Out of the Insane Asylum, and Into the Prison
Kevin Drum commented on this yesterday, but this really is a striking data point about institutionalization in the United States:
Basically, the prison boom of the past 25 years seems to not so much have launched from zero as served as a substitute for a previous high rate of institutionalization in mental hospitals. Throughout the 1960s, we started emptying the mental hospitals. Then when crime went up, we started building tons and tons of prisons. Now it’s worth being clear that the striking visual doesn’t really prove anything. There are probably other statistics you could track that would show a similar time-series just by coincidence. But this is the kind of thing where it’s plausible to say it’s not a coincidence. I don’t personally know much about how mental hospitals were used in the 40s and 50s or have much knowledge of what they were like, but it would be interesting to try to learn more about that and see how much they acted as a kind of ersatz prison system.
52 Responses to “Out of the Insane Asylum, and Into the Prison”
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February 21st, 2009 at 10:21 am
If you look at the demographics of who was in mental institutions and who is now incarcerated — age, race, gender — you’ll see that there is not simple mechanical replacement of one form of institutionalization by another. Mental patients in the first half of the 20th century were mostly white, half female, and older. Not what prisons look like today.
February 21st, 2009 at 10:22 am
From what I’ve read, for the most part the people who went to mental hospitals in the 1940’s and 1950’s were not violent or otherwise criminally inclined. Not many of their present-day counterparts would be in prisons.
February 21st, 2009 at 10:27 am
This idea is inherently attractive to guilt-loving liberals, but it ignores some evidence.
First, a lot of people who were institutionalized in the 40s and 50s are living almost normal lives in the community today.
Second, law enforcement bends over backwards to put mental health patients in the mental health system.
Don’t be confused by the fact that there are people in jail with mental problems. There are also people out of jail with mental problems. A big difference between those two types of people is that people out of jail can go to private doctors and enjoy medical confidentiality.
Thirdly, much of the rise in incarceration results from the drug laws and the mandatory minimums. Subtract those actual numbers from the figures and the mental health-incarceration numbers don’t track so well.
Basically, most mentally ill people don’t do the kinds of things that get you put in prison. That’s a large part of why we realized that locking them up was not appropriate.
February 21st, 2009 at 10:32 am
I think Petey’s probably right, though I would guess that the institutionalized population of persons with a substance addiction has largely transitioned from mental hospitals to prisons.
There’s really no doubt that Matthew will find, upon further study, that mental institutions were and are ersatz prisons. That’s probably why we have a common term, institutionalized, for prisoners and committed mental patients. It’s also why the commitment process is, as I understand it, handled through the courts (at least in NY and CA).
February 21st, 2009 at 10:37 am
No, it’s different drugs. The people who were in mental institutions are now out and on tranquilizers and other prescription psychiatric drugs – they don’t need to steal to get these. The people who are in prison now are largely small-time dealers and frequently users of heroin, cocaine and marijuana. There is some overlap with respect to prescription pain-killers such as oxycontin.
February 21st, 2009 at 10:40 am
Wow. This post really confirms Matt’s expert status on crime related issues.
But seriously deinstitutionalization is as much progressives’ fault as it is cost cutting conservatives’. Just try getting someone with mental health issues to take their medication or try getting them to live in some voluntary assisted-living treatment facility. It is quite a complicated issue and Matt’s ignorance and surprise at the connection between institutionalization and crime make his past arguments on prison issues largely redundant.
February 21st, 2009 at 10:43 am
Now it’s worth being clear that the striking visual doesn’t really prove anything. There are probably other statistics you could track that would show a similar time-series just by coincidence. But this is the kind of thing where it’s plausible to say it’s not a coincidence.
You have won me over with the persuasiveness of your reasoning, sir! By first allowing that correlation doesn’t imply causality and then later declaring your argument is “plausible,” you have created an airtight web of logic!
February 21st, 2009 at 10:44 am
This post really confirms Matt’s expert status on crime related issues…Just try getting someone with mental health issues to take their medication or try getting them to live in some voluntary assisted-living treatment facility.
Yes! Because Mr. Gekko is an expert on mental health issues…
February 21st, 2009 at 10:52 am
There are people in prisons who are mentally ill and don’t belong there, but another place the population “went” after closing state-run hospitals are living in the streets and/or homeless facilities.
A large one in Boston (Pine Street Inn) has a really large population of mentally ill people who receive no mental health care whatsoever.
I agree with comenters above that while the mentally ill are a part of the huge prison population, the “war on drugs” also is a huge component.
