Gone Mental

04.10.14

U.S. Prisons Becoming De Facto Home of the Mentally Ill

A new study reveals that prisons in America house ten times as many mentally ill as the state-run psychiatric wards that could actually treat them.

“If you wanna help, tell the CIA to stop trying to kill me.”

It’s a familiar line that Dr. E. Fuller Torrey, a psychiatrist who’s spent 40 years studying America's treatment (or lack thereof) of the mentally ill, hears from schizophrenic prison inmates. Prisoners in their own mind with no way out, they wreak havoc at jails across the nation: throwing feces at guards, singing for days on end, battling with the voices in their own heads. Worst of all, they’re alone.

In a new study by Treatment Advocacy Center (TAC), a nonprofit dedicated to eliminating barriers to treating the mentally ill, Torrey and his colleagues expose just how bleak America’s mental health situation has become. In 2012, an estimated 356,000 mentally ill inmates were being held in state prison, compared to just 35,000 in state-run psychiatric hospitals. In other words, the number of mentally ill people in prisons is ten times that of mentally ill in state-run psychiatric hospitals.

Torrey’s basic tenet is nauseating: the majority of mentally ill in America are treated like monsters.

“Being in prison if your brain is working normally can’t be easy, but being in prison when your brain isn’t working normally? It must be a living hell,” Torrey tells me. Torrey has himself borne witness to the locking up of the mentally ill, and he paints a grim picture of the scene. “Some throw feces at the guards, sing all night to keep others awake, assault other inmates out of paranoia that they’re in danger.”

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.

During the 50s, the total number of beds in America’s psychiatric state-run hospitals neared 559,000. Today, the number of beds is down to roughly 35,000.

While TAC’s study—titled The Treatment of Persons With Mental Illness in Prisons and Jails—isn’t the first of its kind, it’s notable for two reasons: it’s the first to analyze the data by state, and it’s the most recent illustration that the problem is growing more acute. Some states, such as New York, operate satellite mental health units, providing treatment to upwards of 16,000 inmates at 28 different state prisons. A 2011 study estimated that of the 12,200 inmates at Riker’s Island, ⅓ of the men and ⅔ of the women are mentally ill.

The driving force behind the decrease in available beds, and thus reliable care, seems fueled entirely by money. In an effort to save taxpayer dollars, states have been decreasing the number of beds in their psychiatric hospitals for decades. It’s a practice Folley doubts saves any taxpayer money—and, owing to the high cost of prisons, may cost them more. “The idea that we’re saving money by emptying hospitals is a complete myth. Taxpayers are not saving any money this way.”

A longstanding issue in America, the problem is undoubtedly reaching new highs. During the 50s, the total number of beds in America’s psychiatric state-run hospitals neared 559,000. Today, the number of beds is down to roughly 35,000. With a population almost double what it was in the 50s, this means that the majority of mentally ill are left with two options: jail or the street. “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.

Among the roadblocks to providing beneficial treatment is getting the prisoners themselves to admit they need help. In 31 states, a provision is in place allowing the prison to forego consent and offer involuntary treatment that includes medicine and therapy. For the other 19, things are more complicated, often requiring a court order and approval from a committee to proceed.

In the past six months, The White House has displayed an increased concern for the issue. In September, Vice President Joe Biden announced a $100 million plan aimed at increasing the availability of mental health services, a direct result of the increase in mass shootings in America. It’s a smart move. A Gallup poll from September revealed that 48 percent of Americans blame gun violence on our flawed mental health system.

“Why doesn’t anybody care?” Torrey asks aloud. “That’s more of a political issue. What most people don’t understand is that the great majority of mentally ill in prison don’t need to be there.”

Editor's Note: An earlier version of this article incorrectly implied that New York state requires mentally ill inmates be sent to psychiatric hospitals. In fact, The New York State Office of Mental Health provides psychiatric care to thousands of individuals within prison-based settings and also operates a psychiatric center dedicated to inmate inpatient care, a facility which has no waiting list.