Prisons and Mental Institutions Revisited
I pointed to the provocative chart below a few days ago and was intrigued by the thesis that the prison boom has basically been the flipside of the 60s-era decline in institutionalization of the mentally ill:
Mark Kleiman does it buy it and argues, convincingly in my view, that “the demographics aren’t right.”
As Steven Raphael and Michael Stoll point out in Do Prisons Make Us Safer? (just published), mental-hospital patients tended to be white, female, and elderly, while prisoners are disproportionately black, male, and young.
Certainly, the jails have borne some of the brunt of de-institutionalization; the Los Angeles County jail has been described as the largest mental hospital in the nation. But Raphael and Stoll compute that fewer than 130,000 of the nation’s 2.3 million prison and jail inmates are the products of de-institutionalization; that’s about 10% of the growth in the system.
Yes, it’s important to provide better mental-health services to criminal-justice clients, and doing so will tend to reduce prison and jail headcounts. But de-institutionalization is not among the major sources of mass incarceration. That policy had costs, some of them due to the failure to replace asylum care with good community-based care. Those costs fell on the criminal justice system, on the neighborhoods disturbed by disturbing behavior, and on those released, many of whom wound up on the streets or in homeless shelters.
But surely the civil libertarians got the bigger question right: locking people up for acting crazy is a pretty rotten thing to do, and I’m glad we mostly don’t do it anymore. There’s a revisionist tendency to add de-institutionalization to high-rise public housing on the liberal-good-intentions-gone-awry list. It should be resisted. And the notion that the current level of incarceration is somehow historically normal needs to have stake driven through its heart.
That sounds good to me.
15 Responses to “Prisons and Mental Institutions Revisited”
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February 23rd, 2009 at 11:54 am
It seems to me that prisons are filled with violent offenders, and you are most likely to exhibit violence during your young adult years. If your mental illness comes to the attention of others because of some violent act, you might end up in prison, not a mental health hospital.
Women can have the same mental health problems as men, but may not get exposed via a violent act. Actually women are more constrained than men in what is acceptable behavior, so smaller deviations from “normal” might be picked up before a crime is committed.
Another idea is that prisons have been forced to recognize mental health.
February 23rd, 2009 at 11:58 am
The high levels of incarceration in the 90s should also make us wonder how awesome all that economic growth and reduction of poverty was under Clinton. Unemployment and poverty rates don’t include the incarcerated. So if you double the number of people in prison (as we did under Clinton), and most of them are poor, you can magically reduce poverty and unemployment…without reducing poverty and unemployment.
The criminalization of poverty is one area where liberals are complicit with the worst aspects of American conservatism. We need to radically rethink our understanding of criminal justice. It’s totally unacceptable that we appear to have a bipartisan consensus around locking up as many poor black people as possible; that we have TEN TIMES as many people in prison now as we did in the 70s; and that we have the highest incarceration rate in the world while claiming to be a shining beacon of democracy. It’s not a good political issue, so it gets maligned by the left. But I think our political figures and pundits need more spine on this.
February 23rd, 2009 at 12:03 pm
If you’re interested, I think the original scholarly article on this was by Bernard Harcourt http://www.law.uchicago.edu/files/harcourt/institutionalized-final.pdf –
he talked about on volokh in a few posts, which were interesting.
February 23rd, 2009 at 12:10 pm
I do not think you can discuss this problem without raising the factor of privately run for profit prisons. It is in there vital interest to have more prisoners. I read somewhere (?) recently of a judge accepting bribes to sentence people to these prisons.
In California, at least, the prison guard union exerts a strong force politically.
These are multiplying forces that make rational change even harder.
February 23rd, 2009 at 12:10 pm
The idea that mental-hospital patients tended to be “white, female, and elderly,” in the same way that “prisoners are disproportionately black, male, and young” is rather misleading. The onset age for most serious mental illnesses is between 16-28 (or there abouts), and with the exception of depression(which is unlikely to result in incarceration alone), it strikes males and females in roughly the same proportions.
It would be more accurate to say that mental illness doesn’t have strong demographic connections, while prisoners tend to be young, black, and male.
I’d also point out that 130,00 people in prison or jail simply because we have almost no effective mental health care in this country is hardly a problem to brush aside as insignificant (I’ve also seen numbers as high as 500,000, accounting for about a quarter of the prison/jail population).
February 23rd, 2009 at 12:15 pm
Around 20-30% of prisoners have a mental illness prior to arrest. This is a non-trivial statistic but it probably means the insane are not the reason for the correlation.
Instead, deinstitutionalization should be interpreted much more broadly. Mental institutes were not exclusively for the mentally ill. They treated people with violence and drug problem, people who are likely (if untreated) to commit crime. And given how deinstitutionalization occurred while drugs were becoming a larger problem it is uncertain how much of this associated crime could have been prevented had these people been place in some compulsorily treatment institution.
February 23rd, 2009 at 12:31 pm
As bad as our prisons are, mental hospitals were (and perhaps are) arguably worse.
