Mental Illness: Ten Times More In Prison Than State Hospitals – A National Scandal


The Treatment Advocacy Center in conjunction with the National Sheriff’s Association released another damning report today about the growing number of persons with serious mental illnesses being locked-up each year. Entitled:  “The Treatment of Persons With Mental Illness in Jails and Prisons: A State Survey,”  the report says there are ten times more people with serious mental illnesses in state prisons (207,000) and county jails (149,000) than there are in state mental hospitals (35,000.)

In 44 of our 50 states, the largest single “public mental institution” is a prison or jail. The report noted that Cook County Jail in Chicago, Shelby County Jail in Memphis, and Polk County Jail in Des Moines, individually hold more inmates with serious mental illnesses than all of the state mental hospitals in Illinois, Tennessee, and Iowa.

The ten times figure is significantly higher than what was found in a similar study done four years ago and released by TAC, a non-profit mental health advocacy group. In that study, the number of mentally ill individuals in prisons and jails outnumbered those in state mental hospitals by a three to one margin.

Numerous reports have been released in recent years about the jailing and imprisoning of people who need treatment for mental disorders rather than punishment. Many times these prisoners have been arrested for trespassing or loitering.  In a press release, TAC claimed the situation has become so dire that the United States has turned back the clock to the 1800’s before Dorothea Dix lead a national reform movement that lead to states building mental hospitals rather than allowing persons with mental disorders to languish in jails.

The new report is one of a series that TAC has released that spotlight how the criminal justice system has become a depository for the severely mentally ill, many of whom refused treatment before their arrest.

In February, the group released a study entitled: Mental Health Commitment Laws: A Survey of States that gave states a letter grade based on how they treated individuals who were in crisis. Among other factors, states were graded on whether or not they had implemented Crisis Intervention Team training for law enforcement or if they had established Mental Health Courts to help prisoners get treatment. That study also focused on court ordered treatment, specifically Assisted Outpatient Treatment, which is one of the TAC’s major lobbying efforts.

States that received A grades in their handling of mentally ill prisoners included Utah, Florida, California, Ohio and the District of Columbia. Ranked at the bottom with Fs were: South Carolina, Vermont, Alabama, South Dakota, Iowa, Massachusetts, Mississippi, Arkansas, West Virginia and Rhode Island.

Stephanie Mencimer, a reporter with Mother Jones, offered readers a quick  review of the 190 page TAC report for those not inclined to read the entire document available by clicking here.   Readers in the D.C. metropolitan area can read Anny Shin’s story in The Washington Post that highlights what the report says about the Capital area.

One important tidbit that I am thrilled the national media is focusing on is about how expensive jailing persons with mental illnesses is for taxpayers. Here’s how Mencimer put it:

Putting the mentally ill in jails instead of hospitals isn’t saving the government any money. In Washington state, for instance, in 2009, the most seriously mentally ill inmates cost more than $100,000 a year to confine, compared with $30,000 for others. One reason for the disparity: According to the report, mentally ill people tend to stay in jail longer than other prisoners because they aren’t likely to get bail and also because they are often chronic rule-breakers. For example, according to the report, in Florida’s Orange County jail most inmates stay an average of 26 days, but mentally ill inmates are there for 51 days on average.

Regular readers of this blog are keenly aware of this finding, which was covered dramatically recently when Cook County Sheriff Tom Dart and Miami Dade Judge Steven Leifman testified before the House Energy and Committee subcommittee chaired by Rep. Tim Murphy (R-PA) the only psychologist currently serving in the U.S. Congress and author of a bill that would radically change laws and programs governing mental health.  (Here are links to Dart’s testimony, Judge Leifman’s written statement,  and a review of Murphy’s bill.)

For families unfortunate enough to have a loved one with mental illness entangled in the criminal justice system, the statistics cited in today’s report, while horrifying, are not surprising. The real meat in the new report is information being pushed by TAC that explains how prisoners in many states can be forcibly medicated against their will without their keepers being required to prove dangerousness in court, including a model law that could be adopted. Knowing that civil rights activists will be quick to condemn the idea of forcing prisoners to take medication, TAC and the National Sheriff’s Association provide a detailed account of safeguards that they claim would prevent this practice from being abused yet help prisoners who can be treated with medication but often do not believe they are sick.

I remember being in Los Angeles County’s twin towers jail ten years ago and encountering an inmate charged with homicide. The prisoner had been confronted by an angry shopkeeper who had grown tired of the homeless and mentally ill man living behind his store panhandling customers. An argument broke out and the accused fatally stabbed the shopkeeper. In this instance, the public defender urged his client to not take medication, fearing that jurors would not believe the accused had a mental illness when he appeared in court. When the prisoner became so distraught that he rammed his head into the wall in his cell hurting himself, the jailers got permission to forcibly medicate him. I was shocked when I saw how lucid he had become on medication. In his case, it helped him significantly. As soon as he became well enough to think clearly, however, he immediately stopped taking the pills.

I realize this vignette doesn’t dovetail neatly with what the TAC report describes in its report but I have been haunted by the nightmare that  inmate was caught in ever since meeting him. I saw similar examples in the Miami Dade pre-trial correction center when writing my book. Those experiences certainly caused me to look at forced medication differently from when I was a liberal Washington Post reporter.

Not surprisingly, the new report also pushes AOT which its authors claim has been proven successful in reducing the incarceration of so-called “frequent fliers” who beat a worn path between being homeless on the streets and jails.  According to TAC, a pilot project in Nevada County, California, cut jail time for mentally ill people in the program from 521 days to 17; a North Carolina study of people in AOT found a reduction in arrests from 45 percent to 12 percent.

Regardless of whether you support TAC and its main stalwart Dr. E. Fuller Torrey or denounce both him and his group, TAC and Dr. Torrey have been documenting the growing incarceration of persons with mental illness for years now while other mental health groups have been gun shy. (An exception has been Ron Honberg, legal director of the National Alliance on Mental Illness.) Why mental health advocates are not more angry about this issue is both frustrating and irksome to me. Perhaps they are worried about possibly increasing stigma by spotlighting the number of men and women in jail who are sick and need help. Some consumers don’t like being identified with clearly troubled lawbreakers. Others are squeamish about forced medications and/or treatment — two lightening rod issues.

Typical was the White House summit that President Obama hosted after the Newtown shootings. No one from law enforcement was invited and the not-so-new problem of jails becoming our new asylums was scarcely mentioned. (Click here to read an Op Ed that I wrote for USA Today about that misstep.)

Whether or not TAC’s new report will prompt reform remains to be seen, but I’m glad that its studies are continuing to call attention to what is a national embarrassment and scandal.

(The photo above was taken by Jenn Ackerman, a brilliant and talented mental health advocate who spent time in Kentucky’s prisons documenting how prisoners with mental illnesses were treated. You can read more about her work by clicking here.)

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.