February 21st, 2009 at 10:54 am
Two bits from my vast trove of antiquated anekdota:
(1) There is a lot to be said against the mental insitutions of my youth. One of my mother’s (since my dad was the lawyer I should probably say my parents’) acts of charity was to spring a harmless and quite sane old lady called Rose Schwartz from Agnews State Hospital (site of the most fatalities in the 1906 earthquake and now abandoned) where her relatives, not wanting to deal with her and wanting her money, had stashed her. My brother and I used to be sent over to do her yardwork and it was quite clear that she was not insance and basically capable of living in her own house with the minimum of assistance.
(2) I don’t fully agree with the critics above. When Agnews was emptied and those with mental disorders moved into half-way houses in downtown San Jose not only did the level of petty crime some of these people perpetrated increase but the overall atmosphere of the area went to hell (my future wife — wow, that was a long time ago! — was working at San Jose State and could hardly walk to the train without somesort of threatening incident to which the police response was avoidance) resulting in emptying the place of normal social and economic activity, producing the matrix of empty shop fronts and hostile people that incubates crime.
February 21st, 2009 at 10:59 am
DMontieth,
No I am certainly not but at least I am aware of deinstitutionalization and its effects on crime, prisons, homelessness, and drug use. I thought that was at least a minimum prerequisite for any discussion on prisons and crime but I guess I was wrong.
February 21st, 2009 at 11:01 am
I usually defer to Matt’s intelligence and good judgment, but I’m pretty sure he is totally wrong about this.
If that were true, then you would not have a long delay between the decline in mental-health institutionaliztion and the rise in incarceration; and the slopes for 1974-2000 would not be 4:1 in favor of incarceration.
February 21st, 2009 at 11:21 am
You are more likely to get the correct picture if you chart the decline of the mental institution population to the rise in the homeless population.
From WW II to around 1980 there was essentially no homeless population in the US.
February 21st, 2009 at 11:37 am
Mr. Gekko,
If you’re going to complain about uninformed speculation, it would be wise not to indulge in uninformed speculation with your next breath. Unless, of course, you actually do have experience “getting someone with mental health issues to take their medication” that your modesty prevents you from revealing.
I’m finding it impossible to take your statement that you are “aware of deinstitutionalization and its effects on crime, prisons, homelessness, and drug use” any more seriously than Yglesias’ comment that “this is the kind of thing where it’s plausible to say it’s not a coincidence“. At least Yglesias has the good grace to explicitly reveal his ignorance. Yours, on the other hand, must be inferred.
February 21st, 2009 at 11:47 am
the graph is very striking.
but i think the demographic composition of the relative populations shows that it is just an artefact of other issues.
this is not the same population being shifted from the mental hospitals to the prisons.
the mental hospitals were predominantly white and roughly half female. the prisons today, not so much.
(in addition, a pure substitution-effect should not have the large dip in the ’70s.)
it’s really important for us to think more about incarceration rates, because the u.s. situation is a scandal. but i don’t think this link is going to take us very far.
February 21st, 2009 at 12:01 pm
I work in community mental health currently. I would like to reiterate the points that people have made already. Due to changes in medications and in community supports these people are no longer in the mental hospital, but they are no longer in prison either. In fact, we are doing pretty good for them. Instead of institutionalizing people for long periods of time or even their whole lives, we are able to have them in the community, often living independently. Sometimes they are able to be successful enough to get and keep a job. These people have treatment and medications provided to them by medicaid. The level of supports is quite good.
Don’t blame the closing of mental hospitals for the increase in prison rates. It’s all drug criminalization and mandatory sentences that caused this mess.
February 21st, 2009 at 12:01 pm
1) I take it Matthew hasn’t read Michael Foucault.
2) Speaking of Foucault, anyone heard of the “Panopticon”?
http://en.wikipedia.org/wiki/Panopticon
3) Anyone been in Obama’s Chicago lately?
http://www.suntimes.com/news/politics/1440402,mayor-daley-emergency-surveillance-cameras.article
February 21st, 2009 at 12:07 pm
Correlation is not causation.
There may be evidence for causation, but you have to look deeper than just this chart.
February 21st, 2009 at 12:08 pm
Particularly, making scantily-evidenced claims like this only riles up people like serial catowner, and that’s not pleasant for anyone!
February 21st, 2009 at 12:14 pm
No one who had a clue about the United States would have ever made such a post.
February 21st, 2009 at 12:17 pm
What I wondered when I saw the chart was, who was benefitting financially from running those institutions, and did they then figure out another way to run slightly different institutions and recoup their income stream?
I’m absolutely no expert on any of this, but following the money seems to me to be at least one necessary line of research.
During the 1960s when deinstitutionalization started, my impression is that the mental institutions (and the prisons) were run by the government, ie, that was pre-privatization. Nor were the guards unionized. So that suggests I am wrong. Still, small towns needed the jobs and boost to the economy, and other people may have been benefitting as well. Now, of course, lots of the revenue stream has been privatized to big corporations.
