Early Prison Reform for Mentally Ill in Jails

Dorothea Dix was the first child of an impoverished family. Her father was a Methodist preacher who was an abusive alcoholic. Her mother struggled with depression. In 1841, when she was 38 years old, Dorothea was asked to lead a Bible Study class for women at the Cambridge House of Corrections. It was here that she discovered that the mentally ill were unclothed, in chains, and were being thrown into prisons with criminals in unheated, unfurnished, and foul-smelling cells. When asked why the jail was in these conditions she was told, “those people were mentally ill and didn’t understand anyway” That became her defining moment and the cause to which she devoted nearly all of the remaining forty-six years of her life. She proceeded to visit other jails, and soon her investigations extended over the entire state of Massachusetts. She carefully prepared and took the case to the state legislature where she won support for the expansion of Worcester State Hospital.

Once she had succeeded in Massachusetts, Dorothea traveled to other states and proceeded doing the same process. Although her health was poor, she managed to cover every state east of the Mississippi River. Before her death in 1887 she helped found 47 mental hospitals. Their treatment methods at these hospitals were crude by today’s standards; but they were remarkable steps forward in the mid 1800’s

Today, 127 years after Dorothea’s death, in 44 states the largest institution housing people with severe psychiatric disease is a prison or jail. Nationwide, a study by the Treatment Advocacy Center reports that there are an estimated 356,000 mentally ill inmates compared with 35,000 public-hospital patients. Here, in my home city of Los Angeles, Sheriff Lee Baca once said: “I run the biggest mental hospital in the country.” He wasn’t far from the truth. A jail in Chicago is the one that holds this dishonor.

How Did We Reach This State?

Like many problems, this one was caused by the best of intentions. In 1963 President Kennedy delivered a speech to Congress, where he proposed “…a national mental health program to assist in the inauguration of a wholly new emphasis and approach to care for the mentally ill….central to a new health program is comprehensive community care… …The states have depended on hospitals and homes…shamefully understaffed, overcrowded, unpleasant institutions from which death too often provided the only firm hope of release.” Deinstitutionalization drew enthusiastic support from fiscal conservatives interested in saving funds by shutting state hospitals. Civil rights advocates were enthusiastic because they believed that mental patients needed to be liberated. The Community Mental Health Centers Act was the last law President Kennedy signed before his assassination.

Liberty unchecked can come at a heavy price. The federal grants promised to the states for community mental health clinics barely materialized. Deinstitutionalization, was/and is a well-intended disaster. Many patients, in institutions, were released into the community. However, most communities did not have the facilities to deal with them.

“The lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society,” said psychiatrist E. Fuller Torrey, M.D., lead author of the study. “This is especially true for individuals who – because of their mental illness – are not aware they are sick and therefore refuse medication.”

In comments to Psychiatric News, Torrey said, “it is remarkable that we have let this situation deteriorate to this point.” He added, “Jails and prisons are not built to be mental hospitals, and corrections personnel are neither hired nor trained to be mental health workers. We have returned to the situation that existed in the 1830s when Dorothea Dix began the reform movement to get mentally ill persons removed from jails and prisons and put into hospitals. The fact that we are where we were almost 200 years ago should give us all pause.”

Is There a Solution?

The study provides state-by-state illustrations of how protocols for treating mentally ill inmates who are deteriorating or acutely ill create obstacles that leave inmates without treatment for extended periods or indefinitely, especially in county jails. The report contains several recommendations, including use of court-ordered outpatient treatment—deemed by the Department of Justice to be an evidence-based practice for reducing crime and violence—to help at-risk individuals live more safely and successfully in the community. As a person who became homeless, due to lack of psychiatric care in Los Angeles County, I support any changes to our system which offer an opportunity to end this shameful dilemma.

Whatever solution is applied, it will not be successful until the American people, and their representatives, demand that mental illness be treated as seriously as physical illness. In people’s minds there should be no separation between the two.

Some source material from Psychiatric News Alert