Regarding prisons and jails as housing for mentally ill
June 13, 2014
There are continuing reports, e.g., the Associated Press article by Don Thompson printed in The Union (April 15), that prisons and jails have become the main institutions housing mentally ill persons. I have no doubt that this is true but would like to comment on why.
It is fashionable to lay the blame on inadequate mental-health services caused by lack of funding. There is some truth in this. However, I believe a more important reason is that we have gone very far in the direction of allowing mentally ill persons to opt out of effective treatment until they are caught up in the justice system.
Until about 1962-63, most states had commitment laws that locked up mentally ill persons in state hospitals simply on the basis of being mentally ill. This approach had many problems and, appropriately, went away about that time. I have no desire to have it return.
This was replaced by a concept of community treatment based, in large part, on the emergence of an entirely new class of anti-psychotic medications. These have been expanded upon and improved ever since. While they do still have significant and sometimes even disabling side effects, they are very effective in controlling the major symptoms of most mental illnesses.
... freedom of choice renders the mental health treatment system powerless to override mentally ill persons’ ... decisions to decline treatment.
So, why aren’t these doing the job of keeping mentally ill persons out of jails and prisons?
I submit that the most common reason is that some mentally ill persons, who would benefit from these medications, choose to not avail themselves of treatment. Sometimes this is due to fear of the negative side effects of medications. More often, it is due to the inability of the victim to recognize mental illness in one’s self.
In either situation, our current emphasis on freedom of choice renders the mental-health treatment system powerless to override mentally ill persons’ active or de-facto decisions to decline treatment. In consequence, untreated mentally ill persons commit crimes, large and small, driven by their illnesses, and wind up being incarcerated in institutions that are unprepared to effectively serve them and often treat them cruelly.
If we are serious about limiting the clearly deleterious impact of imprisoning mentally ill persons, we need to rethink the extent to which we allow mentally ill persons who have not committed crimes to opt out of treatment.
In Nevada County, the implementation of Laura’s Law has begun to address this. Unfortunately, Nevada County is very much in the minority in doing so. Other means need to be considered by the Legislature.
Blaming either the mental-health treatment system or the correctional system is not the answer.
Robert Erickson, a member of The Union Editorial Board, is a retired clinical social worker and Behavioral Health director.