My brother has brain damage caused by medical malpractice at birth and has been institutionalized much of his life. He was flogged in a mental hospital. At best, he was drugged into semiconsciousness and put in front of a TV. Since deinstitutionalization he has lived in a group home and worked cleaning up parks.
For my brother, at least, being released from mental institutions has been a very good thing. I suspect it has been from many others as well.
I think we need very good mental hospitals to which people are committed only when absolutely necessary. I suspect that is not what we have, and it certainly wasn’t thirty years ago.
February 23rd, 2009 at 12:42 pm
(attempt_at_humor)
It’s obvious: Having more mentally disturbed old white women loose on the street has some sort of deleterious effect on the raising of African-American youngsters, that steers them toward crime, or at least toward getting arrested.
(/attempt_at_humor)
February 23rd, 2009 at 1:20 pm
I think much of this was pointed out in the comments to your first post, Matt. You should read them!
Secondly, to gekko and jk: Let’s keep in mind that the argument to which Matt initially responded was that today’s high imprisonment rates could be well explained by de-institutionalization. That seems to be a weak claim.
Furthermore, Kleiman’s argument is not that de-institutionalization was perfect, nor that we should ignore the very sick people who are currently in prison (and on the streets). I think most people (including Matt) would much rather see minor drug offenders treated with serious mandatory rehab and counseling. But keep in mind that people like Matt are not the ones opposing this idea— that would be the conservatives.
Given a choice between today’s solution and 1950’s solution, I’m just not sure that we’d want to go back. I don’t think those institutions would have handled the wave of drug (crack) addiction well. Nor do I think they would have been effective in dealing the wave of violent criminals who grew up during & after that epidemic.
One thing institutionalization did accomplish was a lot of really, really unfair incarceration without proper judicial oversight– which was frequently applied to people who were non-violent and not really a threat to society. Many people who had serious mental illness still received inadequate treatment within the institutions (which were not well funded, and had poor oversight) and hence they often got worse.
February 23rd, 2009 at 2:54 pm
It’s totally unacceptable that we appear to have a bipartisan consensus around locking up as many poor black people as possible
Prison remains the welfare system that White America will gladly pay for on behalf of Non-White America, and which politicians sell to the voters at every election.
Kleiman and the commentators in the earlier thread are pretty much right about the differences between the prison population and the mentally ill, and the nature of the mid-20th century mental hospital. That said, if you regard substance abuse problems in the same broad category as mental illness — and they’re certainly grouped together on a practical basis — then you have a whole new category that wasn’t necessarily part of institutional culture in the era of the mental hospital.
February 23rd, 2009 at 4:42 pm
There were improved psychiatric drugs, starting with lithium, that meant that you didn’t have to lock so many people up for their own safety, although the deinstitutionalization movement probably came 2 decades too soon relative to the arrival of effective drugs. So, you ended up with a lot of homeless on the streets.
February 23rd, 2009 at 6:40 pm
Um. Kleinman says that
Perhaps, but they didn’t used to be. The profile up to the major deinstitutionalisations was much younger and more male.
And – big point – Institutionalization wasn’t wholly, or even mainly, for the mentally ill – indeed, it’s mildly interesting that the intellectual community remembers things that way. Most of the people in institutions were classified as retarded.
And there is, of course, a whopping overlap between prisoners and that fraction of the population that tests as retarded. The sorting is quite obvious; less competent people are more likely to get caught (and more likely to be able to be railroaded) and less able to mount a good defence. As a result, they’re very much overrepresented. I did a quick check at one stage of the figures in Victoria (Australian state) – we have quite a reasonable care system by world standards, I don’t think our figures are wildly out of line – and here….
Some of those graphs does represent moving people who test on the borderline out of institutions and into prison. A change, I may say, I’m in favor of (I have myself helped close down several institutions in Victoria), even if that’s as far as the change goes; a prison is a much more stimulating environment with much higher social status and a much more valorised social role. Which isn’t to say that we can’t do better for them.
February 24th, 2009 at 12:27 am
“Another idea is that prisons have been forced to recognize mental health.”
Oh, please. There IS NO “mental health” in US prisons.
I’ve had direct experience with psychs in both county and Federal prisons during my incarceration. These people are sick puppies, people. They are concentration camp guards. The bottom of the barrel in the psych profession – people who couldn’t make it in their own practices or in any serious professional mental health capacity. People with VERY serious mental health issues of their own.
If you rely on them to practice “mental health” in the prison system, you just further torture the inmates.
There are MANY mentally ill prisoners in the prison system – and I can assure you that absolutely zilch is being done for them.
February 24th, 2009 at 8:47 pm
The bottom of the barrel in the psych profession – people who couldn’t make it in their own practices or in any serious professional mental health capacity. People with VERY serious mental health issues of their own.
Prison mental health isn’t just psychiatry, RSH.Though I recently learned that prison psychiatrists make about four times as much as prison psychologists, the ones doing the talk therapy and crisis shit (at greater personal risk than the pill-pushers).
April 9th, 2009 at 4:53 pm
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