From the psych hospital to the jail

Depictions of mental illness and mental health care in literature and film tend to paint a gruesome picture. Patients are often shown being treated harshly by medical staff and living in squalor, controlled by heavy doses of medication and straitjackets. Jour­nalistic reporting on psychiatric hospitals has proven such depictions accurate. Although One Flew over the Cuckoo’s Nest–style psychiatric hospitals have largely disappeared, the question remains: What happened to their patients?

It would be comforting to believe that the closure of many psychiatric hospitals reflected an increase in acceptance and empathy for people with severe mental illness and that those patients now fare better. But that is not the case. Alisa Roth shows that prisons and jails have largely filled the void left by psychiatric hospitals, noting that as many as one in two Americans with severe mental illness will be arrested at some point in their lives. Further, Roth reports, as many as 75 percent of incarcerated women, 60 percent of men in jails, and 55 percent of men in prisons experience mental illness.

Roth documents the often brutal experiences of inmates with mental illness through her visits to many of America’s largest correctional facilities, including Riker’s Island Jail, Cook County Jail, and Los Angeles County Jail. She finds inmates wearing putatively indestructible “suicide gowns” to prevent them from crafting nooses from their clothing, inmates who smeared their cells with feces and were left to live in the mess, and inmates in need of mental health care who did not receive it due to overcrowding or a lack of guards available to escort them to appointments. Many of the inmates she profiles have been abused by guards or engaged in gruesome acts of self-harm, either with their own hands or crude weapons fashioned from seemingly harmless objects. Roth reports that guards often carry knives specially de­signed to cut down inmates who have hanged themselves.