Tuesday, December 9, 2014

Criminalization of Mental Illness


Once in hospitals, patients with mental illness now behind bars in R.I., across U.S.

Published: December 08, 2014 11:15 PM

The Providence Journal

By G. WAYNE MILLER Journal Staff Writer gwmiller@providencejournal.com

PROVIDENCE — As public psychiatric hospitals across America closed from the 1960s into the 1990s, a “transinstitutional shift” occurred that has resulted in record numbers of people with mental illness being imprisoned — often for such petty crimes as trespassing and shoplifting, and sometimes for no offense worse than annoying behavior.

That was a dominant theme Monday during a forum at Butler Hospital that attracted a standing-room-only crowd of mental-health professionals and advocates, and representatives of law-enforcement agencies and state departments. The forum, “Criminalization of Mental Illness,” was sponsored by the Mental Health Association of Rhode Island.

Madelon Baranoski, associate professor of psychiatry at Yale University and a national authority on the issue, spoke of the era of deinstitutionalization, when patients discharged from state hospitals did not receive the support they needed.

“When people were released to the community, resources didn’t follow,” she said. “Housing didn’t follow, jobs didn’t follow, and enough supports didn’t follow. The shift without resources contributed to increased stigma.… The result was a transinstitutional shift to jail. And it’s pretty dramatic.”

Baranoski projected a series of slides showing patients in now-closed psychiatric hospitals, many notorious for their abuses, with others showing inmates in contemporary prisons: except for the uniforms, both groups looked strikingly similar.

She also presented damning statistics.

“In 1960, one in every 300 Americans was confined in a mental hospital,” she said. “Now, one in every 200 Americans is caught up in the criminal justice system: either incarcerated, on probation, on parole, or pretrial. And in some communities, the numbers are much, much greater.”

In Rhode Island, an estimated 15 percent to 17 percent of the approximately 3,200 inmates at the Adult Correctional Institutions have been diagnosed with severe and persistent mental illness, according to the Department of Corrections.

Although Rhode Island initially succeeded better than most states in providing community resources as it moved toward closing its public psychiatric hospital, the old Institute of Mental Health in Cranston, the statewide community system in recent years has suffered. Legislative leadership on mental-health issues has been lacking, as has broad cooperation among state and local agencies and departments. Funding has been cut.

And all too often, here and in other states, people who don’t belong in prison are sent there because they become a “nuisance” to others.

“One big shift was people who were struggling against the burden of mental illness in the community without the resources ended up violating social propriety — often in very, very small ways — but repeatedly,” Baranoski said.

Outreach and diversion programs that substitute treatment for incarceration, the Yale professor said, can prevent unnecessary imprisonments. So can training police officers in the proper approaches to people living with mental illness — approaches that can drive down arrests.

She gave the example of a man in New Haven who cycled in and out of jail before a diversion program was established in the city.

The man, she said, “was in and out of jail for simple things but very annoying things. Like moving mailboxes. Like walking into Dunkin’ Donuts and when someone went up to get a doughnut, drinking that person’s coffee. It wasn’t violent, but it disrupted business.”

Since the program opened, she said, the man has not seen the inside of a cell.

“We can do better,” Baranoski said, “but it takes ingenuity, creativity, tolerance and a lot of money.”

Also speaking at Monday’s forum were A.T. Wall, director of the state Department of Corrections; Craig Stenning, director of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals; John Head, director of communications for the Washington, D.C.-based Bazelon Center for Mental Health Law; and Jo Freedman, mental health coordinator with the Portland, Maine, Police Department.

On Sunday, as part of its ongoing series, Mental Health in Rhode Island, The Journal will publish an in-depth story on people with mental illness in prison. Read earlier installments in the series.

On Twitter: @gwaynemiller