Incarcerating the Mentally Ill Makes Us All Less Safe

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More than 40 years ago, an epidemic began in the United States — an epidemic of mass incarceration.

The epidemic was spurred by President Richard Nixon's "tough on crime" rhetoric and buoyed by the decades of policies that followed; today, 2.4 million people are incarcerated in US prisons or jails. Half of those in federal prisons and a quarter of those in state prisons are there due to drug charges, most of which involve non-violent offenses. Because mental illness and substance abuse so often co-occur, the mass incarceration plague has swept up millions of Americans with mental disease. More than half the people incarcerated today — 1.26 million — have mental health issues.

One of those 1.26 million people is my son.

Mental illness played a significant role in his arrest and conviction on charges of attempted robbery and arson, leading our family to become intimately acquainted with this broken system. My son struggled throughout his life with mental illness and substance abuse, and received at least a half-dozen diagnoses, including oppositional defiant disorder and autism. His behavior worsened after the death of his mother from cancer, and led me to enroll him in a succession of schools for students with special needs.

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Despite exhausting every medical and schooling option available, at 18 my son was arrested for trying to rob a cab with a friend. He was just a few blocks from my office when he was arrested, and what I came to understand about the incident is that it had more to do with his need for socialization and his impulsivity than with any criminal intent.

About a year after that first incident, my son became convinced he was being followed by a drug dealer. He called the police, who ignored him, and then gathered whatever trash he could find around the apartment, set it on the stove, started a fire, and called the Fire Department thinking they would protect him. Instead, he was arrested and charged with arson.

My son spent two years at New York City's notorious Riker's Island awaiting disposition of his case; he is now incarcerated in an upstate prison for the remainder of his five-year sentence. Places like Riker's are not equipped to provide the services that people like my son need, and too many prisons and jails use solitary confinement to manage symptoms of mental illness. Solitary confinement is recognized internationally as harmful to human health, but it's especially detrimental to the well being of those with mental illness.

The mass incarceration epidemic coincided with this country's ill-fated social experiment with deinstitutionalization. Beginning in the 1950s, people living in large psychiatric hospitals were deinstitutionalized with the expectation that psychotropic drugs and community health services would allow for their successful re-entry into society. Instead, in the absence of adequate community services and too much faith in both the efficacy of psychotropic drugs and the ability for mentally ill people to remain on them, people with serious mental illness wound up being reinstitutionalized — into jails and prisons.

In 1955, about 550,000 severely mentally ill patients were in public psychiatric hospitals. By 1994, this number had been reduced to about 70,000. Today, only 40,000 psychiatric beds exist for a US population that has doubled since 1955. And so tens of thousands of people with serious mental illness are living in jails and prisons, turning places like Cook County Jail in Chicago and Riker's into two of the largest mental health hospitals in the country.

Locking up people for being mentally ill because we lack the political will or humanity to provide effective treatment is shameful — but it's also costly. It can cost more than twice as much to incarcerate an inmate who is mentally ill; for instance, the average prisoner in Texas costs the state $22,000 per year, but incarceration of a mentally ill person can cost up to $50,000 a year. Spending on a prisoner's psychotropic drugs alone can cost more than feeding him.

The increased costs are also due to average lengths of stay. At Riker's, the average incarceration period is 42 days, but people with mental illness stay locked up for an average of 215 days. Why? Because people with serious mental illness often cannot follow strict prison rules, which results in time added to their sentences as punishment.

Fortunately, people on the front lines of this country's mental healthcare meltdown — those with mental illness and their families, some correction officials, and groups like NAMI, People, Inc., and CASES — have been advocating for re-entry programs and alternatives to incarceration for those suffering with mental illness. These efforts save both lives and money.

One of the most innovative and holistic intervention programs is the Center for Health Care Services (CHCS) in San Antonio, Texas, which provides wrap-around services for homeless and justice-involved individuals and families as well as emergency medical and substance use services to poor and indigent people. CHCS estimates that their programs save the county approximately $10 million dollars a year.

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As a result of my family's experience, I founded the Greenburger Center for Social and Criminal Justice. One of our most important goals is the development of an Alternative to Incarceration (ATI) for those suffering from serious mental illness or personality disorders who commit serious crimes and present a risk to themselves or the public. Ninety eight percent of those incarcerated return to society, and those with serious mental illness often return to society more traumatized than they were before. We must find better answers, different from the mental hospitals of the 1950s, and different from our current jails and prisons. The status quo is serves no one's interests — and makes us all less safe.

Francis Greenburger is the president and founder of the Greenburger Center for Social and Criminal Justice. Follow the Greenburger Center on Twitter: @greenburgerorg

Photo via Flickr