a bird and a bottle

Mental Illness & Incarceration
January 15, 2007, 9:37 pm
Filed under: criminal justice, law

The Supreme Court last week agreed to hear the case of a mentally ill man who is able to understand why he faces death but has delusions about why he is to be executed, bringing back into the spotlight the question of how the criminal justice system should address mental illness.

The NY Times ran with the story today with a opinion column about the intelligence and efficiency of jailing the mentally ill (hat tip: SF).

Let me first say, before stating my issues with this Op-Ed, that I think it’s about damn time that these issues are getting addressed. In a conversation with a former presidential candidate at a political gathering last year, he acknowledged that the treatment of prisoners, the death penalty,  and criminal justice reform were not even on the table as issues to discuss during political campaigns. It feels like that might be changing.

On the whole, the Times Op-Ed focuses on the right things to really motivate change. The column started with this disturbing anecdote:

Last August, a prison inmate in Jackson, Mich. — someone the authorities described as “floridly psychotic” — died in his segregation cell, naked, shackled to a concrete slab, lying in his own urine, scheduled for a mental health transfer that never happened.

If only this were an unfair representation of the treatment of incarcerated men and women in U.S. prisons. But it’s not. Time and again, women who give birth in jail are shackled during labor, and men and women are raped by fellow inmates and the men and women who “guard” them. The mentally ill make up a substantial portion of the American prison population — 64% of state prison inmates according to the Times Op-Ed — and they are often treated the worst. And many of them shouldn’t be in prison in the first place.

Certainly societies have an interest in keeping crime as low as possible, and can – and have – used incarceration as a means to this end. Though incarceration rates (particularly among women from communities of color) have skyrocketed since the implementation of the War on Drugs, prison populations also surged in the 1940s and 1950s. The Op-Ed author claims that incarceration and institutionalization was responsible for about 1/3 of the drop in crime in the U.S. during the 1990s. The truth is somewhat more complex (pdf) and reflects a weaker correlation between incarceration and crime reduction.

Which is why the Op-Ed’s conclusion concerns me:

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.

I agree that it’s troubling to see how erratically the American criminal justice system has addressed mental illness. But the author’s assumption that institutionalization poses a choice between the Bellevues of the world and the Rikers Islands gives me pause. There’s something glib in the assumption that we can only be reactive in our treatment of mental health and its connection to crime. Yes, the author is right that prisons are not the only institutions that can effectively address the high percentage of people who commit crimes who are also mentally ill. But it seems to me that we first need to address the failures of the public health system (think about Andrew Goldstein, the mentally ill man who pushed Kendra Webdale in front of a NYC subway in 1999, or the man whose case will now be heard by the Supreme Court). Decreasing the number of mentally ill who end up arrested is a more proactive and progressive first step.


2 Comments so far
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Once again, you are spot on. And I think you are correct in pointing out the false choice implied in the piece. The author does state that the “first step is to realize that we have been wildly erratic in our approach to deviance, mental health and the prison.” That erraticism is hardly arbitrary. Mental institutions and prisons were once built out of a desire to control but under the banner of rehabilitation; today, the control has remained but the banner is now emblazoned with retribution. No populations embodies this shift better than the mentally ill.

Comment by professorplum

ProfessorPlum wrote:
“Mental institutions and prisons were once built out of a desire to control but under the banner of rehabilitation; today, the control has remained but the banner is now emblazoned with retribution.”

PP, I think you’re right to point out this shift. A large part of the reason the false choice in the article makes me so uncomfortable is because it seems to consign convicted men and women and the mentally ill to a second-class life. Implicit in my suggestion that there are, or at least should be, other options besides incarceration/institutionalization, is a recognition that this dichotomy has not worked, not in a quote-unquote rehabilitative setting, and certainly not in a retributive one.

Comment by bean

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