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Introduction | A Visit to Jail | Locked Up and Psychotic
From the Street to Jail, and Back | What to Do?

Many police officers and jailers agree with psychologists that jails don't make good mental hospitals. But like it or not, jails have inherited that role. The modern trend started in the 1970's, when most of the nation's state mental hospitals were emptied and closed down.

"Closing state hospitals was very important because we had drugs at that point that worked so well that people no longer had to be in such restrictive environments," says psychologist Linda Teplin of Northwestern University. "The problem, though, is that at the same time we didn't provide the community-based alternatives."

The US Justice Department says 283,000 jail and prison inmates have a serious mental illness.

AP/Wide World Photos

Alternatives like group homes and outreach for the homeless mentally ill. During the Reagan Administration's budget-cutting drive in the 1980's, the federal government slashed funding for such programs, Teplin points out. "In 1975 it was around ten dollars per capita—and these figures are in constant dollars. By 1992 that dropped to just over five dollars per capita. Now, theoretically, state governments were supposed to pick up the slack but in reality they simply have not."

In Hennepin County, as in most every other city, treatment is in short supply. Mental health officials say they'd need five times their current staff of case managers to serve everyone in the county who has a serious mental illness. Then again, those potential clients aren't lining up for help. Which brings up another important change in recent decades: Starting in the late 1960's, courts declared that people with mental illnesses can choose not to get treatment so long as they're not a proven threat to themselves or others.

The man we're calling Mike, the schizophrenic plumber, got arrested when he wasn't taking his Olanzapine. His mother contends Mike should have been forced to take his drugs before he got in trouble.

"These people are not mentally competent to decide for themselves whether or not they need treatment. And how are they ever going to improve? How is society ever going to be able to live with them unless they are treated? In other illnesses, well, I guess if they want to take chances with their health, they have that right. But in mental illness there's too much at stake. Too much at stake."

It's not clear how society could force mentally ill people to take medication outside of institutions. Anyway, civil libertarians would object to forcing treatment on anyone who isn't proven to be dangerous. To do so would be an ominous step backward, they say.

"Keep in mind that we criticized the Soviet Union for defining dissent as a mental illness and confining people who were anti-Communist, as it were, to mental institutions," says Warren Maas, a Minneapolis defense attorney and psychologist.

Maas represents mentally ill people whom prosecutors, judges or relatives are seeking to commit to mental hospitals. Sure, Maas says, mentally ill people who are genuinely dangerous should be confined. But the behaviors that prompt commitment attempts often "aren't danger-based, they simply are annoying and people want them off the street and out of their home or something of that nature," Maas says.

Most groups representing the mentally ill don't want a return to forced treatment or confinement in hospitals. What's needed instead, they say, is more and better voluntary treatment. That might prevent more of the mentally ill from doing jail time.

And for those who inevitably do run afoul of the law? Almost everyone interviewed for this story agrees: jails and mental health programs need to work together more effectively and creatively. So people who break the law because of a mental disease get help for their illness—either after, or instead of, punishment.

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