In the US, if you are severely mentally ill – meaning you have schizophrenia, bipolar disorder, major depression, autism, schizoaffective disorder, or are mentally retarded – the likelihood you will go to prison is 8 times greater than your chances of receiving help at a hospital through voluntary or involuntary commitment.
To give you a better idea of exactly how many people deinstitutionalization affects, here are some numbers . . .
· It is estimated 1 in 17 Americans suffer from severe mental illness (about 20 million)
· As of 2012 the American Psychiatric Association found that nearly 360,000 incarcerated individuals suffer from a serious mental illness
· In 1955 there were 340 public psychiatric beds per 100,000 people. In 2015 there were 17 public psychiatric beds per 100,000 people—a 95% reduction.
In case the impact of these statistics is too difficult for you to understand, allow me to clarify. It’s not that 360,000 people made a conscious decision to engage in criminal activities such as robbery, rape, murder, and arson. This number reflects how the mentally ill being denied beds in psychiatric units are struggling to survive in society. It’s apparent at least 360,000 people are not receiving adequate care from mental health professionals and outpatient treatment centers. This is a system-wide failure not specific to any single state, but deeply impacting each and every one.
Deinstitutionalization is a process that refers to the transfer of mentally ill patients from institutional settings to outpatient, community-based facilities that emphasize a “hands off” approach to treatment while administering high doses of psychotropic medications. In theory, the practice was meant to reduce a reliance upon public hospitals to hold the mentally ill and prompt communities to take an active role in their re-entry instead. In some cases it works, but not for the severely mentally ill.
Considering that reintegration into a community is extremely difficult for sane ex-cons, it’s nearly impossible for insane ones who struggle with simple tasks. Over time, the theory of outpatient care has degraded the number of mentally ill – 20 million nationwide – has increased. Severely mentally ill may be given a prescription of medication to calm the symptoms of their disorder, an appointment with a psychologist and/or psychiatrist, and the responsibility to engage in outpatient care, but that’s exactly the problem. A person who is severely mentally ill is irresponsible. Simple tasks such as finding a job, paying bills, maintaining a place to live, and all of the things associated with a normal lifestyle are very hard to do.
As a result of understaffed outpatient care centers and the numerous problems facing the severely mentally ill, stress builds and activates some of the more debilitating and dangerous symptoms of a disorder. In many cases the individual winds up homeless, but an alarming number commit crimes. Sometimes the crime is minor, creating an in and out pattern of incarceration, and other times the crime is significant enough to warrant a lengthy prison term that leaves the victims asking how this could be allowed to happen.
Public hospitals and asylums are so select in who gets one of their limited beds it can be easier to gain acceptance at an Ivy League school with droves of qualified people waiting to get in. Instead, the mentally ill aggregate in prison where their disorder has been criminalized because there aren’t enough hospitals to hold them. In prison they receive little or no care, often winding up in solitary confinement where their illness is exacerbated by the torture inherent in long periods of isolation and sensory deprivation. For years at a time. If the severely mentally ill person is not beaten or starved to death (see “State locks down info on inmate death” at email@example.com; or look for aarticles about Timothy E. Helms and Alexander Correctional Facility for examples in N.C.) they are released back into the community even worse than before.
The next time you turn and see some homeless guy raving on the sidewalk, read about the horrors of a mass shooting (the Aurora, Virginia Tech, and Newtown shooters all had extensive mental health histories), or ignore the mistreatment and abuse of recalcitrant inmates on lock-up maybe you’ll think of the word deinstitutionalization. Maybe then, when you’re relaxing in a park where the Dorothea Dix hospital used to be, you will understand these are symptoms of a greater disease.
For more information the News & Observer has a number of articles related to this topic, or you can go to: