CHICAGO — THE largest mental health center in America is a huge compound here in Chicago, with thousands of people suffering from manias, psychoses and other disorders, all surrounded by high fences and barbed wire.
Just one thing: It’s a jail. The only way to get treatment is to be arrested.
Psychiatric
disorders are the only kind of sickness that we as a society regularly
respond to not with sympathy but with handcuffs and incarceration. And
as more humane and cost-effective ways of treating mental illness have
been cut back, we increasingly resort to the law-enforcement toolbox:
jails and prisons.
More than half of prisoners in the United States have a mental health problem, according to a 2006 Justice Department study. Among female inmates, almost three-quarters have a mental disorder.
In
the jail here, some prisoners sit on their beds all day long, lost in
their delusions, oblivious to their surroundings, hearing voices,
sometimes talking back to them. The first person to say that this system
is barbaric is their jailer.
“It’s criminalizing mental illness,” the Cook County sheriff, Thomas Dart,
told me as he showed me the jail, on a day when 60 percent of the
jail’s intake reported that they had been diagnosed with mental illness.
Dart says the system is abhorrent and senseless, as well as an
astronomically expensive way to treat mental illness — but that he has
no choice but to accept schizophrenic, bipolar, depressive and psychotic
prisoners delivered by local police forces.
People
are not officially incarcerated because of psychiatric ailments, but
that’s the unintended effect. Sheriff Dart says that although some
mentally ill people commit serious crimes, the great majority are
brought in for offenses that flow from mental illness.
One
47-year-old man I spoke to, George, (I’m not permitted to use last
names for legal reasons) is bipolar, hears voices and abuses drugs and
alcohol. He said he had been arrested five times since October for petty
offenses. The current offense is criminal trespass for refusing to
leave a Laundromat.
The
sheriff says such examples are common and asks: “How will we be viewed,
20, 30, 50 years from now? We’ll be looked on as the ones who locked up
all the mentally ill people.
“It
really is one of those things so rich with irony: The same society that
abhorred the idea that we lock people up in mental hospitals, now we
lock people up in jails.”
A few data snapshots:
• Nationwide in America, more than three times as many mentally ill people are housed in prisons and jails as in hospitals, according to a 2010 study by the National Sheriffs’ Association and the Treatment Advocacy Center.
•
Mentally ill inmates are often preyed upon while incarcerated, or
disciplined because of trouble following rules. They are much more
likely than other prisoners, for example, to be injured in a fight in
jail, the Justice Department says.
• Some 40 percent of people with serious mental illnesses have been arrested at some point in their lives.
In the 1800s, Dorothea Dix led a campaign
against the imprisonment of the mentally ill, leading to far-reaching
reforms and the establishment of mental hospitals. Now we as a society
have, in effect, returned to the 1800s.
Among
those jailed here is Russell, 46, who is being held for burglarizing a
garage. He has been diagnosed with severe depression and said that he
self-medicates with alcohol and drugs. Most of his adult life has been
spent behind bars for one offense after another, and he said he became
aware of his mental health problems when he was being clubbed by a thug
with a baseball bat and realized that he was enjoying it.
“I
just want to be normal,” he said as we spoke in a large dormitory room
for inmates with psychiatric problems. “I want to have a job. I’ve never
had a job. I want to be able to say hi to a co-worker.” He stopped, and
there were tears in his eyes.
In
1955, there was one bed in a psychiatric ward for every 300 Americans;
now there is one for every 3,000 Americans, the 2010 study said. So
while more effective pharmacological treatments are theoretically
available, they are often very difficult to access for people who are
only borderline functional.
“Some
people come here to get medication,” says Ardell Hall, a superintendent
of a women’s unit at the jail. “They commit a crime to get in.”
India,
a 42-year-old woman, suffers from manic depression and post-traumatic
stress disorder. She said she tried at various times to get psychiatric
care but found it almost impossible, so she self-medicates when on the
outside with heroin — and has spent almost all of her adult life in
jails and prisons on a succession of nonviolent offenses relating to
drugs and shoplifting.
TAXPAYERS
spend as much as $300 or $400 a day supporting patients with
psychiatric disorders while they are in jail, partly because the
mentally ill require medication and extra supervision and care.
“Fiscally,
this is the stupidest thing I’ve seen government do,” Dart says. It
would be far cheaper, he adds, to manage the mentally ill with a case
worker on the outside than to spend such sums incarcerating them.
Cook
County has implemented an exemplary system for mental health support
for inmates. While in jail, they often stabilize. Then they are
released, go off their medications and the cycle repeats.
One
woman in the jail, Kristen, said she had been diagnosed with depression
and anxiety disorders. On the outside, her prescription medication cost
$100 a month, so she skipped it.
“When
I’m not on my medicine on a regular basis, I don’t make decisions
well,” she said, explaining her long arrest record for theft and
narcotics offenses. I asked her if access to medicine would keep her out
of jail, and she said: “I don’t know if that’s necessarily true, to be
totally honest. But it would help.”
As
Sheriff Dart puts it: “We’ve systematically shut down all the mental
health facilities, so the mentally ill have nowhere else to go. We’ve
become the de facto mental health hospital.”
Do we really want to go back two centuries? Doesn’t that seem not only inhumane but also deluded — on our part?
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