Fact: "The largest mental institution in the country is actually a wing of a county jail"(NPR, 2008). It has 1,400 mental health beds. This is in downtown Los Angeles, and is affectionately known as the Twin Towers. It is two identical hulking structures, one housing psych patients and one housing criminal offenders.
Fact: 11 of our 50 states have 6 or more mental hospitals. This includes Texas, Minnesota, Illinois, Missouri, Florida, Georgia, Virginia, Delaware, New York, Massachussettes, and Rhode Island (SAMHSA.gov).
Fact: 7 of the 11 states mentioned above also report having a shortage of psychiatric beds in that state, meaning there is an unserved mental health population in those states (SAMHSA.gov).
Fact: In 8 states, over half of state hospital expenditures were for forensic and mental health services (FCSMHA, 2007).
In light of these facts, some questions began to rise for me regarding the state of our mental health and criminal justice systems. Is their union a positive one or a disadvantage to the people they serve? Should we push for mental wards inside of jails, like in LA, or forensic units inside of psych hospitals? And what's the difference?
According to an article by NPR, the second in a 3 part series on our penal system, this is a tangled web we have woven. Let's begin with a small bit 'o history about mental health.
Not too many decades ago, around the 1970's, we had a significant institutionalized population in the nation's mental health hospitals. These were mostly state run hospitals, and they weren't four star accommodations. Then, around the same time we were experiencing several other social movements,such as womens' liberation, civil rights, protests, etc., we also had a social movement to free patients from these over crowded mental hospitals and move toward a community treatment approach. This is where our modern day day treatment programs and outpatient treatment were born.
According to the NPR article, this led to "thousands of mentally ill ended up on the streets, where they became involved in criminal activity". The article also later states that, "Often, the crimes these people commit are the result of their mental illness". This was a quote, but it was simply taken from a mental health worker at the hospital, not a source, and was not later backed up by data in the article. Also, in several places the article, they discuss that some of the inmates in the LA County jail may be feigning mental illness so that they can live on the mental health ward. I felt that this perpetuates the thought process that people who are found mentally incompetent in courts are simply faking and "getting off" by pretending. I found issue with these insinuations, as it was not cited from a source or supported in any way in the article, so I started to look up information to either support or dispute it.
Firstly, I thought, how do we know that the mentally ill were the perpetrators of these crimes? Then several thoughts followed, such as: Is there a prison that rivals the size of the nation's largest mental institution? Are the states where there are more mental hospitals to detain the mentally ill, represented by lower crime rates? Do mentally ill people get their medications when in jail? Do the states with more psych bed shortages have higher crime?
Here's what I found.
- The state with the highest crime rate is Nevada. Interestingly, this is not one of the 11 states with 6 or more mental hospitals.
- The largest penal institution in the US is in Louisiana. It is the largest maximum security prison. It is larger than the country's largest mental hospital, as it has it's own zip code (chacha.com).
- Of the 15 top US states with the highest crime, 3 of them are also part of the list of 11 states with the most mental hospitals. Therefore 20% of the top crime states are also top states for MH institutions.
- Out of the states with the most mental health hospitals, 6 (54%) have the lowest proportion of mentally ill to the general population. (So why do they have so many hospitals?)
-The state ranked 7 out of 50 for highest crime, Delaware, also saw the biggest increase in crime this year. Rhode Island also became more dangerous, moving nine places in the rankings. Interestingly, both of these states are part of the 11 states with the most psych hospitals.
So, I still found myself with questions. The data is somewhat conflicting. Yet, it could be interpreted in so many ways. Should we increase or decrease our number of state mental hospitals? Should mental hospitals offer more forensic services and beds? Should jails offer more mental health treatment? Should there be stand alone facilities that offer both services- Forensic Psychology Hospitals? Which would be more fiscally beneficial to our state and national budgets? How do we differentiate from the criminals and the disturbed, and how different are they? Please post your thoughts and questions.
Sources:
http://www.npr.org/templates/story/story.php?storyId=93581736
http://www.walletpop.com/2010/04/05/most-dangerous-states-crime-rankings-for-2010/
World Prison Population List, 8th Ed.
Funding and Characteristics of State Mental Health Agencies, 2007.
SAMHSA.gov
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