Hard Time or Hospital Treatment? Mental Illness and the Criminal Justice System

Christine Montross
The New England Journal of Medicine
2016; 375:1407-1409

Here is an excerpt:

When law enforcement is involved, the trajectory of my patients’ lives veers sharply. The consequences are unpredictable and range from stability and safety to unmitigated disaster. When patients are ill or afraid enough to be potentially assaultive, the earliest decision as to whether they belong in jail or in the hospital may shape the course of the next many years of their lives.

It’s now well understood that the closing of state hospitals in the 1970s and 1980s led to the containment of mentally ill people in correctional facilities. Today our jails and state prisons contain an estimated 356,000 inmates with serious mental illness, while only about 35,000 people with serious mental illness are being treated in state hospitals — stark evidence of the decimation of the public mental health system.

When a mentally ill person comes into contact with the criminal justice system, the decision about whether that person belongs in jail or in the hospital is rarely a clinical one. Instead, it’s made by the gatekeepers of the legal system: police officers, prosecutors, and judges. The poor, members of minority groups, and people with a history of law-enforcement involvement are shuttled into the correctional system in disproportionate numbers; they are more likely to be arrested and less likely than their more privileged counterparts to be adequately treated for their psychiatric illnesses.

The article is here.

After Decades in Institutions, a Bumpy Journey to a New Life

By RACHEL L. SWARNS
The New York Times
Originally published September 29, 2012

Here are some excerpts:

Once viewed as outcasts to be shunned and isolated in institutions, hundreds of Georgia’s most disabled citizens are taking their first tentative steps back into society. Their fledgling journeys, marked by uncertainty, jubilation and some setbacks, are unfolding as officials embark on an ambitious plan to profoundly reshape the lives of the cognitively and physically impaired.

It is a new strategy for Georgia, one of several states responding to mounting pressure from the Justice Department, which in recent years has threatened legal action against states accused of violating the civil rights of thousands of developmentally disabled people by needlessly segregating them in public hospitals, nursing homes and day programs.

Mississippi, which has nearly 2,000 developmentally disabled people living in its institutions, began moving dozens of them out this spring. Virginia, which reached a settlement with the Justice Department this year, expects to move more than 400 people out by the end of the 2016 fiscal year.

Here in Georgia, about 360 developmentally disabled patients have left state hospitals over the past two years, health officials say, moving mostly into small group homes that house four people each. About 400 more will leave over the next three years, nearly emptying the state’s institutions of people with severe mental disabilities, autism and dementia.

Advocates for the disabled are hailing the move as akin to the demise of racial segregation. For the first time, people who have spent decades in hospital wards will live in the community, have some say in their day-to-day activities and get the opportunity to meet and mingle with their neighbors.

“Everybody has a right to live in the world,” said Pat Nobbie, deputy director of the Georgia Council on Developmental Disabilities, who supports the shift.

The entire story is here.