Mental health has been getting increasing attention since COVID changed our lives. But there’s not much focus on the mental health of a major segment of our population, the 2.12 million people in our prisons. Our state and our nation continue to participate in a quiet crisis that is devouring our youth, our mentally ill, and our tax dollars. As has been true for more than four decades, the United States incarcerates a higher percentage of its population than any other nation in the world. Think about that. Let that thought settle into your consciousness.
Of course, we should start by admitting that there are violent people, real criminals, who need to be locked up behind bars for life, to protect those of us who aren’t violent and aren’t criminals. Throughout my career, I’ve done a lot of work in prisons, and I’ve evaluated prisoners who I don’t ever want to see walking down my street! But it turns out that the number of violent offenders is less than half of our prison population. And violent prisoners are often released prematurely because our jails are so over-crowded.
Most of our prisoners are under the age of 30, and according to the Federal Bureau of Prisons, half are convicted of crimes related to substance abuse. Approximately 15% of the total are people who meet generally accepted criteria for a mental illness, and about half of that group are considered seriously mentally ill.
According to one report from the national organization, Human Rights Watch, “One in six U.S. prisoners is mentally ill. Many of them suffer from serious illnesses such as schizophrenia, bipolar disorder, and major depression. There are three times as many men and women with mental illness in U.S. prisons as in mental health hospitals.” One of the report’s authors, Jamie Felner, observed, “Prisons have become the nation’s primary mental health facilities.” Treatmentadvocacycenter.org currently estimates “that there are currently 356,000 inmates with serious mental illness in jails and state prisons.” To crystalize these estimates, the population of our nation’s prisons roughly matches the entire populations of Pittsburgh, Philadelphia, and most of central Pennsylvania. The number of mentally ill in America’s prisons is approximately equal to every man, woman and child in Cleveland or New Orleans or Corpus Christi.
How did we get into this mess? Some of it started when politicians decided that they could get elected and stay elected by being “tough on crime.” They voted for mandatory minimum sentences, taking discretion away from the judiciary. And, although approximately half of our prisoners were convicted of non-violent, drug related offenses, our elected officials decided to spend our hard-earned tax dollars on building more prisons rather than voting for funding to pay for alcohol and drug treatment.
In Pennsylvania, it costs approximately $42,000 to keep each prisoner behind bars annually, not counting the cost of the cell itself. Where does all the money for prisons come from? Taxes, of course. And, to a significant degree, the money for building prisons was stolen from our public mental health system. Part of John Kennedy’s vision for an American Camelot included a national system of well-funded community mental health centers that would serve the mentally ill in their own hometowns, thereby permitting the closing of a well-developed system of state mental hospitals that had been providing inpatient treatment for the severely mentally ill. Those of us old enough to remember the 1970s recall an era of widely available, well-funded, mental health care provided through local Community Mental Health Centers. Oddly enough, the systematic under-funding and disempowering of our Mental Health Centers coincided with the increase in funding of the prison system to support the “Get Tough on Crime” movement that spread like a well-intentioned plague from sea to shining sea.
Is there anything to be done about all this? Of course!
For starters, we need to depend more on special judicial institutions, sometimes referred to as “Mental Health Courts” and “Drug and Alcohol Courts.” These new courts operate under a different set of regulations and expectations from our normal criminal courts. Provision is made to include mental health professionals, judges are given wide discretion, and the focus is more on rehabilitation and prevention than it is on punishment. These courts are a good place to begin.
Then, we need to improve the funding for our mental health system and stop wasting billions on the largest prison system in the history of the world.
Tell your elected representatives. We need to do more than get tough on crime; we need to get smart on crime. We can do better.
Stephen A. Ragusea, Psy D, is a clinical psychologist in Lewisburg.
