VII. Federal Legislation
Crime and disorder are often associated with deviation from the traditional norms and values of society. To ensure that the norms and values are met and respected, laws are instituted that govern behaviors of individuals and prohibit deviant behaviors. These deviant behaviors are often associated with crime. According to the U.S. Surgeon General, the term mental illness refers collectively to all diagnosable mental disorders: conditions that result in alterations of thinking, mood, and behavior. These alterations often cause deviations from normal behavior and thus are often classified as crime. Couple this with the estimated 5% of the U.S. population that have a mental illness, and the problem of mental illness and crime becomes apparent.
Individuals with mental illness typically access the criminal justice system through law enforcement, courts, and corrections (jail, prison, community corrections, and probation). At the time of arrest, mentally ill offenders begin the journey through the criminal justice system. This flow through the system comprises the following five steps: (1) arrest; (2) booking (jail); (3) court; (4) prison, jail, or probation; and (5) release.
During each of these phases, mentally ill offenders come into contact with different actors in the criminal justice system, ranging from law enforcement officers, prosecutors and defense attorneys, through judicial personnel to corrections personnel. As a result, according to the Bazelon Center for Mental Health Law (http://www.bazelon.org/), these offenders repeatedly use a significant amount of law enforcement and judicial resources during their initial contact. Also, these offenders’ lack of conformity to correctional policy often leads to significantly more time spent in the institutions or on probation, further draining already scarce resources.
To fully appreciate the impact of mental illness and crime, it is important to understand the dynamics of the population of which we speak. In 1955, there were 558,239 severely mentally ill patients in U.S. public psychiatric hospitals; in 1994, there were 71,619. On the basis of population growth, at the same per capita utilization as in 1955, there would have been an estimated 885,010 patients in state hospitals in 1994 (Torrey, 1997). Most of this projected population—more than 800,000 potential patients— live in the community.
The treatment of individuals with mental illness has undergone vast shifts over time. Around 400 BCE, the Greek physician Hippocrates treated mental illness as a physiological disease. Other cultures, including Indian, Egyptian, and Roman, understood mental illness to be a result of displeasure from the gods or some form of demonic possession (MacLowry & Samuels, 2003). Throughout the Middle Ages, many mentally ill people were assumed to be witches or possessed by demons. In 1407, the first European establishment specifically for people with mental illness was established in Valencia, Spain (MacLowry & Samuels, 2003). During the 1600s, mentally ill people were confined in dungeons and mixed with handicapped people, vagrants, and delinquents, while experiencing increasingly inhumane treatment. In the 1700s, several European reformers began to slowly change the way mentally ill people were treated. In particular, the Gaol Act of 1774, promoted by John Howard, the High Sheriff of Bedford, addressed the idea of improving jails. Among other things, Howard published The State of Prisons in England and Wales, with an Account of Some Foreign Prisons in 1777, which was an account of his travels and gaol (jail) inspections across England. His work was so controversial that it was banned in several foreign countries, one of which was France. In his book, Howard advocated for the removal of mentally ill inmates from gaols and their placement in institutions designed for their care.
In addition to Howard’s work in England, the United States had its share of corrections reformers. Thomas Jefferson worked with Benjamin LaTrobe in Virginia to develop a circular prison that provided direct viewing of inmates by the guards. The prison was completed in 1800 and aptly named the Virginia State Penitentiary. Among continuing reforms, such as the separation of males and females (1789) and the separation of juveniles from adults (1823), the separation of mentally ill people from inmates in prisons and jails and their placement in mental institutions occurred in 1854. This was largely due to the work of Dorothea Dix during the 1840s. Living in Massachusetts, she observed mentally ill people of all ages incarcerated with criminals. These individuals were often left unclothed and in dark cells that lacked both heat and bathroom facilities. In addition, many of the mentally ill were chained and beaten on a regular basis. Armed with that information, Dix successfully lobbied for and established 32 state hospitals for the mentally ill over a 40-year period in the mid- to late 1800s (MacLowry & Samuels, 2003). In addition to these reforms, in 1887 a female journalist named Nellie Bly went undercover in Blackwell Island, a New York facility for mentally ill women. Her undercover investigation, sponsored by the New York World newspaper, uncovered widespread mistreatment of patients and corruption of staff throughout the facility. Among the issues she uncovered were poor hygiene practices (with multiple patients using the same towel and comb), food quality issues (patients were fed rancid food and doctors and nurses dined on fresh fruit, bread, and meat), and medical malpractice (patients were rarely seen by doctors). As a result of Bly’s expose, an investigation commenced that resulted in some officials being tried in court and fired, as well as a $3 million allocation for improvements at the facility.
This system was in place for more than 100 years before the deinstitutionalization of the mentally ill, brought about by horrible abuses and lack of accountability in mental institutions, gained momentum. This momentum would carry the mentally ill back into prisons and jails at an alarming rate and make America’s jails and prisons, in essence, warehouses for mentally ill individuals.
During the 1960s, many mentally ill people were removed from institutions and moved toward community placement and local mental health care. In 1963, Congress passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act, which provided federal monies to develop a network of community-based mental health resources that would lessen the burden on the institutions. This legislation presumed that mentally ill individuals would voluntarily seek out assistance and treatment. Unfortunately, this presumption was not correct.
The deinstitutionalization of the mentally ill and the issues faced by communities in regard to lack of treatment and resources resulted in the formation of several advocacy organizations, the most prolific of which is the National Alliance on Mental Illness (NAMI). According to the group’s Web site (http://www.nami.org/), NAMI is “the nation’s largest grassroots organization for people with mental illness and their families. Founded in 1979, NAMI has affiliates in every state and in more than 1,100 local communities across the country.” Among many other functions, NAMI formed an advocacy center called the Law and Criminal Justice Action Center, which is responsible for promoting the interests of people with mental illness in state and federal legislation. NAMI and other advocacy groups have advanced awareness and treatment of mentally ill people in the justice system.
As deinstitutionalization became the norm in the United States, there took place an influx of mentally ill persons into communities that were ill-prepared to care for them. As a result of this influx and the lack of preparedness, communities often turned to the system of last resort: the criminal justice system, which comprises law enforcement, courts, and corrections. Law enforcement and corrections operate 24 hours a day, 7 days a week, thus making them the logical choice for communities experiencing issues with mentally ill people. As a result, many mentally ill people went from state institutions to state and local prisons and jails by way of law enforcement arrest and court convictions.