ANN ARBOR, MI – Across America, prisons serve as an
unofficial holding system for the mentally ill. Families desperate to
get treatment for their loved ones’ psychiatric issues
instead wind up retrieving them from the police station. And judges
wrestle with the prospect of sentencing the same people again and again
for minor offenses, instead of steering them to effective mental health
These phenomena, and more, are part of the
“criminizalization” of mental illness that has
taken place in the United States in recent years, due to
deinstitutionalization, lack of appropriate services, rigid legal
systems and other factors.
Psychiatric institutionalization is rare these days. In
Michigan, most of the institutions have been closed. This
social change sometimes has been referred to as deinstitutionalization.
I never liked that term, though, because it implies that the
changes were made in the context of a considered philosophical
framework. They href="http://www.psychservices.psychiatryonline.org/cgi/content/full/55/10/1112">were
These forces were shaped into
administrative policy by state departments of mental health. The
departments first covertly, then openly, favored the new trend, which
became known by the misnomer “deinstitutionalization.”
There were several simultaneous developments that had a
cumulative effect. In the midst of some tumultuous social
changes, some people tried to make sense of it and guide it to a better
Plenty of good has indeed come of it, but there has been plenty bad,
One good thing is that a lot of bad hospitals have closed.
One bad thing is that some good hospitals closed, too.
One good thing is the the Community Mental Health system was
developed and bolstered during the early years of
deinstitutionalization. One bad thing is that CMHs have never
been adequately funded, and this seems to be getting worse year by
One problem that has not been addressed adequately, is the topic of the
conference. What do we do about homeless persons with mental
illness, particularly those who commit crimes?
It does not really make sense to incarcerate them. It also
does not make sense to warehouse them in a lousy institution.
And it does not make sense to let them wander around.
It might make sense to put them in an institution, if it is well-run
and humane. But that costs a lot. Plus, I am not
sure that there are or even could be enough qualified personnel to run
enough facilities to deal with the problem adequately.
More funding would help, of course, but the fact is that it takes some
pretty special people to run a place like that and to do it well.
I don’t know where all those people would come from.
Furthermore, the problem is so complex that it is difficult to
conceptualize. Consider the three main issues: homelessness,
mental illness, and substance abuse. There is considerable overlap, but
they are not synonymous. Then consider the many other factors
that impinge: developmental disability, poverty, domestic violence,
head trauma, compassionate conservatism, malnutrition, employment
insecurity, dementia, the war on drugs, and more.
So when we talk about the criminalization of mental illness, we are not
talking about a unified or homogeneous problem. We are
talking about a complex network of overlapping problems.
I won’t be able to attend the conference, but I do know one thing about
the subject: we will not make progress on this until everyone accepts
the simply fact that these problems could happen to anyone.
That means you. Homelessness. Mental
Illness. Substance abuse. Anyone.
Panelists will include:
Peter Earley, a former Washington Post reporter whose book
Crazy: A Father’s Search Through America’s Mental Health Madness
chronicles his own son’s experience with mental illness and
the justice system.
William Cardasis, M.D., Director of the Admissions
Unit at the Michigan Center for Forensic Psychiatry.
Deb Pippins, the Program Administrator for Washtenaw
County’s Justice Project Outreach Team, Home Project Outreach
Team and mental health services in the county jail.
State Senator (D-Ann Arbor), who has
worked to improve both the mental health and justice systems in
Michigan as a member of the Appropriations Subcommittee on Judiciary
I am hopeful that they can do some good. My worry is that we
are just going to nibble at the edges of the problem until there is
some kind of fundamental social change. I am not sure that
the social change we need is