It’s a forgone conclusion that U.S. prisons and jails serve as the nation’s de facto asylums for a majority of people with serious mental illness. Now comes a report that applies hard numbers to the depressing picture: Ten times as many people with schizophrenia, bipolar disorder, and other acute forms of brain disease reside in prisons and county jails than in state hospitals, according to the Treatment Advocacy Center.
The study, released on Tuesday, counted 356,000 prison inmates with serious mental illnesses and 35,000 patients being treated in publicly run hospitals. The stark 10-to-one ratio in populations tracks the decades-long reduction in the number of available hospital beds from a peak of 559,000 in 1955. In 44 states, according to the study, the biggest mental health institution is a prison or jail. Three facilities—Cook County in Chicago, Shelby County in Memphis, and Polk County in Des Moines—house more inmates with serious mental illness than all the state hospitals in their respective states.
The alarming study comes from the Treatment Advocacy Center, an Arlington (Va.)-based organization founded by E. Fuller Torrey, an outspoken doctor whose advocacy of forced medication has made him a controversial figure. A state-by-state survey in the report also found protocols for treating the incarcerated woefully inadequate, leaving those who are ill more vulnerable to beatings and rape. “The lack of treatment for seriously ill inmates is inhumane and should not be allowed in a civilized society,” Torrey, the study’s lead author, said in a statement.
Among his recommendations is greater use of court-ordered outpatient treatment, a legal procedure designed for patients who vigorously oppose treatment and are shown to be a harm to themselves or others in the process. Forty-five states have embraced some form of this procedure, which can force people to take prescribed medications such as antipsychotic drugs. Only New York mandates that each county establish a program, and this requirement has shown results: Physical harm to others from patients treated under court order dropped 47 percent, according to one study, and the risk of arrest and hospitalization for such participants fell in another.
For those imprisoned, the Treatment Advocacy Center’s study urges “appropriate treatment”—easier said than done, given budget shortfalls and further fiscal pressures experienced by states. Against the grim findings, Torrey and other advocates have found some hope in a comprehensive set of changes making its way through the U.S. Congress. The Helping Families in Mental Health Crisis Act seeks to preserve hospital beds and make court-ordered treatment more widespread, among other things. Its prime sponsor is Representative Tim Murphy (R-Pa.), a clinical psychologist from Pittsburgh who took on the task of designing an overhaul of the mental health system after the Newtown, Conn., school shootings in 2012.
Murphy’s efforts go directly to tackling the prison problem the Torrey study describes, says D.J. Jaffe, executive director of the New York-based Mental Illness Policy Organization, a nonprofit policy center. “Murphy is trying to get the mental health system to focus on the most seriously ill, which will result in fewer going to jails,” Jaffe says. “There is a lot in his bill designed to reduce incarceration.”
Will Murphy succeed? At a House subcommittee hearing on the matter last week, groups opposed to court-ordered involuntary treatment urged their members and the public to oppose the bill.