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fueled a new campaign, this time to get people out of institutional mental health settings.
In the 1960 s and 1970 s, 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 1990 s, 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 1990 s. 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 exploit or react violently to the
behavioral symptoms of the mentally ill. Frustrated prison staff frequently subject them to
abusive punishment, solitary confinement, or the most extreme forms of available detention.
Many judges, prosecutors, and defense lawyers do a poor job of recognizing the special needs
of the mentally disabled, which leads to wrongful convictions, lengthier prison terms, and
high rates of recidivism.