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Mental Health Patients Are Being Treated as Criminals
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The criminalisation of the mentally ill is one of the cruellest and most easily avoidable tragedies of our era. In the next few days, the state of Arkansas is intending to execute by lethal injection a 60-year-old man called Bruce Ward who showed signs of insanity at the time of his conviction for murder and was diagnosed by a court-recognised psychiatrist in 2006 as being a paranoid schizophrenic.

Ward is one of seven men facing execution in Arkansas after the first death sentence in the state since 2005 was carried out on Thursday. “He appears not to understand that he is about to die, believing instead that he is preparing for a ‘special mission’ as an evangelist,” says a report by the Harvard University Fair Punishment Project. A second man scheduled for execution is Jason McGehee who suffers from bipolar disorder and possible brain damage.

The prison systems in the US and UK have replaced psychiatric hospitals as the place where people suffering from severe mental illness are most likely to find themselves. It is a process that has been going on since the 1960s, fuelled by a desire to save money, a belief that medication would replace hospitalisation, and a liberal reaction against what was seen as unnecessary incarceration. Between 1955 and 2016, the number of state hospital beds in the US available to psychiatric patients fell by over 97 per cent from 559,000 to just 38,000. An expert noted despairingly that the biggest de facto psychiatric institutions in the US today are Los Angeles County jail, Chicago’s Cook County jail and New York’s Riker’s Island. Those who are not in prison or hospital “become violent or, more often, the victims of violence. They grow sicker and die. The personal and public costs are incalculable,” says a report by the Treatment Advocacy Center in Virginia. Mentally ill people, usually poor and unemployable because of their condition, are sometimes advised that the only way they will get even the crudest treatment is by being sent to prison.

The same process is happening in Britain. One of the justifications for closing down the old asylum system was that they were too much like prisons, but the paradoxical result has been that psychiatric patients are now ending up in real prisons. The number of beds available for mental health patients in the UK has dropped by three quarters since 1986/87 to about 17,000, while the Centre for Mental Health says that 21,000 mentally ill people are imprisoned, making up a quarter of the prison population.

For many mentally ill people, the prospect of incarceration is becoming probable in an unexpected reversion to eighteenth century practice. Some are left to wander the streets but most are looked after by their families who may not have the resources to do so. Deceptively progressive sounding words, like ‘deinstitutionalisation’ in the US and ‘care in the community’ in the UK, are used to describe the ending of the vast system that once catered for psychiatric patients.

Some of these institutions were hellholes, and others became unnecessary because medication was available from the 1950s that controlled some of the worst symptoms of mental illness. But the old system did at least provide an asylum in the sense of a place of safety where people who could not look after themselves were cared for. Supposing ‘care in the community’ had been more than an attractive slogan, it might have provided something of a replacement for the old asylums, but the care it provided was always inadequate.

The reality of the new system was best described by the detective-story writer P.D. James, an administrator in the NHS in London whose husband was a long-term patient in a mental hospital. She wrote that since the 1970s community care “could be described more accurately as the absence of care in a community still largely resentful or frightened of mental illness.”

Not much has changed for the better since P.D.James was writing, as was made plain this week by the report of the Sir Thomas Winsor, the Chief Inspector of Constabulary, who complained that the police are increasingly being used as the “first resort” for people with mental health problems. He said that sometimes they ended up spending the night in police cells even though they had committed no crime because no hospital beds were available. He added that the “inadequacy” of mental health provision should “disturb everyone”.

Marjorie Wallace, the founder and chief executive of SANE, a mental health charity, explains that governments have every incentive to keep mental patients out of hospital, since “providing a single bed costs the same as ‘treating’ 44 people in the community.” She welcomed Theresa May’s intention expressed in a speech earlier this year to do something about “the burning injustice of mental health and inadequate treatment”, but says that this will remain a Utopian vision unless there is more ring-fenced money for psychiatric services which are already close to breakdown.

There is more open discussion than there used to be about mental illness, with a campaign against stigmatisation and exhortations for people to seek counselling or simply speak up about their mental troubles before they become chronic and irreversible. Prince Harry spoke movingly about the negative consequences for himself of repressing his grief over the death of his mother when he was twelve years old. Celebrities reveal their anxieties and breakdowns. Such openness is important because it reduces personal isolation and makes people feel that they will not be treated as pariahs if they speak up.


When I first began to write about schizophrenia in 2002, I found that my friends and relatives divided into those who knew nothing about mental illness and those who knew all too much about it. But the latter had often never mentioned previously that they were looking after a sister with schizophrenia or a brother who could not leave his flat without having a breakdown. One friend disclosed a terrible story of a sister-in-law who had poured petrol over herself and set it alight, suffering burns over three quarters of her body from which she took weeks to die in agony.

Openness and discussion are important, but they skirt the heart of the problem, which is that a proportion of people who are mentally ill cannot look after themselves. The severity and incurability of a mental illnesses are often underestimated and there may be exaggerated expectations of preventing their onset by early intervention. The precise causes and nature of mental illness remains very much a mystery so a large number of people are always going to become desperately ill. Schizophrenia, for instance, is to mental illness what cancer is to physical illness. When Prince Harry talked about psychological troubles, debilitating though these may be, they are still not the same as full blown psychosis or, in other words, madness.

