In the 1960s mental health world, deinstitutionalization was slated to be the wave of the future. After World War II, the stage was set to discontinue the use of insane asylums to house the mentally ill. The public, whose feelings of altruism and empathy were fueled by properous times, was taken aback by the appalling conditions and 'treatments' such as lobotomies and electroshock therapy that were happening in asylums such as the stately Victorian Kirkbride-design Danvers State Hospital, pictured above. The deinstitutionalization plan was to remove the chronically mentally ill from institutions and socialize them back into their communities where they would receive outpatient treatment and reap the benefits of a new array of psychotropic drugs that seemed promising in ending their suffering and psychoses.
The essential problem with mental health treatment was that it was only available to those who could pay for it. To make mental healthcare accessible to all, it was included in the services covered by Medicare and Medicaid when they were created in the 1960s. It was at this point in the shift toward deinstitutionalization that the process failed. States continued to shut down psychiatric hospitals, releasing hundreds of thousands of mentally ill people who lacked the skills or resources to survive on their own back into their communities over the next twenty years. The plan for those people to receive services from comprehensive community mental health centers never actualized, often leaving those people with no or little treatment and no place to live.
By the late 1980s, it was becoming apparent that the prison system was becoming the new psychiatric asylum. It is estimated that there are 300,000 mentally ill people currently serving time in prison, 70,000 of whom are diagnostically psychotic. The prison system is not set up for dealing with the problems that result from mentally ill offenders being housed in general population and what is essentially happening is that the mentally ill are being punished for being sick at every turn:
They are adjudicated for crimes they committed that were partially or wholly driven by their mental illness. They are confined in institutions with mental health staff who often have caseloads of several hundred offenders. They are given antiquated psychotropic medications that generally make them more tolerable to others rather than treating the underlying causes of mental illness and teaching them the skills they will need to survive. They are released back into a society as unprepared as when they left it and many research studies have shown that mental health services in the community are largely inaccessible to offenders who are being released from prison. They are stimatized by being labelled mentally ill and more stigmatized for seeking treatment.
The burden that deinstitutionalization has placed on our society is far-reaching. The most obvious burden is financial. Crime is expensive. From the damages incurred in the crime to the walk though the judicial system all the way through the offender's incarceration, every citizen pays for crime. Victims of crime pay most of all. You cannot replace a sense of safety and security with any monetary amount. A less obvious burden is the psychological toll that being afraid of mentally ill criminals has on us as a society. You can't turn on the news without hearing stories about some 'psychopath' or 'lunatic' who shot up a mall or raped and murdered a child. One study done to measure how well our society understands mental illness showed that a third of our population associates the word 'psychotic' with someone who has the propensity to be violent. Our constant stream of breaking news and reality television has enabled us to create a perfect culture of fear.
What we are doing now is not working. We need more resources in the community that are available for providing a continuity of care for mentally ill offenders without making them outsiders in our society. People tend to be very unsympathetic toward the mentally ill. There are celebrities and ribbons and marathons to support sufferers of cancer and AIDS yet mental illness trumps both of them as the leading cause of disability in the United States and no one seems to care. There is the perception that mental illness is a lifestyle choice rather than a real, genetic, treatable brain disorder. It would do us well to remember that it is a brain disorder in human form that suffers, loves and is afraid of doing the wrong thing and hurting other people. This is what it looks like:
