Jails That Masquerade as Psychiatric Hospitals


In the eyes of many, the current societal approach to the treatment of psychiatric disorders cannot possibly be considered humane. More in this commentary.

"Out of sight, out of mind."

And we believe ours is a civilized society.

Listen to the description of Cook County Jail by Laura Sullivan of NPR.

Cook County is one of many large county jails that masquerade as a public mental hospital. At least one-third of the 10,000 inmates at Cook County have serious mental health problems. At Cook County, the mentally ill do receive psychiatric care. There are wards for men and for women. The NPR story reports that these struggling men and women, having truly “hit bottom,” go so far as to commit minor crimes to cause their own incarceration. They are that desperate to maintain access to their necessary psychiatric medications. At least they are taking responsibility-in the only way they know how

The current societal approach to the treatment of psychiatric disorders cannot possibly be considered humane. 

When did it become reasonable not to provide treatment to the people who suffer most in our society? When did homelessness become a compassionate alternative to hospitalization? When did serious mental illness, in essence, become a crime? There is no “liberty,” or “pursuit of happiness,” when people with serious mental illness are not provided good care and good treatment. Psychosis is not a civil liberty.

It is a misconception that most state mental hospitals of the past were “snake pits.” One Flew Over the Cuckoo’s Nest was a fictional dramatization of a minority of such institutions. The majority provided humane care, even if effective treatment did not then exist. Those institutions at least provided “asylum.” Relatively effective treatment is now available, yet we now provide neither care nor treatment.

Out of curiosity, I went to the website of the Cook County Sheriff’s Office. The home page emphasizes the Sheriff’s Mental Health Hotline-certainly ironic for a law enforcement agency in a big city. Sheriff Thomas J. Dart’s website, and NPR’s interview with him, make clear the compassion the Sheriff and his staff feel for the souls entrusted to them. It is our responsibility as a society to provide the resources consistent with such compassion.

“Out of sight, out of mind,” is a mechanism for personal and societal denial. It isn’t compassionate. It isn’t responsible. It isn’t consistent with a civilized society. It must not continue.

Further reading:
Kramer DA, Verhulst J. Guns, Violence, and Mental Health: Did We Close the State Mental Hospitals Prematurely?Psychiatric Times.


Dr Kramer is Emeritus Clinical Professor of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. He is also Chair, Committee on Research, Group for the Advancement of Psychiatry; and a Distinguished Life Fellow, American Academy of Child & Adolescent Psychiatry. He writes a column for AACAP News, “The Biological Roots of Child Psychiatry.”

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