MENTAL ILLNESS: MOVING FROM PUNISHMENT TO TREATMENT

When the State of Arkansas announced that it intended to execute eight death-row inmates in eleven days, the story became national news.  What was apparently lost in the story is that more than half of these death-row inmates were likely suffering from serious mental illnesses that gave rise to the criminal acts for which they were to be executed.  The question that we need to be asking is whether the public-safety (or moral/punitive) response to mental illness, which is evident in its extreme form in these Arkansas cases, is truly serving our interests.

Neuroscience, genetics and psychiatry have greatly expanded our understanding of mental illnesses in the past twenty years, and they give us many reasons to re-think our punitive approach to persons who are suffering from these illnesses.  Neuroscience tells us that some people have more free will than others, and that some people have more self-control than others; these findings are linked to structural elements of the brain.  Genetics tells us that certain mental illnesses may be coded in our DNA.  Psychiatry has developed new therapies that enable the vast majority of persons with mental illnesses to lead productive, satisfying, and relatively stable lives.

Despite these developments, too many among us cannot seem to let go of our punitive response to mental illness. As the branch of mathematics known as game theory shows, the desire to punish is overwhelming, even when punishment is irrational and economically burdensome.  When an antisocial act occurs, especially one that is also horrific, our attention shifts from science to our own (often flawed) intuitions about human nature.  We embrace the idea that mental illness is a failure of will or a defect of character — that a mentally ill person’s antisocial behavior manifests a failure of personal responsibility.

We punish those who, in our view, have shown a failure of personal responsibility.  (Too many of us attribute great value to personal responsibility whenever we find it lacking in others. It is overlooked, however, when we engage in inconsiderate or unethical behavior as commuters or airline passengers, and in either scenario, we blame our lapses on others or on the environment.  But I digress . . .)  In a punishment regime, we heap condemnation on the offender for the violation.  In effect, our prison systems are managed by Departments of Condemnation.

THE COST

Much has been written, in the past several years, about the crisis of mass incarceration in the United States.  The National Academy of Sciences published a report entitled “The Growth of Incarceration in the United States” in 2014. (The report is available at www.nap.edu for free download in PDF format.) Here is a table from the report:

Punishing Post Table

The report also indicates that an estimated fifty-six (56%) percent of state prison inmates and sixty-four (64%) percent of persons held in jails suffer from mental illness.  The prison system has become the safety net – or the “default” destination – for mentally ill persons who are not receiving adequate or effective treatment. We need to do better.

Of course, doing better inevitably raises fiscal concerns.  In light of recent data, we ought to be asking how the monetary and social costs of incarcerating persons with mental illness compare against the projected costs and potential benefits of providing adequate and effective treatment that would enable mentally-ill persons (a) to lead productive lives and (b) to avoid entanglements with the criminal justice system.

In “The Growth of Incarceration in the United States” at pages 314 – 315, the National Academy of Sciences frames the fiscal problem as follows:

The corrections system and the public safety system more broadly (that is, police, prosecutors, and the courts) command a larger share of government budgets than was the case 30 years ago. Budgetary allocations for corrections have outpaced budget increases for nearly all other key government services (often by wide margins), including education, transportation, and public assistance. Today, state spending on corrections is the third highest category of general fund expenditures in most states, ranked behind Medicaid and education.  Corrections budgets have skyrocketed at a time when spending for other key social services and government programs has slowed or contracted. As a result, the criminal justice system increasingly is the main provider of health care, substance abuse treatment, mental health services, job training, education, and other critical social and economic supports for the most disadvantaged groups in U.S. society.

Between 1972 and 2010, public expenditures for building and operating the country’s prisons and jails increased sharply, keeping pace with the increase in the number of people held in those facilities.  (footnotes and citations omitted)

CHANGE BENEFITS ALL

It is time to acknowledge the extraordinary costs and inefficiencies inherent in our use of the justice system to address mental illness.  It is time to move mentally ill persons from prisons to treatment facilities and to shift expenditures accordingly.  It is time to elevate the recovery, restoration and re-integration of mentally ill persons over the societal impulse to punish, so that more of our people can lead productive lives, for their benefit and for the benefit of all of us.

Advertisements

One thought on “MENTAL ILLNESS: MOVING FROM PUNISHMENT TO TREATMENT”

  1. Most of those Arkansas death row inmates are/were victims of lifelong physical and psychological abuse, or victims of a major mental illness. Throwing people away has become our society’s treatment. Prisons all claim or acknowledge that they aren’t equipped to deal with the ever growing population with mental illnesses. However it seems that most people say “who cares what happens to them as long as they don’t live near me and I don’t have to think about them.”
    The excerpt from the National Academy of Sciences is frightening since the Departments of Corrections operate without oversight. My understanding is that our government is giving the most amount of money to the least transparent and least accountable segment of government services.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s