America's Biggest Mental Health Facilities Are Our Jails

The three institutions that house the most mentally ill people in the United States aren't hospitals or health care facilities.  They're the Los Angeles County Jail, the Cook County Jail in Chicago and Riker's Island in New York City.

As the United States dismantled its system of mental hospitals in the last century, some former patients integrated into communities and families, but many did not. Homelessness spiked among the mentally ill, as did admissions to prisons and jails.

Which brings us to today: too often, when we have nowhere else to send mentally ill people in need of treatment, they end up in jail.

But in budget-strapped jails, mentally ill prisoners aren't getting the care that they need. Some people never get proper care, and their illness is simply never diagnosed.

In 1955, nearly a million Americans lived in state mental health facilties, as Te-Ping's previously written here. Today, that number is 60,000. Many of those Americans with mental illnesses who've since left mental health facilities are in prison or on probation. About 15% of prisoners in American jails suffer from some form of mental illness, and the number is about the same in prisons — which means more than 300,000 mentally ill Americans live behind bars.  And when a short stay in jail doesn't include any services or evaluation, these individuals will be convicted and sentenced to prison — or released without a safety net, in which case they're more likely to return.

Colin blogged this week about the fact that suicide is the leading cause of death in American jails. There's no doubt in my mind that many of these deaths could be prevented if we offered treatment and services — rather than a revolving jail door — to the thousands of mentally ill individuals living on the fringes of American society.

The International Association for Forensic and Correctional Psychology recently formed a committee to revise standards of care for jails and prisons — a much-needed effort, considering how we rely on such facilities to provide mental health services as a last (or first) resort.

Meanwhile, psychological care and other services have been slashed in juvenile facilities as well. This week, the federal government announced it would step in to address the lack of services in four of the worst New York prisons. Right now, New York does not have a single full-time psychiatrist to treat the 800 juveniles it has locked up at any given time.

The last four decades in the U.S. saw the disastrous mix of an exploding prison population and consistent cutbacks in care and services for the most vulnerable. We're finally seeing a plateau in the number of prisoners we lock up. But if we want to see a sustainable future for the system, we must first stop criminalizing the mentally ill.

H/t: JusticeReform, @Piper

Photo Credit: 826 Paranormal