Many police officers and jailers agree with psychologists that jails
don't make good mental hospitals. But like it or not, jails have
inherited that role. The modern trend started in the 1970's, when
most of the nation's state mental hospitals were emptied and closed
"Closing state hospitals was very important because we had
drugs at that point that worked so well that people no longer had
to be in such restrictive environments," says psychologist
Linda Teplin of Northwestern University. "The problem, though,
is that at the same time we didn't provide the community-based alternatives."
US Justice Department says 283,000 jail and prison inmates have a serious mental
AP/Wide World Photos
Alternatives like group homes and outreach for the homeless mentally ill. During
the Reagan Administration's budget-cutting drive in the 1980's, the federal government
slashed funding for such programs, Teplin points out. "In 1975 it was around
ten dollars per capitaand these figures are in constant dollars. By 1992
that dropped to just over five dollars per capita. Now, theoretically, state governments
were supposed to pick up the slack but in reality they simply have not."
In Hennepin County, as in most every other city, treatment is in
short supply. Mental health officials say they'd need five times
their current staff of case managers to serve everyone in the county
who has a serious mental illness. Then again, those potential clients
aren't lining up for help. Which brings up another important change
in recent decades: Starting in the late 1960's, courts declared
that people with mental illnesses can choose not to get treatment
so long as they're not a proven threat to themselves or others.
The man we're calling Mike, the schizophrenic plumber, got arrested
when he wasn't taking his Olanzapine. His mother contends Mike should
have been forced to take his drugs before he got in trouble.
"These people are not mentally competent to decide for themselves
whether or not they need treatment. And how are they ever going
to improve? How is society ever going to be able to live with them
unless they are treated? In other illnesses, well, I guess if they
want to take chances with their health, they have that right. But
in mental illness there's too much at stake. Too much at stake."
It's not clear how society could force mentally ill people to take
medication outside of institutions. Anyway, civil libertarians would
object to forcing treatment on anyone who isn't proven to be dangerous.
To do so would be an ominous step backward, they say.
"Keep in mind that we criticized the Soviet Union for defining
dissent as a mental illness and confining people who were anti-Communist,
as it were, to mental institutions," says Warren Maas, a Minneapolis
defense attorney and psychologist.
Maas represents mentally ill people whom prosecutors, judges or
relatives are seeking to commit to mental hospitals. Sure, Maas
says, mentally ill people who are genuinely dangerous should be
confined. But the behaviors that prompt commitment attempts often
"aren't danger-based, they simply are annoying and people want
them off the street and out of their home or something of that nature,"
Most groups representing the mentally ill don't want a return to
forced treatment or confinement in hospitals. What's needed instead,
they say, is more and better voluntary treatment. That might prevent
more of the mentally ill from doing jail time.
And for those who inevitably do run afoul of the law? Almost everyone
interviewed for this story agrees: jails and mental health programs
need to work together more effectively and creatively. So people
who break the law because of a mental disease get help for their
illnesseither after, or instead of, punishment.
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