Prisons are the New Asylums
The mental health care system in America is broken, as is evidenced by Frontline’s documentary The New Asylums. In 2005 when the film aired, less than 55,000 Americans were receiving treatment in psychiatric hospitals compared to the 500,000 mentally ill who were serving time incarcerated (Navasky and O’Connor 2005). By 2016, nearly 2.2 million people (or 655 out of every 100,000 people) were in U.S. prisons or jails (Kann, 2019). Today, 1 in 5 adults experience mental illness in their lifetime and approximately 20% of state prisoners have a “recent history” of mental illness. That statistic increases to 70% for juveniles in the justice system (NAMI 2019). Prisons have become the new asylums for the mentally ill.
Prisons should not be the go-to for housing and caring for the mentally ill population, yet many of America’s citizens who struggle with mental health issues continue to end up in prison or jail. Prison personnel are generally ill-equipped to take care of the mentally ill and it is not the job of the incarceration system to do so. Yet, many people with mentall illness commit nonviolent crimes in order to get “access to prison therapy sessions, mental health treatment meetings, crisis wards, and prison disciplinary tribunals” (Navasky and O’Connor, 2005). According to the film, people have a better chance at getting access to the medicine they need and routine therapy in prison than they do in their community.
Currently, there are not enough mental health institutions to house or help the mentally ill population. The switch from mental asylums to prisons as the new asylums can be traced back to the 1960 deinstitutionalization movement, which resulted in a large population of mentally ill relying on underfunded, underprepared community-based services (Chapin, 2017; Navasky and O’Connor, 2005). Unfortunately, that began the shift from receiving help in mental institutions to seeking help in the carceral system.
For those who do not intentionally get arrested for the health benefits, many have committed crimes because they are not getting the medical treatment needed to maintain symptoms of their mental illness. For instance, someone with schizophrenia who has a paranoid episode in a mall may get arrested for public disturbance. Chapin (2017) notes that many police officers today attempt to help people who have committed crimes due in part to their mental illness by taking them to mental institutions rather than arresting them, but a lot of mental institutions have long waiting lists or are underprepared to take on more patients. So, the mentally ill end up in the carceral system just the same. Indeed, America’s health care system for helping its mentally ill population is failing its citizens.
While Medicaid and Medicare have provided funding to help people with mental disorders get treatment (Chapin, 2017), the 2010 Patient Protection and Affordable Care Act has perhaps had the greatest impact on mental health treatment thus far. Since its inception, the ACA has made strides toward improving the health arena. For instance, in 2013 open enrollment in the Healthcare Marketplace began, thus offering health plans with specified needs. In 2014, uninsured and self-employed people could finally afford private health insurance, and funding for community health centers increased. In general, the ACA has helped reduce the costs and expand the coverage of Medicaid, Medicare, and other health policies that affect the mentally ill.
Still, in many states Medicaid will only cover adults who have children with disabilities while Medicare is largely geared towards helping adults 65 years and older. There remains a gap in the system for adults who struggle with significant mental disorder(s) who need assistance with obtaining medical insurance, affording and maintaining their medication regimen, therapy etc. While the prison system has filled this gap, that is not the purpose for which the carceral system exists. Despite the strides toward insuring health care for all, those struggling with mental health issues continue to suffer from a system of stigma and lack of community-based help. In 2019, the prison system continues to be the new asylum in the United States.
In order to properly fill the gap left by deinstitutionalization, we must look toward boosting communities so that they can better assist the mentally ill and help them become productive members of society — a term which will mean different things for each individual, depending on the extent of their abilities and available treatment of their mental illness(es).
The city of New York proposed ThriveNYC: A Mental Health Roadmap for All which lays out six important steps for working towards better mental health that I think could be quite useful for other cities across the United Sates to adopt. The six steps include (1) changing the culture to reduce stigma, (2) early action to promote prevention and early intervention, (3) closing treatment gaps and reducing disparities in care accessibility, (4) partnering with communities for effective solutions to mental health issues, (5) using better data to evaluate and improve programs, and (6) strengthening the government’s ability to lead and coordinate efforts across communities (Belkin et al., 2016).
In order to reduce the amount of mentally ill going into the prison system and increase the amount of mental health care U.S. citizens receive, we need to develop policies that focus on boosting community efforts and resources and are built on the ideology that by helping those who struggle with mental illness, we help all of America.
Belkin, G., Linos, N., Perlman, S., Norman, C. & Bassett, M. (2016) A roadmap for better mental health in New York City, The Lancet, 387(10015), 207–208.
Chapin, R. (2017). Social policy for effective practice, (4th Ed.). NY: Routledge
Kann, D. (2019, April 21). 5 facts behind America’s high incarceration rate. CNN. Retrieved from https://www.cnn.com/2018/06/28/us/mass-incarceration-five-key-facts/index.html
National Alliance on Mental Illness (2019). Mental health by the numbers. Retrieved from https://www.nami.org/learn-more/mental-health-by-the-numbers
Navasky, M. & O’Conner, K. (Directors). (2005, May 10). The new asylums. [Television series episode] In M. Navasky and K. O’Connor (Producers), Frontline. PBS. Retrieved fromhttps://fordham.kanopy.com/video/frontline-new-asylums
