https://www.city-journal.org/miami-dade-criminal-mental-health-project%E2%80%8B
Barbaric conditions in mental institutions were a common target of journalistic exposés during the asylum era of the nineteenth and twentieth centuries. These days, though, most accounts of gross maltreatment of the mentally ill concern jails, not hospitals. Deinstitutionalization emptied America’s asylums in the name of providing more humane treatment, but that approach has left many seriously mentally ill people on the streets, where, untreated, they can spiral into disorder and violent behavior—often putting them behind bars. This year, Alisa Roth’s book Insane: America’s Criminal Treatment of Mental Illness and a series of articles by the Virginian-Pilot on mental illness in American jails have detailed the many ways in which incarceration tends to worsen serious mental illness.
For starters, jails are full of criminals. Serious offenders often harass, harm, and degrade those locked up for more minor offenses, including the mentally ill. Jails are noisy, and the population is highly transient (the standard stay is less than a month), making for “an especially unstable and disorienting social environment,” in Roth’s words. Effective treatment depends on an accurate diagnosis, but that can be a complicated process under ordinary circumstances (there’s no brain scan or blood test for mental illness), and even worse for a newly arrived jail inmate who may never have seen a psychiatrist before. When the mentally ill have trouble following jail rules, their difficulties can come across to corrections officers as insubordination.
Their propensity to break rules and commit additional crimes behind bars helps explain why mentally ill inmates often stay in jail far longer than typical inmates. They behave erratically, so it’s hard for them to mix with the general inmate population; but putting them in solitary confinement is unlikely to improve their condition. Recovery from mental illness requires not only therapy and medication but also meaningful opportunities for recreation and employment tailored to needs and capabilities. These aren’t likely to be abundant in jail, since, among other reasons, the unpredictability of release dates frustrates the development of plans for care. Incarcerated Americans have a constitutional right to mental-health care, thanks to Supreme Court and federal court rulings, but, far too often, those guarantees don’t equate to real-world benefits.