The nation’s 3 largest mental health facilities are Los Angeles County Jail, Rikers Island, and Cook County Jail.1 The authors of one study estimate that using the most conservative numbers, as of 2004 the total number of persons in jails and prisons in the United States with a severe mental illness was at least 321,884. This number includes approximately 10% of jail inmates, 18% of state prison inmates, and 16% of federal prison inmates.2
More recent data from the Bureau of Justice Statistics show that the number of persons under the supervision of adult correctional authorities declined by 1.3% during 2010, reaching 7.1 million at the year’s end.3 The report notes that approximately three-quarters of the decline in the total correctional population (down 91,700) during 2010 was attributed to the decline in the number of probationers (down 69,500) during the year. However, the report does not make note of the effect of this decline on the relative number of inmates with severe mental illness compared with those without severe mental illness.
In contrast to the rising number of persons suffering from serious mental illness in our correctional systems, from 1955 to 1994, the number of psychiatric patients being treated in the nation’s public mental institutions dropped from 558,239 to 71,619.4 This drop in numbers is all the more telling when considered in comparison with the country’s increase in population from 1955 to 1994.
The closing of large state mental institutions was spurred partly by the belief that psychiatric patients would fare better if treated in the community rather than behind institutional walls. If we are to hold to this belief, then mental health professionals, policy makers, and law enforcement officers are obliged to think, and then think again, about how we can best serve the large numbers of persons suffering from serious mental illness now moving from behind hospital walls to behind bars, to open streets, and back again.
There are 2 primary areas for improvement. The first is diverting persons with mental illness away from jails and prisons, and into treatment. The second is expanding the services and treatment centers in the community.
The deinstitutionalization movement began in the late 1950s after the first antipsychotic medication was introduced. This psychiatric advancement, among other complex fiscal and legal factors, resulted in an exodus of psychiatric patients into the streets and communities of America, which, in turn, caused law enforcement to have a much greater interaction with persons who had a serious mental illness. A report by the Treatment Advocacy Center and National Sheriffs’ Association states that in 2004 there was approximately one psychiatric bed available for every 3000 persons in the United States, in contrast to 1955, when there was one psychiatric bed available for every 300 persons.5
1. National Public Radio. Nation’s Jails Struggle With Mentally Ill Prisoners. September 4, 2011. http://www.npr.org/2011/09/04/140167676/nations-jails-struggle-with-ment.... Accessed December 12, 2012.
2. Lamb HR, Weinberger LE, Marsh JS, Gross BH. Treatment prospects for persons with severe mental illness in an urban county jail. Psychiatr Serv. 2007;58:782-786.
3. Glaze LE. Correctional populations in the United States, 2010. December 2011. http://bjs.ojp.usdoj.gov/content/pub/pdf/cpus10.pdf. Accessed December 12, 2012.
4. Deinstitutionalization: a psychiatric “Titanic.” 1997. http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html. Accessed December 12, 2012.
5. Torrey EF, Kennard AD, Eslinger D, et al. More mentally ill persons are in jails and prisons than hospitals: a survey of the states. May 2010. http://www.treatmentadvocacycenter.org/storage/documents/final_jails_v_h.... Accessed December 12, 2012.
6. Adams K, Alpert GP, Dunham RG, et al. Use of force by police: overview of national and local data. October 1999. https://www.ncjrs.gov/pdffiles1/nij/176330-1.pdf. Accessed December 12, 2012.
7. Steadman HJ, Deane MW, Borum R, Morrissey JP. Comparing outcomes of major models of police responses to mental health emergencies. Psychiatr Serv. 2000;51:645-649.
8. Teplin LA. Keeping the peace: police discretion and mentally ill persons. Natl Inst Justice J. 2000;7:8-15. https://www.ncjrs.gov/pdffiles1/jr000244c.pdf. Accessed December 14, 2012.