Insane

1. The criminal justice system has become America's de facto mental health care provider

Today, the country's largest providers of psychiatric care are not hospitals at all, but rather the jails in Chicago, Los Angeles, and New York City.

A mental health crisis. Across the United States, jails and prisons have become the primary institutions housing and "treating" people with mental illness. By some estimates, up to half of all incarcerated individuals have a mental health condition. This represents a dramatic shift from decades past, when dedicated psychiatric hospitals were the main facilities caring for those with severe mental illnesses.

Unprepared and under-resourced. Correctional facilities are woefully ill-equipped to provide adequate mental health care. They lack proper staffing, training, and resources to address complex psychiatric needs. Many incarcerated individuals receive little to no treatment, exacerbating their conditions. The emphasis on punishment and control in prisons often directly conflicts with therapeutic goals.

A self-perpetuating cycle. Once in the criminal justice system, people with mental illness face numerous barriers to re-entering society successfully. Lack of treatment, loss of benefits, housing instability, and the stigma of both mental illness and a criminal record create a revolving door between incarceration and unstable life in the community. This cycle is devastating for individuals, families, and society at large.

2. Solitary confinement exacerbates mental illness and causes long-term psychological damage

More than half of all prison suicides occur in solitary confinement.

Torture by another name. Solitary confinement involves isolating prisoners in small cells for 22-24 hours a day, often for extended periods. This practice causes severe psychological harm, including:

• Anxiety and depression
• Paranoia and hallucinations
• Self-harm and suicide attempts
• Difficulty with social interaction and impulse control

Disproportionate impact. People with pre-existing mental illnesses are more likely to end up in solitary confinement due to rule violations stemming from their conditions. The isolation then dramatically worsens their mental state, creating a vicious cycle.

Long-term consequences. Even after release from solitary or prison, many individuals struggle with lasting psychological effects. They may have difficulty readjusting to normal social interactions and environments. Some experience PTSD-like symptoms for years afterward. Despite widespread recognition of its harmful effects, solitary confinement remains a common practice in many U.S. prisons.

3. Lack of adequate community mental health resources fuels the cycle of incarceration

At the time the arrests, more than a third of prisoners with mental illness show signs or have symptoms of their disease when they're arrested but haven't been diagnosed or treated within the past year.

Failing safety net. The closure of many state psychiatric hospitals in the late 20th century was not matched with sufficient community-based mental health services. As a result, many people with severe mental illness lack access to consistent treatment, housing support, and crisis intervention services. This gap in care leaves them vulnerable to homelessness, substance abuse, and interactions with law enforcement.

Criminalization of mental illness. Without proper support systems, individuals experiencing mental health crises often come into contact with police rather than medical professionals. Minor infractions or public disturbances stemming from untreated mental illness can lead to arrest and incarceration rather than appropriate psychiatric care.

Limited alternatives. Even when law enforcement recognizes a person's need for mental health treatment, they often lack options beyond jail. Emergency rooms and the few remaining inpatient psychiatric beds are frequently overwhelmed. This leaves officers with little choice but to process people through the criminal justice system, perpetuating the cycle of inadequate care and repeated arrests.

4. Police often lack proper training to handle mental health crises, leading to tragic outcomes

In 2015 and 2016 combined, nearly five hundred people with mental illness were fatally shot by the police, according to calculations by the Washington Post. This means that for each of those years, one in four police shootings was of a person with mental illness.

Escalation vs. de-escalation. Traditional police training emphasizes rapid control of situations through authoritative commands and force if necessary. This approach often backfires when dealing with someone in a mental health crisis, who may be unable to comply with shouted orders or react fearfully to aggressive tactics. The result can be unnecessary use of force, including fatal shootings.

Crisis Intervention Team (CIT) training. Some police departments have implemented specialized training programs to better equip officers for mental health-related calls. CIT training teaches:

• Recognizing signs of mental illness
• De-escalation techniques
• Connecting individuals with appropriate services

Systemic challenges. While CIT and similar programs show promise, implementation is inconsistent across the country. Many departments lack resources for comprehensive training. Additionally, the fundamental mismatch between law enforcement's public safety mission and the healthcare needs of those in crisis remains a significant obstacle.

