New Bedlam: Jails—Not Psychiatric Hospitals—Now Care for the Indigent Mentally Ill

Humanist, May, 1999 by Spencer P.M. Harrington

When Timothy Williams arrived in late 1997 at the Alexandria Adult Detention Center (AADC) in Alexandria, Virginia, he'd just come off a spree of nine burglaries, mostly stealing VCRs and other home electronics to support his crack habit. The thirty-eight-year-old Alexandria native is dually cursed with a drug addiction and paranoid schizophrenia, and during his last term in a Virginia penitentiary had tried to commit suicide by cutting his arms 200 times with a razor. He was off his anti-psychotic medication.

"When I'm on medication," he says, "I'm a nice guy to be with. When I'm off it, I'm a damn devil."

Fortunately, this time Williams was jailed at the AADC, a federal demonstration project for treating the mentally ill in jail. He says counselors there patiently persuaded him to get back on his anti-psychotic medication. "If they hadn't come to me, I'd have been dead now by suicide," says Williams.

Sadly, many U.S. jails are nowhere near as equipped to handle the mentally ill as the AADC, and newspapers are full of suicides of inmates with a history of mental illness. A 1997 Justice Department investigation of the Men's Central Jail in Los Angeles included a report of an inmate who, despite a known history of mental illness and suicide attempts, was not being housed in a suicide observation cell. Repeated requests for anti-psychotic medication by the inmate and a social worker were ignored, and he was soon found hanging in his cell, "cold to the touch."

The report describing this incident reads like a series of all-too-truthful apologues illustrating how detainees with mental illnesses slip through the cracks, wither, and die behind bars. With incarceration rates rising yearly, more and more people with schizophrenia, severe depression, and manic-depressive disorder (the so-called severe mental illnesses) are serving time in jails, which have become the largest de facto providers of mental health services in many cities around the country.

According to a 1997 American Jails website article, "Jails and Prisons: The Numbers Say They Are More Different Than Generally Assumed," by corrections expert Michael O'Toole, between 600,000 and one million jail admissions each year are people who suffer from severe mental illness, and studies of men in large urban jails have shown rates of schizophrenia, major depression, and manic-depressive disorder to be two to three times higher than in the general population.

The jailed mentally ill are usually low-income people with no money, friends, or family to bail them out. About half don't realize they are ill and don't understand why they need medication. People with mental illnesses end up in custody because public mental health centers have, for a variety of reasons, been unwilling or unable to help them.

Without the medication they need to keep their illness in check, they sometimes lapse into psychosis and behave in bizarre ways that attract the attention of police. Because police often find the local mental health care system unresponsive, they resort to arresting people with mental disorders. Jailed on misdemeanor charges and released within a year, the indigent mentally ill then forage for services as best they can until, unmedicated, they relapse into psychosis.

Some commit a small offense that again lands them in jail, while others are capable of horrific crimes. Earlier this year, thirty-two-year-old Kendra Webdale was pushed to her death under a Manhattan subway train by a paranoid schizophrenic. Another paranoid schizophrenic, Russell E. Weston Jr., was charged last year with the shooting deaths of two police officers at the U.S. Capitol.

In too many states, a ping-pong game has developed between jails and community mental health centers in which the indigent mentally ill are swatted back and forth between institutions. This situation benefits no one, least of all the mentally ill.

Most jails were not designed to be mental hospitals, and most jailers were not trained to care for psychotics. Budgetary constraints, antiquated facilities, and the short sentences imposed on misdemeanants compound the difficulties of mental health treatment in jails.

Finally, the ping-pong game is expensive and not in the best interests of public safety. Better community treatment for the indigent mentally ill would result in fewer costly psychiatric hospitalizations, reduced jail expenses and more space for serious criminals, and more street time for police freed from responding to mental health emergencies. According to a 1996 Pacific Research Institute for Public Policy report, California, for example, now spends between $1.2 billion and $1.8 billion annually on the mentally ill in its criminal justice system. Comprehensive community treatment programs might reduce these expenses and help turn some former inmates into productive members of society.

An unhappy truth revealed by a study of nineteenth-century mental health reform in the United States is that the central issue confronting activists of the 1840s is the same one confronting activists today: removing the mentally ill from jails. It was widespread practice in eighteenth-century America to house insane paupers, as they were then called, in jails and poorhouses.