Those suffering from mental illness are generally over-represented in the US criminal justice system. This has been characterised as the “criminalisation of the mentally ill”, which means a legal response rather than a medical one is used to deal with behaviours related to mental illness.

It is generally accepted that the mentally ill do not belong in prison, but complex structural factors have contributed to the “warehousing” of the mentally ill in prisons.

How deinstitutionalisation drove the mentally ill into the criminal justice system

The criminalisation of mental illness began with the deinstitutionalisation of psychiatric facilities in the 1950s. The US government believed mental hospitals were repressive and mandated a shift in caring for the mentally ill from an institutional setting to a community-based one.

The goals of this movement included:

• To release individuals from psychiatric hospitals and train them to self-regulate and self-medicate.
• To transfer individuals to community-based care centres and locally run facilities.
• To reduce the cost of long-term institutionalisation.

Reintegrating these individuals into the community required careful support and supervision to ensure the patients were receiving proper medical care and taking their medication.

Unfortunately, this never materialised in the following decades. A lack of funding and a lack of comprehensive community support led to prisons and jails becoming replacements for psychiatric facilities.

Because of inadequate community support, many newly released mentally ill patients became homeless. With the increased release of the mentally ill, inadequate community care and increased homelessness came an unexpected turn towards the criminal justice system.

Disruptive behaviours are often a symptom of mental illness but the police typically respond to these situations by arresting the person instead of referring them to an appropriate treatment centre.

As soon as they are arrested, detained and convicted even once, these individuals are likely to be repeatedly cycled through the criminal justice system. This is only one of the factors leading to the criminalisation of mental illnesses.

There are several structural factors that have contributed to the over-representation of the mentally ill in prison:

• Lack of sufficient community support. Individuals with mental illness struggle to find steady housing, employment and mental health services. Because of their condition, they also have a hard time maintaining consistent contact with friends, relatives and treatment providers.
• High rate of substance abuse. Many people have a problem with substance abuse as well as their mental illness. It is difficult to treat such co-occurring disorders rather than mental illness or substance abuse alone. There is also a lack of treatment programmes that address co-occurring disorders despite the growing demand.
• Stigma of being labelled a criminal. Sometimes, treatment is denied to persons who have committed a criminal offence or have been previously incarcerated. The staff at treatment facilities may consider the person too dangerous or disruptive for treatment, even if the offence for which they were arrested or convicted was non-violent in nature.
• Problems with treatment. Sometimes, mentally ill individuals try many treatment plans without success. Others may refuse treatment because they are in denial, dislike the side effects of their medication or the symptoms of the illness itself prevent them from seeking help. The pressures to find housing and income can also interfere with the ability to maintain steady treatment.
• Lack of timely access to treatment. Long waiting lists have prevented people from managing their mental illness. Ease of access to treatment facilities would facilitate early intervention and diagnosis, which would divert these individuals from the criminal justice system.
• Lack of cross-trained staff. Although there is a surge in the arrest and detention of mentally ill individuals in the US, criminal justice professionals are still ill-equipped to respond to the disturbances they cause. This lack of understanding about the systemic issues around the criminalisation of the mentally ill is contributing to their over-representation in the criminal justice system as well as within the crisis intervention sphere.
• Solitary confinement. Solitary confinement is an extreme measure used for dangerous and uncontrollable prisoners. Often, those suffering from mental illness have a harder time adjusting to being in prison. They may behave badly and the correctional authorities respond with disciplinary measures such as solitary confinement. When individuals with pre-existing mental illnesses are placed in solitary confinement, their symptoms are dramatically worsened.

The 2007 Ashley Smith case in Ontario, Canada, was a prime example of how the correctional system failed to provide an identified mentally ill, high-risk, high-needs inmate with appropriate care. Despite being on suicide watch, Ashley Smith strangled herself with a piece of cloth as the guards watched on video monitors for 45 minutes before intervening.

What needs to change

• Police. The police need to be better trained to recognise the symptoms of mental illnesses. They also need to be able to refer the individuals they encounter to mental health services instead of the criminal justice system.
• Courts and corrections. Like police officers, the courts and corrections staff also need to be trained and educated on how to interact with mentally ill offenders. Corrections services need to develop stronger screening systems to detect mental illness in its early stages before deterioration. Additionally, corrections services need to provide strong in-custody treatment with pre- and post-release care planning, support and follow-up.
• Community. Most importantly, it is paramount that people with mental illness have strong support in the community in terms of housing, income, job skill development and especially timely access to treatment within the mental health system.

Dennis Relojo-Howell is the founder of Psychreg and host of The DRH Show. You can connect with him on Twitter @drelojo_howell