Mental illness a monumental prison problem

AMERICA just can't get it right when it comes to mental illness.

Decades ago, we shut down most of the country's psychiatric hospitals because they had become locked, Dickensian wards of cruelty and neglect for those with acute depression, schizophrenia, bipolar disorder and other conditions.

Exhibit A: Our region's own Pennhurst State School and Hospital, whose many buildings were shuttered in 1987 because of atrocities - sexual abuse, beatings, torture - inflicted upon residents of its sprawling Chester County campus.

Instead, we declared, America would provide treatment in the community, rendered with the compassion, dignity and humanity that had been lacking in our psychiatric houses of horror.

The intentions were good. The execution has been a travesty: chronic underfunding of services, substandard treatment, lopsided access to care. As a result, tens of thousands of mentally ill Americans aren't even diagnosed until they land in prison for actions they took while in the midst of a breakdown.

As a result, America's prisons have become our new asylums - only worse, because they're not equipped to handle the needs of people in psychiatric crisis.

"This is America's greatest tragedy," says U.S. Rep. Tim Murphy, R-Pa., a practicing psychologist and national advocate for stronger and better U.S. mental-health services - in hospitals, in prisons and in the community. "We have traded the hospital bed for the jail cell."

The numbers tell the tale.

In Philadelphia, as my colleague Dana DiFilippo reports in today's Daily News, 12 percent of the 8,500 inmates in the city's six jails are considered "seriously mentally ill," while another 4 percent are on the system's behavioral-health caseload with less-serious mental-health needs.

Those stats mirror the nation's. According to a 2014 report by the Treatment Advocacy Center, a nonprofit group that pushes for better mental-health policies and services, we now have 10 times more mentally ill Americans in our prisons and jails than in our remaining psychiatric institutions.

In 2012, that worked out to an estimated 356,268 inmates with severe mental illness, compared with 35,000 mentally ill individuals in state psychiatric hospitals.

That shameful reality would change if we were committed to recognizing, diagnosing and treating mental illness before it hits a crisis point - and if we had more hospital beds to accommodate those for whom even excellent outpatient care is not enough.

One doesn't preclude the other; a humane society needs both. Right now, we have neither.

"In the last 20 years, we have criminalized mental illness and seen massive increases in suicide, homelessness and incarceration," says Murphy, who has introduced the Helping Families in Mental Health Crisis Act (H.R. 3717). Among other things, the bill seeks to better coordinate mental-health and substance-abuse services at the federal level, improve access to care and address patient-privacy policies that can prevent families from helping loved ones.

Prisons are no place for the mentally ill, as studies by the Treatment Advocacy Center point out: They're not structurally appropriate for patients, and the staffs are not recruited as psychiatric caretakers. In addition, mentally ill inmates cost more to house, are usually incarcerated longer than other inmates, can be a harm to themselves and others and are more likely to commit suicide.

They're also more vulnerable to abuse and more likely to be placed in solitary confinement when they act out - which only worsens their condition.

In no other area of health care would we tolerate the escalation of an illness to its crisis point - and then punish the patient for having it in the first place. That's because, in every other area of health care, we have the humanity and decency to push the notion of prevention, early diagnosis and adequate care.

As Murphy points out, we'd never tell a diabetic to wait until his kidneys fail before teaching him how to monitor his insulin levels. We'd never tell someone with a suspicious lump to wait until it doubles in size before seeking a doctor's opinion. We'd never advise someone with chest pain to wait a few more days before getting to the ER.

For those with mental illness, though, we tell them to buck up. To behave. To try harder. And when they can't, we tell them to go away, or to go get help that doesn't exist. And when they can't find it (if they even know to try) we blame them for the illness that has by now exhausted loved ones, gotten them fired from jobs, made them homeless - or landed them in prison, which was never meant to provide the help they have needed for so long.

The closing of mental hospitals was supposed to help the mentally ill.

But all we've done is trade one institution for another.

Phone: 215-854-2217

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