousands of mentally ill individuals. Under-funded, overcrowded, and lacking adequate numbers of mental health personnel, the criminal justice system has failed to meet the treatment needs of its new wards. Studies by independent non-profit organizations and by President George W. Bush’s New Freedom Commission on Health have identified a cyclical “revolving door” problem: incarceration, lack of treatment, release, and repeat incarceration of mentally ill offenders. These groups have sought to effect change through legislation, rather than through litigation, the traditional process of reform. In October 2004, thanks to the findings of these groups and pressure by lobbyists representing mental health interests, Congress passed the Mentally Ill Offender Treatment and Crime Reduction Act, intended to divert nonviolent, mentally ill criminals from prison to treatment centers, to treat violent offenders more effectively, and to create interagency cooperation to reduce the recidivism rate of the mentally ill. However, the potential boons of the act have not yet been seen. As is often the case for programs geared toward the mentally ill in the United States, the Mentally Ill Offender Act went unfunded in 2005 and may perhaps lack funds in 2006 as well.

The problem of the mentally ill in the prison system is staggering. A recent Human Rights Watch (HRW) report estimates that there are from 200,000 to 300,000 mentally ill offenders in the nation’s prisons; the exact number is unknown since many prisoners suffering from mental illness have not been diagnosed. A report by the Bureau of Justice Statistics states that 16 percent of prisoners currently suffer from or have been treated for mental illness. One quarter of all female inmates has suffered from mental illness at some point. However, according to the June 2004 Congressional testimony of psychologist and professor Dr. John Monahan of the University of Virginia, “only one third of the men and one quarter of the women detained with mental illness in jail report receiving any treatment while they were detained” and “three quarters of [mentally ill offenders] have a co-occurring substance abuse problem.”

Many advocacy groups argue that the problem of the mentally ill in prison stems from the breakdown and fragmentation of American mental health programs over the past forty years. Prisons have replaced state mental hospitals. According to the Sentencing Project, which studies the criminal justice system, three factors led to the migration of the mentally ill from hospitals to prisons. First, with the improvement of medications and the increased pressure of advocacy groups, which sought to free the mentally ill from involuntary incarceration in hospitals, the 1960s saw the birth of the deinstitutionalization movement. State hospitals closed as the mentally ill were transferred to newly-created, elective community treatment centers. However, ill-planning and lack of funds prevented the centers from adequately meeting the needs of the mentally ill released from state hospitals. Second, reduction in state funding of mental health programs and insurance companies’ increased unwillingness to cover long-term mental healthcare has made treatment less accessible. Finally, a change in mental health laws, preventing compulsory treatment, has resulted in a large population of offenders whose mental illnesses have not been addressed. However, not all mental health experts agree on this causal link between the closing of state hospitals and the sizable number of mentally ill prisoners. Some cite the war on drugs with its increased incarceration rate as a reason for fuller prisons.