[Editor’s Note: What follows is Dr Knoll’s introduction to his series Tales From the New Asylum, several of which are posted on www.psychiatrictimes.com/blog/knoll.]
Back in 2003, an APA President put it about as plainly as one can: “A reasonable person could not fail to see the correlation among decreased funding for mental health resources, the closure of hospital beds, and homelessness and criminalization.”
In fact, “trans-institutionalization” had been evolving for some 50 or so years, and the theory underlying it was published over 70 years ago. The theory seems to be a global one—other countries have found that “as the availability of mental hospital beds has fallen, so the number of people in prison has risen.”
Ironically, if one were to go in search of an integrated mental health “system” treating patients with serious mental illness, one might come closest to finding something basic in this country’s prisons. We are currently in an age when society believes “prison is the preferred place of disposal for large numbers of mentally disordered people.” We have “re-created,” at substantial cost and effort, the “asylums” of a bygone era behind prison walls.
Fortunately, psychiatry has played a critical role in studying the transinstitutionalization phenomenon, as well as serious correctional mental health issues, and continues to do so. Jail diversion efforts are enormously desirable. However, the barrier to achieving a middle ground has remained the same since deinstitutionalization—the absence of a truly organized, adequate mental health system in free society. As long as this problem persists, competent correctional psychiatrists will be an absolute necessity.
Maybe psychiatry tried to “resign,” but before it could, it was highjacked and taken, quite against its will, to a prison. This is about a psychiatrist who woke up and found himself to be just one of an entire new generation of psychiatrists who have been specifically trained to practice in prisons. But I’m not a number—I’m a free man. Or at least I’m free to believe this . . .
These are my Tales.