5. Diversion programs and mental health courts show promise in breaking the cycle

Since its founding in 2008, more than 60,000 people have been diverted from the criminal justice system. The program estimates that it's saved Bexar County taxpayers more than $50 million per year.

Alternative pathways. Diversion programs aim to redirect individuals with mental illness away from jails and prisons and into community-based treatment. These can occur at various points in the criminal justice process:

• Pre-arrest diversion by law enforcement
• Pre-trial diversion programs
• Mental health courts as an alternative to traditional criminal courts

Comprehensive approach. Successful diversion programs often involve collaboration between multiple agencies:

• Law enforcement
• Courts and prosecutors
• Mental health providers
• Social services

Promising results. When properly implemented, diversion programs have shown the potential to:

• Reduce recidivism rates
• Improve mental health outcomes
• Save money compared to incarceration costs
  However, these programs are still limited in scope and availability across much of the United States.

6. Racial and economic disparities compound the crisis of mental illness in prisons and jails

As with much in the criminal justice system, race also plays a part: African Americans and Hispanics are more likely to be arrested than whites.

Intersecting inequalities. The overrepresentation of people with mental illness in the criminal justice system intersects with broader racial and economic disparities:

• People of color are disproportionately arrested and incarcerated
• Low-income communities often lack access to quality mental health care
• Racial bias can affect diagnosis and treatment of mental illness

Compounding disadvantages. Once in the system, these disparities create further barriers:

• Less likely to afford bail or private attorneys
• May face harsher sentencing
• More difficulty accessing treatment programs or alternative sentencing options

Systemic reform needed. Addressing the crisis of mental illness in the criminal justice system requires confronting these broader inequalities. This includes improving access to mental health care in underserved communities and addressing bias throughout the legal system.

7. Reforming the system requires a complete overhaul of both criminal justice and mental health care

Both the official mental health care system and the de facto one, the criminal justice system, need to be completely overhauled.

Fundamental rethinking. Truly addressing the crisis of mental illness in the criminal justice system requires more than piecemeal reforms. It demands a comprehensive reimagining of how society approaches both mental health care and criminal justice.

Key areas for reform:

• Greatly expanded community-based mental health services
• Alternatives to incarceration for non-violent offenses
• Improved mental health training for all criminal justice personnel
• Elimination of harmful practices like solitary confinement
• Better coordination between health care, social services, and criminal justice systems

Political and cultural shifts. Achieving these reforms requires overcoming deeply entrenched attitudes about mental illness, crime, and punishment. It also involves reallocating significant resources from incarceration to treatment and prevention.

8. Death penalty cases highlight society's punitive approach to mental illness

About half of the people executed nationwide between 2000 and 2015 had been diagnosed with a mental illness and/or substance use disorder in their adult lives.

Extreme punishment. The continued execution of individuals with severe mental illness represents a stark failure of both the mental health and criminal justice systems. It highlights how even the most vulnerable can face society's harshest punishment.

Legal ambiguity. While the Supreme Court has ruled that executing people with intellectual disabilities is unconstitutional, there is no clear prohibition on executing those with mental illness. This leaves significant discretion to individual states and courts.

Broader implications. The treatment of mental illness in death penalty cases reflects wider societal attitudes. It demonstrates a tendency to prioritize punishment over treatment and a failure to fully reckon with the impact of severe mental illness on an individual's actions and culpability.

9. Improving mental health care in prisons is not enough - we must keep people out of the system

We have known for more than two hundred years that keeping people with mental illness locked up in jails and prisons does little but make them worse. We know how to lock up masses of people. Now we need to figure out how to treat them.

Prevention is key. While improving mental health care within correctional facilities is crucial, the ultimate goal must be preventing people with mental illness from entering the criminal justice system in the first place. This requires:

• Early intervention and consistent community-based care
• Crisis response systems that don't rely primarily on law enforcement
• Addressing root causes like poverty, trauma, and lack of access to health care

Shifting resources. The vast sums currently spent on incarcerating people with mental illness could be more effectively used to fund comprehensive community mental health services, supportive housing, and other preventative measures.

Cultural change. Truly addressing this crisis requires shifting societal attitudes away from punishment and towards a public health approach to mental illness and related issues like substance abuse. This involves education, advocacy, and confronting stigma at all levels of society.

Last updated: November 13, 2024