https://www.city-journal.org/keeping-mentally-ill-out-of-jails
Stephen Eide joins City Journal associate editor Seth Barron to discuss how America’s health-care system fails the mentally ill, and the steps that cities and states are taking to keep the mentally ill out of jail and get them into treatment.
Audio Transcript
Seth Barron: We’re back with another edition of 10 blocks. This is your host, Seth Barron, associate editor of City Journal. People in big cities around the country regularly encounter individuals who are clearly troubled and often seriously mentally ill. Despite decades of work and attention to the issue, our society has not yet come up with an effective way to treat the mentally ill in a humane manner. In fact, many of these people wind up getting arrested, either for minor or serious crimes and then cycle in and out of the jail system, which has become the nation’s de facto mental health treatment facility. I’m joined now by Steven, I’d senior fellow at the Manhattan Institute and Contributing Editor to City Journal. He writes frequently on the intersecting issues of mental illness and homelessness, and has a piece in the current issue of City Journal entitled “Keeping the Mentally Ill Out of Jail.” Hi Steve. Thanks for joining us.
Stephen Eide: Hey Seth, so nice of you to have me on.
Seth Barron: So Steve, why is this a problem? Why aren’t the mentally ill in mental hospitals?
Stephen Eide: Well, that’s the way that we used to do it. When we talk about the public mental health care system, what the government does to help them mentally ill, it used to do that in only one way. Up until the 1950s, we ran these massive mental asylums, mental institutions that house hundreds of thousands of people. For various reasons, we decided to phase that system out, through a process known as deinstitutionalization. So now for the most part, we try to treat mentally ill, even people with serious mental illnesses such as schizophrenia, bipolar, depression, in the community, and outpatient for forms of treatment as much as possible. That has meant a somewhat fragmented system of delivery for mental health care. And oftentimes people have difficulty accessing the treatment that they need for their particular condition. And one of the reasons why we know that this approach does not work very well, why we regularly debate how to reform mental health care is the large numbers of mentally ill people in jails and prisons. In fact, in every state, the largest mental health facility, inpatient mental health facility you could say, is a jail which has a larger patient load than the than the largest state mental hospital at this point. So, this is a problem. In various ways, we try to address this rate of high levels of mental illness amongst our incarcerated population.
Seth Barron: Yeah. But what’s the problem with sending these people to jail if they’ve committed a crime? Are you in favor of an insanity defense?
Stephen Eide: Yes, but for most part, when we talk about the very large population mentally ill behind bars, we’re not talking about people who are guilty by reason of insanity. That’s a real sliver. And we’re really talking about jails, places where people go after they’ve been arrested before their case has been processed, before their offense, has been adjudicated. The idea I think is that most of these people are there because they’re sick, not because they’re criminals. Many of them are picked up for low level offenses, nonviolent offenses, and had they received proper treatment, they wouldn’t be there, but because they’re not receiving treatment, that’s where they wind up and many of them as many kind of journalistic exposes show, such as a series of the Virginia pilot newspaper last year, their condition tends to worsen while they’re behind bars.