The present system has failed and the result is the creeping criminalisation of madness. The only way to reverse this is to build a core of dedicated hospitals that will care for and protect psychiatric patients who cannot do this for themselves and are a potential danger to themselves and others.

(Republished from The Independent by permission of author or representative)
• Category: Ideology • Tags: Mental Health 
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  1. The old ‘loony-bins’ weren’t very nice places, but they served a useful purpose. However they were expensive to run, and what better way to cut this expenditure than by pretending it was in everyone’s best interests?

    (The same applies to the homes for the mentally challenged aka “people with a learning disability”, whose “care” in the community often leaves them vulnerable to abuse and worse.)

  2. naro says:

    90% of the mental hospital beds were closed in the USA due to liberal pressure groups as well as the advent of the anti psychotic drugs, and the promise that patients will be well managed as outpatients. As it happen not all patients are compliant with their medication or treatments, and from time to time lash out in dreadful and violent attacks against family and strangers. We must open many more long term chronic mental health hospitals.

    • Replies: @Logan
  3. But surely Bruce Ward is in prison because he was convicted of murder, not because he’s mentally ill.

    • Replies: @Tsar Nicholas
  4. @Clark Westwood

    But conviction for murder requires a degree of responsibility, so if he is incompetent due to mental illness then can he be convicted of murder? And if he can, what about the toddler who accidentally sets off a gun that kills somebody?

    • Replies: @Clark Westwood
  5. There is a difference between committing a crime while having a mental illness and having a mental illness that makes it impossible for you to know you are committing a crime. If your mental illness makes it impossible for you to know you are committing a crime, then clearly you have a moral duty to request that you be kept in protective custody for the rest of your life.

    This is part of what the courts have to figure out. If you kill someone to rob them of money or to rape them, you may well claim that you didn’t know what you were doing, as it may be the only viable defense open to you, but you will have a hard time convincing a jury.

    If, on the other hand, you are depressed and you try to kill yourself by shooting and the bullet goes right through you and kills someone else, and you survive, you might have a good case for not guilty of murder by reason of insanity.

  6. In the UK, schizophrenics carry cards explaining their diagnosis. However, the police are not trained to assess this so the schizophrenics end up in police cells. The trauma of course makes things worse and follow up treatment is required.

  7. There are some LEFTIST [intellectually idiotic] propaganda about: nurture versus genetics among proportionally violent dog races. This people really believe that most of violent pitbulls, for example, are violent because their nurture style/ ”their” owners, trying to dismiss the role of genetics in this behavior.

    Similar thing have happened to the human mental disorders & pathologies, for example, persistently violent behavior, where ”sociological” causes has been hegemoneized as ”only or fundamental causes” to the disrupt of disordered to pathological human behaviors. While it’s correct to say that there is certain role of environmental circunstances to increase pre-existent dispositions dismiss entirely the genes on this behavior creates this situations where vulnerable but also potentially dangerous people are nurtured within a culture of hope that with specific interventions they will improve their mental and social functionality.

    Inclusion is one of this word of the day.

    What’s happen with pitbull or other proportionally more violent dog breeds/races.

  8. @Tsar Nicholas

    Mr. Cockburn’s thesis is that mental illness is being criminalized. But the crime consists of murder (or manslaughter or rape or assault or whatever), not of being mentally ill. Being mentally ill, by itself, is not a crime.

    Which is not to say that whether and when mental illness should be a defense to a criminal charge or should be a mitigating circumstance is not an important issue.

  9. The only way to reverse this is to build a core of dedicated hospitals that will care for and protect psychiatric patients who cannot do this for themselves and are a potential danger to themselves and others.

    Who is going to pay for them?

  10. This has been my career for forty years, and you are correct, sir. In most states, one cannot be committed to a hospital unless one has shown significant dangerousness. This is by statute, not custom, and courts enforce a high standard of dangerousness.

    We have backed ourselves into a terrible corner. Another Fred rightly asks who will pay for all this. Bringing people in out of the cold, offering them food, shelter, and respectful speech is no longer an option. We have set things up so that people must receive an array of services dedicated to helping them living independently, and right quickly. that is extremely expensive. You must buy the imported truffles, you cannot have a sandwich anymore.

    Did I mention that there are lots of expensive legal requirements that go with this?

    They don’t really believe in mental illness. The laws arose from paranoid liberals fantacising that The Man wanted to lock them up for being artistes, or wearing their hair long. Can’t have that, so millions of people suffer. Liberals are outraged that conservative legislatures don’t want to pay for the programs they believe people deserve, but they kid themselves about how much it will cost. Or they lie. that is also possible.

  11. Increasingly, the police just shoot them down like mad dogs. And truth be told, most folks are just fine with that, since present society really has no other answer.

