Mental Hell-th
Hell on earth does, indeed, exist. Just ask products of a system that deinstitutionalized, with the best of intentions, the mentally ill back in the 1960s, in order to provide what was thought to be better care in the community, rather than in state-run asylums with the horrors they engendered in the minds of those who oversaw them in previous decades. The movement toward treatment of the mentally ill in the community was further buttressed by Academy Award-winning films, like One Flew Over the Cuckoo’s Nest, in the 1970s. The cycle has now become vicious today, however, and it begins with mental health agencies, child protective services, special education, juvenile justice, residential treatment centers, therapy sessions, psychological evaluations, medication management, psychiatric hospitalizations, and a plethora of other mental health services in youth, and proceeds through a repetitive waxing and waning of criminal activities and incarcerations. It appears that the mentally ill, from “modest beginnings” in their youth, are destined to reach the “big show” in our nation’s state prisons and local jails, if something is not done to create alternative mental health facilities and institutions. The numbers are staggering. More than half of all prison and jail inmates have a mental health problem of some kind, with the prevalence of mental disorders in the criminal justice system outstripping its rate in the general population by three times. To make matters worse, as many as 40 percent of people in the U.S. with mental illnesses are not receiving treatment, which “fast-tracks” them into lives of crime and eventual incarceration in state and local criminal justice facilities, where only about one-third of them will receive adequate mental health treatment. The bottom line: inmates with mental health issues released into the public domain with few “people skills,” with the inability to live self-sufficiently, and with overriding mental health deficiencies ranging from schizophrenia and bipolar disorder, to depression and acute psychosis from drug abuse, will most likely fall victim to recidivism and land once again in detention facilities, due to an utter lack of innate structure and responsibility that would enable them to live freely in society.
So, we must pose the question of why the U.S. criminal justice system has become what state mental institutions of yore once were? Obviously, when the latter facilities were closed, the “slack” had to be picked up somewhere by someone. It had never dawned on the public, our state legislatures and federal government, and communities across the nation that many “criminal” offenders, who, in reality, were victims of unrecognized or perhaps even ignored acute and/or chronic mental illnesses, would repeatedly recycle through state prison or local jail systems, draining precious dollars from state and federal coffers already stretched thin. Police officers in communities across the nation had not been trained adequately to recognize mental illness, district courts had remained nearsighted and continued to sentence offenders with mental illnesses to jails instead of treatment services, mental health courts had not existed to date, government had failed its responsibility to help the weakest links in our population chain and those who could not help themselves, funding for mental health services had continued to remain scarce, and community corrections and mental health providers had failed to collaborate with one another. All that has changed now, as mental health services, even now in times of financial shortfalls, contribute to re-entry of offenders from prison back into the community, via a series of evidence-based practices and programs.
While criminal recidivism and repeat incarceration have been reduced and continue to show signs of slow, progressive decline, the picture is not completely rosy. Money, as always, is the name of the game, and, while treatment of mental disorders constitutes greater than 6 percent of all health care spending, public health care financing for treatment and prevention of mental illnesses and for housing, employment, and other community services available to ex-incarceration populations falls substantially short of the ideal, or even the minimally adequate.
As states like New Mexico and Oregon vie for new, innovative approaches to financing community and mental health services, such as mental health call centers, transitional housing of freed offenders until gainful employment can be found, law enforcement street supervision programs, and mental health services in the jails themselves, the gap between mental health services and the criminal justice system continues to widen, although to a lesser degree than in the past.
While the descent into “mental hell-th” has been temporarily halted for many misdiagnosed “criminals,” without further availability of state and federal funding to mental health treatment and rehabilitative services, a further fall from grace and transformation of the sick role into hardened criminality is envisioned.
© 2008, Albert M. Balesh, M.D. All rights reserved.
So, we must pose the question of why the U.S. criminal justice system has become what state mental institutions of yore once were? Obviously, when the latter facilities were closed, the “slack” had to be picked up somewhere by someone. It had never dawned on the public, our state legislatures and federal government, and communities across the nation that many “criminal” offenders, who, in reality, were victims of unrecognized or perhaps even ignored acute and/or chronic mental illnesses, would repeatedly recycle through state prison or local jail systems, draining precious dollars from state and federal coffers already stretched thin. Police officers in communities across the nation had not been trained adequately to recognize mental illness, district courts had remained nearsighted and continued to sentence offenders with mental illnesses to jails instead of treatment services, mental health courts had not existed to date, government had failed its responsibility to help the weakest links in our population chain and those who could not help themselves, funding for mental health services had continued to remain scarce, and community corrections and mental health providers had failed to collaborate with one another. All that has changed now, as mental health services, even now in times of financial shortfalls, contribute to re-entry of offenders from prison back into the community, via a series of evidence-based practices and programs.
While criminal recidivism and repeat incarceration have been reduced and continue to show signs of slow, progressive decline, the picture is not completely rosy. Money, as always, is the name of the game, and, while treatment of mental disorders constitutes greater than 6 percent of all health care spending, public health care financing for treatment and prevention of mental illnesses and for housing, employment, and other community services available to ex-incarceration populations falls substantially short of the ideal, or even the minimally adequate.
As states like New Mexico and Oregon vie for new, innovative approaches to financing community and mental health services, such as mental health call centers, transitional housing of freed offenders until gainful employment can be found, law enforcement street supervision programs, and mental health services in the jails themselves, the gap between mental health services and the criminal justice system continues to widen, although to a lesser degree than in the past.
While the descent into “mental hell-th” has been temporarily halted for many misdiagnosed “criminals,” without further availability of state and federal funding to mental health treatment and rehabilitative services, a further fall from grace and transformation of the sick role into hardened criminality is envisioned.
© 2008, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
11/10/2008 03:48:00 PM
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