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November 23, 2014

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Inside a mental hospital called jail

The largest mental health center in America is a huge compound here in Chicago, with thousands of people suffering from manias, psychoses and other disorders, all surrounded by high fences and barbed wire.

Just one thing: It’s a jail. The only way to get treatment is to be arrested.

Psychiatric disorders are the only kind of sickness that we as a society regularly respond to not with sympathy but with handcuffs and incarceration. And as more humane and cost-effective ways of treating mental illness have been cut back, we increasingly resort to the law-enforcement toolbox: jails and prisons.

More than half of prisoners in the United States have a mental health problem, according to a 2006 Justice Department study. Among female inmates, almost three-quarters have a mental disorder.

In the jail here, some prisoners sit on their beds all day long, lost in their delusions, oblivious to their surroundings, hearing voices, sometimes talking back to them. The first person to say that this system is barbaric is their jailer.

“It’s criminalizing mental illness,” the Cook County sheriff, Thomas Dart, told me as he showed me the jail, on a day when 60 percent of the jail’s intake reported that they had been diagnosed with mental illness. Dart says the system is abhorrent and senseless, as well as an astronomically expensive way to treat mental illness — but that he has no choice but to accept schizophrenic, bipolar, depressive and psychotic prisoners delivered by local police forces.

People are not officially incarcerated because of psychiatric ailments, but that’s the unintended effect. Dart says that although some mentally ill people commit serious crimes, the great majority are brought in for offenses that flow from mental illness.

One 47-year-old man I spoke to, George, (I’m not permitted to use last names for legal reasons) is bipolar, hears voices and abuses drugs and alcohol. He said he had been arrested five times since October for petty offenses. The current offense is criminal trespass for refusing to leave a laundromat.

The sheriff says such examples are common and asks: “How will we be viewed, 20, 30, 50 years from now? We’ll be looked on as the ones who locked up all the mentally ill people.

“It really is one of those things so rich with irony: The same society that abhorred the idea that we lock people up in mental hospitals, now we lock people up in jails.”

A few data snapshots:

• Nationwide in America, more than three times as many mentally ill people are housed in prisons and jails as in hospitals, according to a 2010 study by the National Sheriffs’ Association and the Treatment Advocacy Center.

• Mentally ill inmates are often preyed upon while incarcerated or disciplined because of trouble following rules. They are much more likely than other prisoners, for example, to be injured in a fight in jail, the Justice Department says.

• Forty percent of people with serious mental illnesses have been arrested at some point in their lives.

In the 1800s, Dorothea Dix led a campaign against the imprisonment of the mentally ill, leading to far-reaching reforms and the establishment of mental hospitals. Now we as a society have, in effect, returned to the 1800s.

Among those jailed here is Russell, 46, who is being held for burglarizing a garage. He has been diagnosed with severe depression and said that he self-medicates with alcohol and drugs.

Most of his adult life has been spent behind bars for one offense after another, and he said he became aware of his mental health problems when he was being clubbed by a thug with a baseball bat and realized that he was enjoying it.

“I just want to be normal,” he said as we spoke in a large dormitory room for inmates with psychiatric problems. “I want to have a job. I’ve never had a job. I want to be able to say hi to a co-worker.” He stopped, and there were tears in his eyes.

In 1955, there was one bed in a psychiatric ward for every 300 Americans; now there is one for every 3,000 Americans, the 2010 study said. So while more effective pharmacological treatments are theoretically available, they are often very difficult to access for people who are only borderline functional.

“Some people come here to get medication,” says Ardell Hall, a superintendent of a women’s unit at the jail. “They commit a crime to get in.”

India, a 42-year-old woman, suffers from manic depression and post-traumatic stress disorder. She said she tried at various times to get psychiatric care but found it almost impossible, so she self-medicates when on the outside with heroin — and has spent almost all of her adult life in jails and prisons on a succession of nonviolent offenses relating to drugs and shoplifting.

Taxpayers spend as much as $300 or $400 a day supporting patients with psychiatric disorders while they are in jail, partly because the mentally ill require medication and extra supervision and care.

“Fiscally, this is the stupidest thing I’ve seen government do,” Dart says. It would be far cheaper, he adds, to manage the mentally ill with a case worker on the outside than to spend such sums incarcerating them.

Cook County has implemented an exemplary system for mental health support for inmates. While in jail, they often stabilize. Then they are released, go off their medications and the cycle repeats.

One woman in the jail, Kristen, said she had been diagnosed with depression and anxiety disorders. On the outside, her prescription medication cost $100 a month, so she skipped it.

“When I’m not on my medicine on a regular basis, I don’t make decisions well,” she said, explaining her long arrest record for theft and narcotics offenses. I asked her whether access to medicine would keep her out of jail, and she said: “I don’t know if that’s necessarily true, to be totally honest. But it would help.”

As Dart puts it: “We’ve systematically shut down all the mental health facilities, so the mentally ill have nowhere else to go. We’ve become the de facto mental health hospital.”

Do we really want to go back two centuries? Doesn’t that seem not only inhumane but also deluded — on our part?

Nicholas Kristof is a columnist for The New York Times.

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