Out of Sight, Out of Mind: Mental Illness Behind Bars




David R. Rubinow, M.D.

The American Journal of Psychiatry

October 1, 2014



In the 1840s, Dorothea Dix traveled the country confronting state legislatures about the unconscionable treatment of prisoners and urging, in particular, the building of hospitals for those with psychiatric illness. By the 1880s, there were 75 psychiatric hospitals in the United States, and a survey estimated that less than 1% of prisoners had mental illness. For the next 90 years, it was widely accepted in the United States that people with mental illness belonged in hospitals rather than prisons.

Then it all came undone. In 1955, approximately 560,000 patients occupied state hospital beds; today the number is approximately 35,000. It is no mystery where the patients went: In 1880, 0.7% of U.S. prisoners had serious mental illness; in the 1970s, the rate was approximately 5%, and today it is likely more than 20% (an estimated total of almost 360,000 inmates). In a rather astonishing yet woefully unsurprising statistic, Torrey et al. estimate that there are 10 times as many mentally ill persons in prisons than in state hospital beds. Furthermore, in their state-by-state survey of the “treatment of mentally ill persons in prisons and jails,” as the article is ironically titled, the authors conclude that the resources and policies required for “treatment” of incarcerated patients are virtually absent. It would appear, then, that we somehow have achieved the complete reversal of policies initiated over 170 years ago to ensure the humane treatment of those with mental illness. How did we get here?



Full article at http://ajp.psychiatryonline.org/article.aspx?articleID=1911272






Human Services and Justice Coordinating Committee