  12. “Being mentally ill, by itself, is not a crime.”

    Neither is being poor, though it might as well be, in consumer corporatist America. Thus the highest incarceration rate in the whole world, right here at home.

  13. I am dealing with this issue in my own family. It made me look into how it came about that the state relinquished responsibility for taking care of marginally well functioning mentally ill people, especially those with violent tendencies. As best that I could find out, this started with Ronnie Reagan who piggybacked on liberal human rights idiocy (very clever) and enabled legislation to release these people on the streets, or where possible in family care thereby transferring the burden upon the citizenry.

    I can’t read this in any other way than simply for the system to save money. A policeman’s bullet is way cheaper than the annual cost of maintaining people in institutions that have to be more resource intensive than general prison.

    For this reason, genuinely mentally ill people go to regular prison and their mortality rate is probably even higher than being left on the street. Win-win as always within the system.

    That this is by design is factually proven by the fact that the that the bar for having serious crimes mitigated due to mental illness has been raised to such heights that even Caligula couldn’t have reached it.

    However the money for foreign interventions is still a bottomless well.

    Tar, feathers and rope are the solution sets.


    • Replies: @Logan
  14. gustafus says:

    Sorry, but too many news stories about the latest hacking, self immolation, or dismemberment of a child, small animal or parent tell us “he/she had a history of mental illness”

    That too often means low IQ. The breeding populations of the world with IQ”s below 90 are incapable of self governance… do not and cannot defer gratification … cannot resolve conflict without violence…. and are conditioned to believe they are “victims” of cultural imperialism.

    ECON 101.. the more your have of anything… the less value is attached to same. The universal first rule of economy does not exclude homo sapiens. And this conversation is long overdue now that the planet is over run with worthless… YES WORTHLESS … low IQ breeding stock, who now threaten the very existence of Western Civilization.

    YES … I am an unapologetic racist. YES…. I want mass sterilization, or incarceration of much of what we call “humanity”. There is precious little humanity left on the planet. And from what I’ve witnessed – [and I’ll compare passport stamps with anyone on this board] – there is more “humanity” within a troop of lowland gorillas, than in the festering cities of the 3rd world.

    Sorry…. Hitler and Goebbels gave genocide a bad name …. now when we need them most.

    • Replies: @Santoculto
  15. @gustafus

    It’s not all lower IQ who have psychopathic predispositions… PERIOD.

  16. Amongst the myriad of aspects regarding mental illness, the one most impacting being : Psychiatrists, Psychologists have no clue as to the nature or workings of the human mind, and their pseudo “science” has caused more damage, more harm, than could ever be put to word, simply because their flawed clueless opinions are employed within court procedures and have resulted in untold numbers of completely erroneous verdicts, sentences.

    Authenticjazzman “Mensa” society member since 1973, airborne qualified US Army vet, and pro jazz artist.

  17. Klokman says:

    Mr Cockburn should read the works of Dr Thomas Szasz, beginning with The Myth of Mental Illness.

    Psychiatric hospitals have always been a form of prison, and it has become fashionable in recent decades to incarcerate criminals in them under the guise of “insanity.”

    Early this morning I wrote in my journal about the insanity of humanity which justifies actions by the collective which are proscribed for an individual, usually under some form of pretext that somehow supersedes the same moral principles they all must live by individually.

    The system is operated by hypocrites.

  18. @Klokman

    @ Klokman Szasz was a crackpot who never saw patients. He wasn’t 100% wrong, but he’s mostly just useless.

    If you don’t think “insanity” is real, you have not the least idea what you are talking about.

    @ authentic jazzman Some psychologists and psychiatrists do have more than a little clue as to the workings of the human mind. I see them all the time, and they relieve considerable misery. They are in fact much more common at involuntary hospitals than elsewhere in their professions.

    I always have my suspicions whenever someone these claims.

  19. Ex-Saffer says:

    The BBC’s A History of the Madhouse reveals the curious fact that Enoch Powell, when Minister of Health in the early 1960s, was instrumental in shuttering the asylums, mostly because of their expense. But he was also mindful of the ways in which the public had come to abuse the asylum system. It was not uncommon for men who had grown tired of their wives to arrange to have them committed. Not content with taking up this avowedly progressive cause, Powell also championed the recruitment of Pakistani and Indian nurses to the NHS.

  20. Logan says:

    To be fair, conservatives were happy to go along with the closure of mental hospitals. It saved quite a lot of money.

    It was supposed to be coordinated with a massive expansion of “community mental health services.” Which never really happened.

  21. Logan says:
    @Timur The Lame

    Your points are well taken, but we can’t really blame it on Reagan.

    In 1955 there were over 558,000 patients in mental hospitals. The really steep decline in number of people in the institutions started in 1965. Reagan was still doing Death Valley Days.

    When Reagan took office in 1981, the number was below 100,000, despite the population having increased about 50%.

    Deinstitutionalization was pretty well complete by the time Reagan became President.

    Although I have seen desperate attempts to blame the whole thing on Reagan because of his actions as governor of CA.

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