I don’t have data, but those are the types of questions that come to my suspicious mind.
February 21st, 2009 at 12:17 pm
One thing I recall reading, which ties in with Gene O’Grady’s prior comment, is that mental hospitals in the 1940’s and 1950’s housed many elderly people with varying levels of dementia, who didn’t have family members available or willing to care for them. They also housed some younger people with severe physical disabilities.
February 21st, 2009 at 12:41 pm
I wonder how much of this has to do with this being the proto-”Feminine Mystique” generation of women who were told they were crap and weren’t allowed to advance. In the period between the “Rosie the Riveter” days of WWII to the rise of feminism, the cognitive dissonance was probably even worse in that women had proven themselves during the war years. It was also a bad time to be a gay man. A lot of such people simply would be less likely to be in a position to be in a mental institution today.
February 21st, 2009 at 12:50 pm
DMonteith,
I actually do have first hand experience on this issue and that is why Yglesias semi-flippant speculations on crime, drugs, and prisons bother me. And it is not so much about taking their meds but refusing treatment (which is often related to not taking their medication). My problem (it is still ongoing and unresolved) is my mother’s second cousin, a heroin addict with severe mental health problems, refuses to go on methadone treatment. He has been to jail on several occasions, is entirely dependent on the state but not once has he ever been forced into some form of genuine rehabilitation. And this mind you is in Canada. What I can’t understand is why we won’t let these mentally ill people form most basic contracts but we still will let them decide whether or not they want to be treated. It is a controversial debate but Matt’s apparent unawareness of deinstitionalization is quite insulting given all the arguments he has made surrounding this issue.
February 21st, 2009 at 12:58 pm
# gcochran Says:
February 21st, 2009 at 12:14 pm
No one who had a clue about the United States would have ever made such a post.
Second that. Unbelievable.
February 21st, 2009 at 1:38 pm
Funny, I thought it would be more illuminating to examine how today’s prisons are being used as “ersatz” mental hospitals.
February 21st, 2009 at 1:39 pm
Next up: how pirates historically have prevented global warming!
February 21st, 2009 at 1:42 pm
Riker’s Island in New York City runs the largest mental “hospital” in the state. I believe the same thing is true in Los Angeles and Miami. As for senile old women, you could probably do a similar chart showing the rise of nursing homes and the closing of state hospitals. A lot of families sent granny off to the state hospital when she was no longer able to care for herself – ending up with massive “back wards” full of elderly dementia patients. They’re now on Medicaid, living in nursing homes, which are often no better than prisons.
In New York City, at least, a large proportion of the imprisoned population is comprised of “dual diagnosis” mentally ill inmates “self-medicating” their mental disorders with street drugs. They’re arrested because of illegal drug possession, but it’s the underlying mental illness that’s the real problem.
This country may pride itself on getting rid of the mental hospitals, but don’t fool yourself into thinking the problem of mental illness has been solved – it’s just better hidden from view now.
February 21st, 2009 at 1:51 pm
I think this confirms that MY really loves him some pretty graphs. But not much else.
February 21st, 2009 at 1:58 pm
Before the reforms of the 1960s and 1970s, a lot of people were sent to mental institutions for things like eccentric behavior, homosexuality, or mild mental retardation. Most such people today are neither in prisons nor mental hospitals. Nor should they be.
Unfortunately, the taxpayer revolt of the 1970s, combined with One Flew Over the Cuckoo’s Nest, caused the pendulum to swing a bit too far in the other direction. “Danger to self or others” as a requirement for forcible institutionalization sounds good, but it means that there is no effective way to deal with a large subset of seriously mentally ill people who today often wind up on streets or in jail. This is why the streets of large cities are filled with babbling schizophrenics and other colorful but disturbed individuals who need professional help.
February 21st, 2009 at 2:05 pm
Back in 1939, Robert A. Heinlein predicted that future history would call the 1960s and 1970s “The Crazy Years.”
February 21st, 2009 at 2:52 pm
Don’t blame the closing of mental hospitals for the increase in prison rates. It’s all drug criminalization and mandatory sentences that caused this mess.
I second that.
February 21st, 2009 at 2:57 pm
A little over half (56%) of the US prison population has a serious mental illness, according the Human Rights Watch, citing official figures.
February 21st, 2009 at 3:23 pm
a lot of people who were institutionalized in the 40s and 50s are living almost normal lives in the community today.
So? Don’t you think a lot of people who are institutionalized now could also be living normal lives in the community today?
