Incarcerated with the madness

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Christopher Carr

Christopher Carr does stuff and writes about stuff.

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  1. Avatar Creon Critic says:

    Torrey began the research for this project over a year ago when a visit to Erie County Jail in Buffalo, New York left him stunned. Upon arrival, he found what he believed to be a paranoid schizophrenic and bipolar inmate who had been sitting in his cell hallucinating for over a year. Without treatment he’d gone ballistic, cutting down tension polls that wiped out electricity in hundreds of homes nearby. Solitary confinement, Torrey says, was likely his next home.

    This is cruel, inhumane, and as a society we should be deeply ashamed of the steps in the process that led to this point for the Erie County inmate and the thousands of inmates he represents.

    Put another way, there’s a big difference if Mr. Smith simply commits premeditated murder for insurance money and alternatively, if Mr. Smith suffers from a mental illness and could have been prevented from harming anyone by a functioning mental health system that got him the necessary treatment. Not recognizing that boundary makes prisons a tool for separating the (likely poor) mentally ill from their freedom. And not recognizing that boundary runs counter to all sorts of fine line drawing that (rightly) operates in our legal system (e.g. first-degree murder, second-degree murder, manslaughter) – those distinctions are part of the necessary interpretation of actions the criminal justice system assesses to determine culpability.

    And prisons (and jails) should not function as a backstop health care system due to our underprovision in our actual health care system.

    “I know of police officers who have stumbled on homeless who are mentally ill and completed debilitated. They put them in jail—just to keep them safe,” Torrey says.

    Report

    • Avatar Kim says:

      It’s really hard to get paranoid schizophrenics into treatment.
      They’re capable of living on their own (which means that you a priori would not like to incarcerate them), but they’re really not likely to show up to get therapy/treatment (and can sometimes go off medicine, which is not good for them or the neighbors).Report

  2. Avatar zic says:

    Remember that our mental-health system is so non-functional that many families are told they need their loved one to commit a crime that draws police attention in order to get help; particularly a problem when the person is 18 or older.

    We are actively invoking the justice system as a way in lieu of mental health services.Report

    • Avatar LeeEsq says:

      The problem with the American mental health system is the for profit nature of American healthcare in general. Treating metnal illness can take years or even decades. Making a profit under these scenarios is difficult at best. As long as we insist that our healthcare system be operated on some sort of market principle than we are going to have woefully inadequate mental healthcare.Report

  3. Avatar greginak says:

    This is old news. High numbers of mentally ill in prison has been an issue in the pysch/mental illness treatment communities for years. The issue is that prison makes mental illness worse leading to more recidivism.
    Also that in many cases treating the MI is far better solution. Of course to access treatment for MI you need a method of payment, such as health insurance, which is still only beginning for many people. It was the evil Clinton admit who pushed parity for mental health and physical health in insurance. R’s in many cases screamed socialism, end of the world, trust the free market, blah blah blah then also, the same things they say now.

    I used to work with a fair number of people who had been involuntarily committed due to committing serious crimes. In every case, keeping them in a state psych hospital was far more humane and safe then prison which isn’t to say that state psych hospital are great places. However to get committed you have to be really really really out there which most people aren’t.Report

  4. Avatar Saul DeGraw says:

    Greginak is right this old news.

    In some ways, society has never been good about how the mentally ill are treated and while we have made many medical strides since the days of Bedlam, we might still view mental illness in the same ways.

    Part of the problem might be the activist rush to shut down psychiatric hospitals during the 1950s-1970s. Now these places were not great. Many times they were a tool of out of site and out of mind and the conditions in said places were horrible.

    That being said, I don’t think using prisons for this purpose is any better and is probably worse. We need to get much better at treating the mentally ill before crimes happen. The subway pushes that happened in NYC a few years ago were unsurprisingly committed by people with histories of mental illness and delusion but they had to commit a really bad act before anyone would do anything.

    I don’t see why people need to die or be seriously injured before intervention can be done to deal with a mental illness.Report

    • Avatar Kim says:

      Often because we prioritize folks freedom over getting them treatment.
      You can stay depressed and simply say, “I’ll treat it with liquor”.

      Now, this guy probably needs some sort of help, yes?
      Possibly he’s getting it through alcohol (I’d say let us evaluate that at least! at least!)Report

    • Avatar LeeEsq says:

      Many of the psychiatric hospitals that were shut down were basically places of torture or at least places where the mentally ill were ignroed rather than treated. The problem wasn’t that they were shut down, its that the replacement wasn’t adequately thought through and that refusal to properly fund necessary things.Report

      • Avatar Kim says:

        The other problem is that Insurance seems to think that they can put a timeline on “how long it takes to get treated for XYZ”. If you aren’t done being treated, they will stop paying. This leaves a lot of people booted out before they’re really done being helped.Report

      • Avatar Saul DeGraw says:

        Good points. I am more angry about the lack of adequate replacements and lack of will for funding than anything else.Report

      • Avatar LeeEsq says:

        Kim, I pointed out that our profit-focused healthcare system makes treating mental illness much more difficult becasue these things take years to treat. At least when it comes to mental health issues, we should ignore the question of markets and profits in healthcare probably.

        Saul, its a proverbia case of penny wise and pound foolish because funding mental health is a lot cheaper than funding prisons.Report

      • Avatar Kim says:

        Lee,
        my above perspective is dealing with acute care.

        I think that profit/loss is very relevant in dealing with mental illness.
        Hell, we have computer games that can reduce PTSD and anxiety
        [come on, they’ve gotta be out of the lab by now!]…
        And some of the drugs that we’re using are only being used because they make someone a profit.Report

    • Avatar notme says:

      Saul:
      I have to give you credit as this is the closest I think I’ve ever come to hearing a liberal admit that deinstitutionalization wasn’t the panacea it was promised to be. Usually liberals break down and start blaming Reagan.Report

      • Avatar Kim says:

        Stats said 33% got better after being deinstitutionalized, 33% got worse, and about 33% stayed about the same.

