Have you seen Netflix’s new critically acclaimed series Orange is the New Black?
If you haven’t, you should.
The series, based on the real life experiences of Piper Kerman, who served over a year in federal prison for her involvement in a drug trafficking scheme, offers a gripping look at life for women behind bars.
The show grapples with homosexuality, racism, and class differences in prison. But it is its look at the impact of mental illness on our prison population, and the astounding number of inmates who have serious mental disorders and addictions that drew our attention. We see, for example, how mentally ill inmates—like the character Crazy Eyes— are subjected to stigmatization and abuse by other prisoners and guards. And how another character—Tiffany “Pennsatucky” Doggett—illustrates the way prisoners fear the psychiatric ward, where inadequate and often inappropriate treatment is doled out.
But why are seriously mentally ill people in prison in the first place? In the modern era, the influx of prisoners with mental illness began in the 1950’s and 1960s. New drugs like thorazine promised to help treat severe mental illness cheaply and outside of institutions. States and the federal government pushed for community-based care, which led to a massive shutdown of psychiatric treatment facilities. It turned out, however, that the promise of community-based treatment was not to be fulfilled. By the 1980s as a result of the shuttering of psychiatric institutions, the streets and prisons became home to many of the nation’s seriously mentally ill.
A May 2010 report by the Treatment Advocacy Center and National Sheriffs’ Association estimated that there were three times as many mentally ill people in prison than in psychiatric hospitals nationwide and, in some states, like Arizona and Nevada, prisons house 10 times as many mentally ill people as hospitals do. That report found that Pennsylvania (2 to 1) and New Jersey (1.6 to 1) both are better than average among the states.
This transformation of the last half-century has been as financially costly as it has been morally disgraceful. According to the National Alliance on Mental Illness (NAMI), in 2002 prisoners with mental illness cost the United States approximately $9 billion a year. Researchers from the Treatment Advocacy Center found that a single mentally ill inmate on average cost states upward to $50,000 per year, while the average prisoner costs roughly $22,000 per year. A 2006 study by the Bureau of Justice Statistics found that more than half of prison inmates suffered from a mental disorder, constituting approximately 1.25 million people. And, according to NAMI, between 25% and 40% of the nation’s mentally ill pass through the criminal justice system. Yet only 6 in 10 state inmates and 4 in 10 local inmates report receiving treatment while incarcerated.
And the treatment that is provided within prisons is often designed and delivered as a way to maintain order rather than as a part of a long-term recovery plan. Those suffering from severe mental illness such as bipolar disorder, post-traumatic stress disorder, psychosis or schizophrenia are either left untreated or heavily medicated. They are given very little aftercare upon release. Prisoners with addictions—a majority of whom have co-occurring mental illnesses—will often quickly use again after their release. If drug use does not land them back in prison, they are more likely to commit a crime as a result of their addiction. Inevitably, persons with serious mental illnesses become repeat offenders.
It is simply impossible to effectively help a person recover from mental illness while they are living in an institution designed to punish them.
Orange is the New Black helps illustrate these sad facts. In so doing, it provides both mental health care advocates and the prison reform movement a rare opportunity to raise awareness and bring some sanity to the current penal-mental healthcare complex.
Andrea Segal is a research associate with the Scattergood Program for Applied Ethics of Behavioral Health Care in the University of Pennsylvania Perelman School of Medicine’s Department of Medical Ethics & Health Policy. Dominic Sisti directs the program.
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