Richard Nakamura, Ph.D., of the National Institute of Mental Health
presents data on the criminalization of mental illness at the annual
congressional briefing sponsored by APA and the National Alliance on Mental
Illness. See article below.
Federal support is needed to reverse the increasing"
criminalization" of mental illness and drug addiction, according
to APA and federal health officials.
A growing body of evidence demonstrates that the criminal justice system
has taken over from the public health system as the destination for many with
mental illness and addictions. That was the message delivered to members of
Congress and their staffs last month at the annual Mental Illness Awareness
Week event sponsored by APA and the National Alliance on Mental Illness
"With the reduction of psychiatric beds in past years, there is only
one place that can't say `no' when you need someone kept away from society:
the criminal justice system," said Richard Nakamura, Ph.D., deputy
director of the National Institute of Mental Health.
Nakamura and others cited statistics such as those from 1996 research by
Linda Teplin, Ph.D., that found that 1 million, or 8 percent, of jail bookings
annually involve persons with severe mental illness. A more recent study of
the Chicago jail found that 6 percent of males and 12 percent of females
entering the system had severe mental disorders, including schizophrenia,
mania, and major depression. A 2005 study by H. Richard Lamb, M.D., and Linda
Weinberger, Ph.D., concluded that as much as 24 percent of the prison
population has a severe mental illness.
More recently, the Department of Justice's Bureau of Justice Statistics
(BJs) reported that more than half of all prison and jail inmates have mental
health problems (see page
6). Tom Hamilton, Ph.D., NAMI's liaison to APA's Committee on Jails
and Prisons, said that the report was flawed, however, because it did not
address the number of inmates suffering from severe and persistent mental
"I suspect if most of us spent much time in these places, we would
all develop mental health "problems,'" Hamilton said.
Generally, discrepancies in the number of inmates with mental illness
identified by researchers are likely due to differences in the ways they
define mental illness, he said. But despite the varying percentages of
prisoners with mental illness, people with mental illness are more than twice
as likely to be incarcerated.
The cause of the burgeoning number of prison inmates with mental illness in
recent decades appears linked to the falling number of state psychiatric beds
since the 1960s, Hamilton said. He presented data from Texas to illustrate"
transinstitutionalization" of inmates from state psychiatric
hospitals to the criminal justice system. Jail data from Harris County, Texas,
which includes Houston, showed that 37 percent of inmates had a serious mental
illness, based on a matching of jail and county public mental health
The nationwide deinstitutionalization of patients with mental illness,
which led to the loss of 90 percent of state psychiatric beds over the last 50
years, was supposed to be replaced with a system of 2,000 community mental
health centers. But most states viewed the closure of psychiatric hospitals as
a chance to save money, Hamilton said, which resulted in the creation of fewer
than 700 "underfunded" community-based mental health
Also contributing to the problem is the prevalence of substance abuse among
people charged with or convicted of crimes. Nearly 6 in 10 mentally ill
offenders reported they were under the influence of alcohol or drugs at the
time of their latest offense, according to a 1999 BJS report. It also found
that one-third of offenders identified as mentally ill were alcohol
"Just locking up addicts so they can't feed their addictions sounds
good, but the problem is that it just doesn't work," said Wilson
Compton, M.D., director of the Division of Epidemiology, Services, and
Prevention Research at the National Institute on Drug Abuse, about the high
recidivism rates research has found among inmates with untreated
Although the problems are severe, evidence is mounting that specific
programs and approaches can reduce the number of inmates with mental illness
and drug addictions, the speakers noted.
Research has found significant progress in reducing addiction rates among
inmates when public-health efforts are combined with those of the
criminal-justice system, Compton said. The combination takes advantage of the
person's incarceration to provide consistent addiction treatment over several
months, an approach likely to prevent drug relapses and recidivism. The
efficacy of jail-based treatment was reported by a 2006 Maryland study that
found that 69 percent of heroin-addicted inmates who received counseling and
drug therapy in the months before their release continued treatment one month
after leaving prison, and only 29 percent tested positive for heroin.
"This study and others have led to major changes, where treatment is
at least being talked about as part of incarceration for those who need
it," Compton said.
Nakamura pointed out that research has found jail-diversion programs for
suspects with serious mental illness and co-occurring substance use conditions
reduce the time they spend incarcerated without increasing the public-safety
risk. Studies have also found that the costs for jail diversion are no higher
than those for imprisonment of those with mental illness, who often languish
in jail on minor charges because they lack the understanding or funds to fight
Other programs that deserve federal support are Crisis Intervention
Training for police officers and postincarceration programs to eliminate
recidivism, speakers pointed out.
Rep. Grace Napolitano (D-Calif.) told attendees that she supported their
goals of reduced incarceration and improved care for those with mental
illness, but that better national cost/benefit data are needed to convince
Congress to support these programs.
"The Republican majority understands cost/benefit, so you have to
show how these programs can save the government money," Napolitano
Until the nation develops a "safety net" to treat everyone with
mental illness, she added, the criminalization of mental illness and drug
addiction will continue to plague society.
The report "Mental Health Problems of Prisons and Jail
Inmates" is posted at<www.ojp.usdoj.gov/bjs/abstract/mhppji.htm>.▪