Time Magazine on decriminalising mental illness

Time magazine has an article on attempts to train law enforcement to prevent people with mental illness from needlessly ending up in behind bars. It includes some startling information, like the fact that more Americans receive mental health care in prisons than in hospitals.

“If you think health care in America is bad, you should look at mental health care,” says Steve Leifman, who works as a special advisor on criminal justice and mental health for the Florida Supreme Court. More Americans receive mental health treatment in prisons and jails than hospitals or treatment centers.

In fact, the country’s largest psychiatric facility isn’t even a hospital, it’s a prison ‚Äî New York City’s Rikers Island, which holds an estimated 3,000 mentally ill inmates at any given time. Fifty years ago, the U.S. had nearly 600,000 state hospital beds for people suffering from mental illness. Today, because of federal and state funding cuts, that number has dwindled to 40,000. When the government began closing state-run hospitals in the 1980s, people suffering from mental illness had nowhere to go. Without proper treatment and care, many ended up in the last place anyone wants to be.

The article starts with a telling correction of a journalistic slip, apologising for stating that one reform was inspired when a man with schizophrenia shot a policeman, when in fact, it was the policeman who shot the patient.

A 1999 US survey found that over 60% of people thought that someone with schizophrenia is ‘somewhat’ or ‘very likely’ to commit an act of interpersonal violence, when we know that people diagnosed with the condition are much more likely to be the victim of violence than the perpetrator.

It seems there are some positive developments, however, and the article describes the Miami Police’s innovative and successful methods of including people with experience of mental disorder in their training, and when dealing with distressed people they encounter.

Link to Time article ‘De-Criminalizing Mental Illness’ (via Spikol).

4 Comments

  1. Steve
    Posted August 17, 2007 at 3:51 am | Permalink

    But why shouldn’t the mentally ill be held accountable for their crimes? The notion, of course, is that their mental illnesses cause the criminal behavior. But time and time again, research shows that it is substance abuse and not mental illness that is the largest predictor of criminal behavior among the mentally ill.

  2. Mark(p.s.)
    Posted August 17, 2007 at 4:39 am | Permalink

    I (of course) believe the criminal should be held accountable for their crime(s).
    from the article “people suffering from mental illness had nowhere to go”
    doctors label someone mentally ill, institutionalize someone, their patient/prisoner has no life or job skills, then their mental illness is responsible for their failing to succeed RIGHT.
    RE:Jail and mental illness
    guilty go free and innocent get jail.

  3. Doctor X
    Posted August 17, 2007 at 9:46 pm | Permalink

    Looking at numbers treated in hospitals and numbers treated while in prison is not, in itself, a useful comparison.
    Americans are avid consumers of mental health services. Outpatient treatment is commonplace and, in many cases, preferable to hospitalization. Many of those receiving outpatient treatment are supported by the state on permanent disability and their treatment is paid by the state.
    The number of patients in hospitals compared to prisons is relatively low because of the de-institutionalization movement which arose to protect mentally ill persons from involuntary and prolonged commitment and, secondarily, because health insurers rarely pay for hospitalization longer than one month. You can certainly criticize the quality of care received by individuals living in “half-way” outpatient homes and in subsidized living while on long-term SSI (disability) for psychiatric disorders, but I’m sure when you tally the numbers who are receiving treatment and support outside of prison, you will get a more accurate picture.
    Back in the 1960s and earlier, when substantially higher numbers of Americans were hospitalized in huge institutions for long periods of time, the care was often atrocious, but the ratio of hospitalized to imprisoned patients looked wonderful. The system is not good, in my opinion, and the available treatment leaves much to be desired, but the numbers in this case don’t really tell the story.

  4. Doctor X
    Posted August 17, 2007 at 9:46 pm | Permalink

    Looking at numbers treated in hospitals and numbers treated while in prison is not, in itself, a useful comparison.
    Americans are avid consumers of mental health services. Outpatient treatment is commonplace and, in many cases, preferable to hospitalization. Many of those receiving outpatient treatment are supported by the state on permanent disability and their treatment is paid by the state.
    The number of patients in hospitals compared to prisons is relatively low because of the de-institutionalization movement which arose to protect mentally ill persons from involuntary and prolonged commitment and, secondarily, because health insurers rarely pay for hospitalization longer than one month. You can certainly criticize the quality of care received by individuals living in “half-way” outpatient homes and in subsidized living while on long-term SSI (disability) for psychiatric disorders, but I’m sure when you tally the numbers who are receiving treatment and support outside of prison, you will get a more accurate picture.
    Back in the 1960s and earlier, when substantially higher numbers of Americans were hospitalized in huge institutions for long periods of time, the care was often atrocious, but the ratio of hospitalized to imprisoned patients looked wonderful. The system is not good, in my opinion, and the available treatment leaves much to be desired, but the numbers in this case don’t really tell the story.


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