clearly describe what he wanted me to do. He complained about the conditions of his confinement until a random thought caused him to abruptly switch topics. He sent letters, too, but they were just as hard to follow as his phone calls, so I decided to speak with him in person to see if I could make better sense of how to help.
For over a century, institutional care for Americans suffering from serious mental illness shifted between prisons and hospitals set up to manage people with mental illness. In the late nineteenth century, alarmed by the inhumane treatment of incarcerated people suffering from mental illness, Dorothea Dix and Reverend Louis Dwight led a successful campaign to get the mentally ill out of prison. The numbers of incarcerated people with serious mental illness declined dramatically, while public and private mental health facilities emerged to provide care to the mentally distressed. State mental hospitals were soon everywhere.
By the middle of the twentieth century, abuses within mental institutions generated a lot of attention, and involuntary confinement of people became a significant problem. Families, teachers, and courts were sending thousands to institutions for eccentricities that were less attributable to acute mental illness than resistance to social, cultural, or sexual norms. People who were gay, resisted gender norms, or engaged in interracial dating often found themselves involuntarily committed. The introduction of antipsychotic medications like Thorazine held great promise for many people suffering from some severe mental health disorders, but the drug was overused in many mental institutions, resulting in terrible side effects and abuses. Aggressive and violent treatment protocols at some facilities generated horror stories that fueled a new campaign, this time to get people out of institutional mental health settings.
In the 1960s and 1970s, laws were enacted to make involuntary commitment much more difficult. Deinstitutionalization became the objective in many states. Mental health advocates and lawyers succeeded in winning a series of Supreme Court cases that forced states to transfer institutional residents to community programs. Legal rulings empowered people with developmental disabilities to refuse treatment and created rights for the mentally disabled that made forced institutionalization much less common. By the 1990s, several states had a deinstitutionalization rate of over 95 percent, meaning that for every hundred patients who had been residents in state hospitals before deinstitutionalization programs, fewer than five were residents when the study was conducted in the 1990s. In 1955, there was one psychiatric bed for every three hundred Americans; fifty years later, it was one bed for every three thousand.
While these reforms were desperately needed, deinstitutionalization intersected with the spread of mass imprisonment policies—expanding criminal statutes and harsh sentencing—to disastrous effect. The “free world” became perilous for deinstitutionalized poor people suffering from mental disabilities. The inability of many disabled, low-income people to receive treatment or necessary medication dramatically increased their likelihood of a police encounter that would result in jail or prison time. Jail and prison became the state’s strategy for dealing with a health crisis created by drug use and dependency. A flood of mentally ill people headed to prison for minor offenses and drug crimes or simply for behaviors their communities were unwilling to tolerate.
Today, over 50 percent of prison and jail inmates in the United States have a diagnosed mental illness, a rate nearly five times greater than that of the general adult population. Nearly one in five prison and jail inmates has a serious mental illness. In fact, there are more than three times the number of seriously mentally ill individuals in jail or prison than in hospitals; in some states that number is ten times. And prison is a terrible place for someone with mental illness or a neurological disorder that prison guards are not trained to understand.
For instance, when I still worked in Atlanta, our office sued Louisiana’s notorious Angola Prison for refusing to modify a policy that required prisoners in segregation cells to place their hands through bars for handcuffing before officers entered to move them. Disabled prisoners with epilepsy and seizure disorders would sometimes need assistance while convulsing in their cells, and because they couldn’t put their hands through the bars, guards would mace them or use fire extinguishers to subdue them. This intervention aggravated the health problems of the prisoners and sometimes resulted in death.
Most overcrowded prisons don’t have the capacity to provide care and treatment to the mentally ill. The lack of treatment makes compliance with the myriad rules that define prison life impossible for many disabled people. Other prisoners