Today the New York Times ran an editorial that states “The New York City jail system must be redesigned to serve the growing number of inmates with mental illnesses.” While the article points out what should be done, it doesn’t explain why there has been such growth in mentally ill inmates.
One key reason is that over the past few decades city, county and state governments in the U.S. have closed most of their psychiatric hospitals. The graph below shows the number of psychiatric beds per 100,000 people in the USA over time.
The reduction in beds was not caused by a drop in the number of people needing the services of mental health professionals, since the number of people seeking both inpatient and outpatient services at mental health facilities has climbed over time. Instead, one reason for the reduction in mental hospitals was reporting that suggested some were abusive institutions that kept people locked up involuntarily for indefinite periods of time.
An intended or unintended by-product of shuttering or reducing the size of many institutions for people with mental health problems was to shift many people with mental health problems from hospitals to prisons. Another key factor in shuttering these hospitals was economic. In 2009 the cost per year for a psychiatric bed was about $200,000, while in 2009 it cost about $35,000 to house someone in prison! A prison bed is cheaper than a psychiatric bed because prisons provide fewer services than psychiatric hospitals to their inmates.
Shifting the mentally ill from hospitals to prison just because it is cheaper is not the right solution. The mentally ill should be moved out of the prison system and into places designed to help, not warehouse them. I don’t have an easy solution on where to find the money needed for rebuilding psychiatric hospitals. Nevertheless, I hope this blog helps us begin a debate on whether our society should be helping or simply holding the mentally ill.