The United States government has a checkered past in its relation to helping those with mental health issues. From institutionalizing large swathes of the population to closing most federally funded institutions and criminalizing those Americans who need treatment — the attempts of supporting those with mental health needs have primarily been ineffectual and reactionary measures which often do more harm than good.
For the first half of the 20th century, the US government funded state and nationally run psychiatric hospitals that were largely unsuccessful at supporting their patients. Electroshock therapy, lobotomies, and forced sterilization left people without relief and, instead, with the burden of managing additional trauma.
After decades of ineffectual treatment and ballooning inpatient populations however, public demand for reform reached a fever pitch after WWII. The National Mental Health Act of 1946 saw the federal government take on a more significant role in supporting improvements and introducing psychotropic drugs to alleviate symptoms for conditions like epilepsy.
For the first time, these drugs allowed people to become outpatients and manage their illnesses through medication in their communities, instead of through institutions.
The move for deinstitutionalization took hold in the 1950’s, and by the late 1960’s the defunding of institutions by the federal government began a long wave of closing most mental health facilities. This laid the burden on states and local communities to pick up the tab, which they attempted to fund by offering grants for small, local organizations like halfway houses. However, many states resisted opening mental health centers, and inpatient beds around the country fell from 413,000 in 1970 to 37,679 in 2016.
While deinstitutionalization was excellent for many with mild symptoms that could be supported with the continuing advancement of medical research and the implementation of new drugs, people with severe mental health issues suffered dramatically from the lack of inpatient beds around the nation. (Only half of the community centers that were proposed to be built ever were.)
With the Social Security Act of 1980 came significant cuts in personal income from the federal government to those with mental health issues, which caused the homeless population to skyrocket. Unable to support themselves financially, those who were housed in psychiatric wards slowly drifted into the street, shelters, and temporary housing. Fast-forward to today and it is currently estimated that 26% of adults living in homeless shelters have serious mental illnesses.
And with homelessness oftentimes comes incarceration. Without enough financial support, many dealing with homelessness and mental health issues find themselves without consistent access to medication and other basic needs. These challenges create desperate and unstable circumstances which can lead to self-medication with street drugs and petty crime. It is no coincidence that the War on Drugs began in the 1980’s and that Riker’s Island, the Los Angeles County Jail, and Chicago’s Cook County Jail are currently the three largest mental health facilities in the nation.
We’re choosing to deinstitutionalize those with mental health issues only to re-institutionalize them in our nation’s jails and prisons. In 2005 the US Department of Justice found that 56% of people in state prisons, 45% in federal prisons, and 64% in local jails had mental health issues. (A staggering 75% of women in local jails were found to have mental health issues.) Our country went from attempting to solve mental health problems with little success (and sometimes horrific experimental trials) to locking people away in prison, often in solitary confinement cells with no access to rehabilitation strategies.
Today our nation must demand significant changes to how our criminal justice system engages with those with mental health issues. In 2000, the Miami-Dade County Criminal Court decided to take a new approach to low-level offenders with mental illnesses. Created by Judge Steven Leifman, the Miami-Dade Mental Health Court Project connects an offender with a mental health expert, they create a 6-12 month treatment plan, and if the person sticks to the program, their charges are dropped or significantly reduced. With the implementation of this project, the county has closed a jail, seen daily inmate rates drop from 7,000 to 4,000, and a decline in recidivism rates among those with mental illness, saving taxpayers millions of dollars. Additionally, the county has partnered with local police officers to steer those having a mental health crisis to treatment facilities instead of jails.
It is evident from the nation’s previous failings that institutionalizing those with mental illness, whether in a psychiatric or prison ward, doesn’t rehabilitate anyone. Offering people a path to getting the right medication, stabilizing their lives through work programs, and requiring accountability through dignified treatment plans is a way forward that not only heals and supports those who need it, but also saves millions of dollars for the fiscally-minded taxpayer.
Judge Leifman has hit on something that could fundamentally and exponentially change our nation and distended criminal justice system.
The US spends an estimated $80 billion a year on incarceration. If Leifman’s project can save Miami-Dade $8 million a year, the national savings would be in the billions.
What’s more, the ability for millions of people currently incarcerated to live productive, meaningful lives could profoundly transform countless communities. Having an untreated mental health issue should not seal one’s fate to an institution any more than having a broken bone should. With Leifman’s approach we have an incredible opportunity as a nation to transform our criminal justice system and millions of lives through treatment, support, and accountability.
It is time to demand significant reforms to our federal, state, and local court systems. While we can’t fix the nation’s past, we can begin to heal our present and our future by offering those with mental health issues an optimistic way forward, instead of a prison cell.
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Ann Lewis is an artist, activist, and writer based in Detroit. Her artwork reflects upon social and environmental justice issues.