Introduction

During the 1960s, policymakers across the country decided to close mental health institutions in favor of community treatment. In 1955, there was one psychiatric hospital bed for every 300 Americans.

Today, according  to the Treatment Advocacy Center, a Virginia-based non-profit dedicated to the treatment of severe mental illness, there is one psychiatric hospital bed for every 3,000 Americans. As the Journal Sentinel reported, there are 20 times as many people with mental illness in jails and prisons as there are in psychiatric hospitals.

As it became obvious that the community treatment experiment was not working, some policymakers found it easier and less expensive to stigmatize mentally ill persons as criminals and send them to prison, rather than to treat them with the attention and compassion that is required for those suffering from a debilitating disease.

Once in prison, mentally ill inmates have a difficult time getting out. Prison rules are often violated by offenders who believe cellmates, guards and even family at home are out to harm them.

The mentally ill are often targeted by fellow inmates who are aggravated by the strange manifestations brought on by their illness. Mentally diseased inmates may have a problem concentrating in programming and therefore fail to complete required treatment programs.

Prisons are not completely to blame.

Prison medical systems were not designed nor equipped to provide quality mental health services to prisoners in need. Seriously mentally ill inmates often face overworked or undermanned staff overwhelmed with the need to evaluate and implement treatment plans for an ever growing population of ill inmates.

Our board and the Pennsylvania Department of Corrections work extremely hard to assist inmates with mental illness transition back into the community.  Some of my colleagues have committed considerable time and energy to this process.

Such efforts do not eliminate the fact that an absence of available psychiatric hospital bed space makes it extremely difficult to place those inmates with violent criminal histories and intensive treatment needs.

Until we are willing to acknowledge that our prisons have become de facto mental hospitals— and unless we are willing to make the hard and costly decisions that both protect the public and humanely treat those inflicted with disease— I believe the American mental health gulag will continue to indelibly blur the line between justice and expediency.

Matthew T. Mangino is a member of the Pennsylvania Board of Probation and Parole and the former district attorney of Lawrence County, Pennsylvania. He also has blog on crime and punishment at www.mattmangino.com and welcomes comments from readers.

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