Report: 10 times more mentally ill in prisons than hospitals

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A national report released earlier this week contained an eye-popping statistic: State jails and prisons have 10 times more mentally ill inmates (an estimated 356,268) than state psychiatric hospitals have patients.

In 44 states including Minnesota, at least one prison or jail holds more people with serious mental illnesses than the largest state psychiatric hospital, according to the new study by the Treatment Advocacy Center and the National Sheriffs’ Association.

The numbers now are similar to the U.S. mental health system in 1830, before reformers like Dorothea Dix led efforts to push the mentally ill out of prisons and into hospitals, report author Dr. E. Fuller Torrey noted.

“We’ve basically gone back to where we were 170 years ago,” Torrey tells Kaiser Health News. “We are doing an abysmal job of treating people with serious mental illnesses in this country. It is both inhumane and shocking the way we have dumped them into the state prisons and the local jails.”

Torrey and others have said an effort begun in the 1950s to deinstitutionalize the mentally ill sought to get patients out of large, public institutions and into community treatment programs, with support systems designed to get patients jobs and housing.

And the numbers fell: from roughly 560,000 patients in state hospitals in 1950 to 154,000 in 1980, the new report says. But these days, too many mentally ill people end up in jail or prison, the report says.

In all, the Department of Justice has estimated that nationwide about 15 percent of state prisoners, and 24 percent in jails, "reported symptoms that met the criteria for a psychotic disorder."

The report offers a grim picture in Minnesota: "The largest public institution for seriously mentally ill individuals in Minnesota is the Security Hospital at St. Peter. Its 400 patients are restricted to forensic cases and sex offenders. For mentally ill individuals who need brief hospitalization for medication stabilization, there are very few options, since the remainder of the state hospital system has been virtually closed. In Minneapolis, many end up in the Hennepin County Jail, which, 'on any given day holds 100 to 200 inmates with severe psychiatric disorders.'"

State leaders have taken note. "We've been using our criminal justice system as a substitute for a well-functioning mental health system – we've sort of criminalized mental illness and addiction," Sen. Al Franken, D-Minn., said last year, as he introduced a bill to combat the issue.

The problem can be especially acute in rural areas. “In my opinion, we’ve gone back to the dark ages,” Kandiyohi County Attorney Jenna Fischer told the Star Tribune last year. “It’s a tiny segment of the mentally ill, but we are failing them.”

The Star Tribune noted that Minnesota spent several decades shifting patients out of huge state hospitals into more local programs, and for many, the change was largely successful. But for others with volatile mental states, the change has not gone smoothly – during one 18-month span, roughly 4,000 in the state with acute mental illness ended up in jail, where judges committed them to state facilities, the newspaper notes.

The issue of moving the sex offenders out of the state's St. Peter facility have been the subject of much debate and a class-action lawsuit in recent months.

Gov. Mark Dayton and a federal judge have urged state lawmakers to review whether roughly 700 sex offenders held at St. Peter and a facility in Moose Lake can be civilly committed indefinitely – or whether keeping them there violates their rights and amounts to further punishment after they have served prison sentences.

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