February 21st, 2009 at 4:27 pm
Mr. Gekko,
Your “expertise” consists of anecdotes concerning a distant relative in Canada? My inference is looking pretty solid at this point.
I’m not, by the way, making any claims one way or the other about your or Matthew’s positions here (though I must admit that I mistrust you on the basis of your pretty consistent history of knee-jerk contrarianism in comment threads here). I probably know as much about this issue as either of you, and this state of relative ignorance prevents me from making any strong claims/arguments about it. This despite the fact that my mother’s first cousin has drug problems and has been in and out of jail for years. Oh, and he lives in the US, too.
February 21st, 2009 at 5:44 pm
No, it’s different drugs. The people who were in mental institutions are now out and on tranquilizers and other prescription psychiatric drugs – they don’t need to steal to get these.
Not entirely true, insofar as not everyone has access to a doctor capable of writing a prescription or an insurance plan that will pay for it. A friend of mine who works at a non-profit organization combatting mental illness among the uninsured reports that a large portion of their clients self-medicate with alcohol or illegal drugs in the absence of professional mental health care. So this is a segment of the population that’s likely to be well-represented in a prison population swollen by small-time drug users.
February 21st, 2009 at 6:41 pm
Some of the comments above are silly.
“for the most part the people who went to mental hospitals in the 1940’s and 1950’s were not violent or otherwise criminally inclined” — as much as I love the fact that MattY’s commenters have such profound knowledge of the inclinations of mental patients sixty years ago, it is *also* true that most people in our jails today are not violent or otherwise criminally inclined; rather, they have committed crimes, and are being punished for it, until such time as contact with hardened criminals makes them fit to return to society.
“First, a lot of people who were institutionalized in the 40s and 50s are living almost normal lives in the community today.” Indeed. The same might be said of the people who were jailed in the 40s and 50s. Neither mental illness nor committing a crime necessarily implies a permanent incapacity for leading a normal life.
“Second, law enforcement bends over backwards to put mental health patients in the mental health system.” Yes, because the inmate population gets such excellent health care that mental illness is regularly identified, treated, and referred to treatment at a psychiatric institute. You are probably thinking of the sorts of mental illness that lead to the insanity defense, or to a completely unmanageable inmate, but that isn’t the full extent of mental illness.
February 22nd, 2009 at 12:14 am
I’m an appellate defender in Illinois. Over the 11 1/2 years I’ve been at my job, I’ve encountered a few clients who were severely mentally ill. They eventually ended up at Dixon, a prison that has mental health treatment facilities. But there have been many more clients who suffer to a lesser degree with mental illness of some sort or the other who are dumped in the general prison population. While I don’t think there’s a one-to-one correlation between those now in prison who would have, in the past, been in a mental institution, I do think that a significant number of our incarcerated have some type of mental illness that is being left untreated.
February 22nd, 2009 at 10:32 am
“A big difference between those two types of people is that people out of jail can go to private doctors and enjoy medical confidentiality.”
and the poor crazies get to be homeless. How many mentally impaired people are going to be employed and have access to private care? Its seems more likely they will ruin their lives before anyone figures out that they need medical attention and by that time they can’t afford it.
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March 7th, 2009 at 1:46 am
i truly believe that no one wakes up in the morning, in their right mind and just totally goes balistic, enough for them to be institutionalized for the rest of their lives. i know for a fact and i am not a doctor but without we all know that misuse and also abuse of drugs is a big player in the game. Also peoples lifestyles, and the big picture of how to deal with every day life, job, income, problems with children. i can tell you that it is obvious of our government, just to let these people to live in institutions which really, if you think about it is no different than a jail cell. our government is all about money and if you are not a part of society or a tax payer,or a problem,such astraffic tickets, dui, murders etc. y dou think that they put u on the 9th floor of a hospital or baker act you when u do not comply or act like they want you to, with people that are taking care of them that are under paid and think u are disfunctional, very scary. i am the kind of person that hates to even take any kind of pillsand definetly anti drug. i just wish there was someting i could do. thanks for listening. keep the faith. it really sickens me in the big picture, in my own life i have so many friends that their parents or brothers andsisters are into major drugs and in their 20- 30- 40’s and have lost their teeth,sanity and estyle and not one time do i not not get a call asking me for help, we are talking meth, oxycodone, oxycotin, the list goes on and on, i live in florida and just sickened, thanks for listening, wish the best for everyone..
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We put people in mental hospitals like cordwood for one reason and that is the same reason that most drugs are sold for mental health reasons…OUR PSYCHIATRISTS DON’T KNOW HOW TO FIX THEM!
All you have to do is look at the history. Money is the main motivation of psychiatry today. huge amounts of money.
Anyone met a poor psychiatrist?
They have it made …check out http://www.cchr.org
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