Where have all the mentally ill gone?

Behind bars.  As anybody who has had a class with me knows, I have long been fascinated by prisons and our prison-industrial complex.  In today's New York Times, Bernard Harcourt, a criminology professor at Chicago has a very intersting op-ed that shows quite clearly that our huge prison populations are tied to the de-institutionalization of the mentally ill.  We have roughly the same amount of perons intstitionalized now as we did 50 years ago.  The difference is that the vast majority are now in prisons whereas generations ago this vast majority was in mental asylums.  Some highlights from the column:

According to a study released by the Justice Department in
September, 56 percent of jail inmates in state prisons and 64 percent
of inmates across the country reported mental health problems within
the past year.

Though troubling, none of this should come as a
surprise. Over the past 40 years, the United States dismantled a
colossal mental health complex and rebuilt ? bed by bed ? an enormous
prison. During the 20th century we exhibited a schizophrenic
relationship to deviance.

After more than 50 years of
stability, federal and state prison populations skyrocketed from under
200,000 persons in 1970 to more than 1.3 million in 2002. That year,
our imprisonment rate rose above 600 inmates per 100,000 adults. With
the inclusion of an additional 700,000 inmates in jail, we now
incarcerate more than two million people ? resulting in the highest
incarceration number and rate in the world, five times that of Britain
and 12 times that of Japan.

What few people realize, though, is
that in the 1940s and ?50s we institutionalized people at even higher
rates ? only it was in mental hospitals and asylums. Simply put, when
the data on state and county mental hospitalization rates are combined
with the data on prison rates for 1928 through 2000, the imprisonment
revolution of the late 20th century barely reaches the level we
experienced at mid-century. Our current culture of control is by no
means new…

But the graph poses a number of troubling questions: Why did we
diagnose deviance in such radically different ways over the course of
the 20th century? Do we need to be imprisoning at such high rates, or
were we right, 50 years ago, to hospitalize instead? Why were so many
women hospitalized? Why have they been replaced by young black men?
Have both prisons and mental hospitals included large numbers of
unnecessarily incarcerated individuals?

Whatever the answers, the pendulum has swung too far ? possibly off its hinges.

would be naïve, today, to address any of these questions without also
considering the impact of imprisonment on crime. One of the most
reliable studies estimates that the increased prison population over
the 1990s accounted for about a third of the overall drop in crime that

However, prisons are not the only institutions that seem
to have this effect. In a recent study, I demonstrated that the rate of
institutionalization ? including mental hospitals ? was a far better
predictor of serious violent crime from 1926 to 2000 than just prison
populations. The data reveal a robust negative relationship between
overall institutionalization (prisons and asylums) and homicide.
Preliminary findings based on state-level panel data confirm these

The effect on crime may not depend on whether the
institution is a mental hospital or a prison. Even from a
crime-fighting perspective, then, it is time to rethink our prison and
mental health policies. A lot more work must be done before proposing
answers to those troubling questions. But the first step is to realize
that we have been wildly erratic in our approach to deviance, mental
health and the prison.

A recent article in the Raleigh News & Observer told how with the dismantling of NC's mental health system young people with schizophrenia were being housed in nursing homes sharing rooms with patients in typical elderly decline.  You don't need a degree in public health to know that's stupid.  Seems like we could use some more rational policies with regards to both how we deal with criminals and the mentally ill.  Alas, these are areas where emotion rather than reason to often rules the policy debates. 

About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

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