        [This stands in contrast to the anecdotal but true… someone getting institutionalized for speaking a foreign language.]Report

    • Avatar Zane says:

      @saul-degraw , I wouldn’t put all the blame for the way deinstitutionalization happened on those who argued that mental institutions were often terrible places and that very often the people in them did not require that kind of care/restriction. Keep in mind that state legislators were extremely eager to see the cost savings that came about by eliminating the institutions and not properly funding (or structuring) the outpatient mental health services that were supposed to support people within the community.

      That those cost savings ended up being illusory is probably not apparent to many.Report

  5. Avatar Chris says:

    It seems to me that prisons have three purposes, at least two of which they don’t fulfill very well (particularly in cases of mental illness):

    1) Deterrent: you don’t want to commit a crime because you get a massive amount of freedom taken away if you do.
    2) Rehabilitation
    3) Protecting the innocent: Keeping habitual criminals away from the people they may harm.

    Now, #1 is impacted by mental illness because people aren’t thinking rationally, and the deterrent power of prison only works if you’re thinking at least somewhat rationally. #2 is impacted by mental illness because it affects how you rehabilitate a person. #3 is impacted because how long you need to keep a person off the streets is dependent on whether their potential for committing crime is affected by the treatment of mental illness.

    So, even if you don’t care about the cruelty of imprisoning mentally ill people and not treating them (or imprisoning them when treatment would get you better results), you should care about it so that prisons are able to function better.Report

    • Avatar Jaybird says:

      Oooh, now THIS is a chewy comment. I think that I’d at least have to add “4) middle-class employment opportunity” and (then, maybe, bump it up a couple of slots).

      Once upon a time, I’d say that the main purpose of incarceration might have been rehabilitation of criminals but I don’t know that we can seriously make the argument that that’s what it *DOES* today.

      And while it might be fallacious to say that “what it does is what its purpose is”, I think that it illuminates more than it obscures. Recidivism is above 70% for the stuff you’d most likely think of when you’d think of felonies… from The Wikipedia:

      http://en.wikipedia.org/wiki/Recidivism#Recidivism_rates

      Released prisoners with the highest rearrest rates were robbers (70.2%), burglars (74.0%), larcenists (74.6%), motor vehicle thieves (78.8%), those in prison for possessing or selling stolen property (77.4%) and those in prison for possessing, using or selling illegal weapons (70.2%).

      What is actually happening to people in prison? Why shouldn’t we suspect that that isn’t the real point?Report

    • Avatar kenB says:

      I think there’s at least one more function, which is, roughly, enforcing the public’s sense of “justice”. If we just cared about prevention and rehabilitation, then the conversations around sentencing would be largely driven by statistics and analysis, but in fact it generally comes down to the public wanting criminals to get what they “deserve.” Of course, this too is impacted by mental illness in rather the same way that #1 is, but instead of being (theoretically) measurable, it comes down to vague ideas of agency and free will.Report

      • Avatar Jaybird says:

        I see Ken covered this.Report

      • Avatar KenB says:

        I wasn’t going to point it out, but thanks for noticing.Report

      • Avatar Chris says:

        I agree that justice is something we talk about with the prison system, but I’m not sure what the mapping is from crime to prison in terms of justice, and I’m not sure it’s possible to make such a mapping. That’s not to say that I don’t think justice is a real thing, I’m just not sure how prison serves it outside of the functions I described. A person does X, and after Y years, they are thoroughly rehabilitated and unlikely to every do X again, or crimes A, B, C…Z either. Or the time they’ve spent in prison is a sufficient deterrent to keep them from doing X or A and so on again. Has justice been served, or is there a number on top of that that needs to be reached before justice is done?Report

  6. Avatar zic says:

    This might bear on the discussion.

    It seems countries that more-strongly believe in free will have higher murder rates; and the relationship is that the belief in free will is linked to the desire to punish others for wrong doing.

    (That’s my paraphrase, it’s quite possible I misinterpreted.)

    http://www.motherjones.com/environment/2014/03/free-will-nietzsche-punishmentReport

  7. Avatar Zane says:

    Chris, I think the problem that many have with the fact that we have so many people with mental illness in the prison system is that some non-miniscule proportion of those people in prisons would not be there if they had access to good mental health care while in the community.

    Anyone who’s tried to access community mental health or who has worked in community mental health knows that it is fragmented, underfunded, provides only particular kinds of services, often doesn’t provide services that are intense enough, and that workers typically have caseloads too large to provide effective and meaningful personalized care and support. Also, the system that funds mental health care for the indigent is usually completely separate from the system that provides for medications (if there is one).

    And let’s not forget that not just prisons but local jails also house many people with serious mental illness. The Los Angeles County Jail is the largest mental health facility in the United States (http://www.npr.org/2013/09/15/222822452/what-is-the-role-of-jails-in-treating-the-mentally-ill). Jails not only hold people awaiting trial, but also minor offenders serving their sentences.

    This does not seem cost effective to me.Report

    • Avatar Christopher Carr says:

      Do other countries have this problem?Report

      • Avatar Zane says:

        That’s a good question, and I don’t know the answer. However, it’s worth noting that other industrialized nations have universal health care. Access to medical providers and medications at least wouldn’t be gated in the same way it is in the United States currently. (And while the ACA will help quite a few people, we will not have universal health care from it.)

        As far as other mental health services, I don’t know how those services are structured elsewhere.Report