“A by-product of the war’s aggravation of the long-existing personnel shortage, this data represents the collated reports of more than 3,000 conscientious objectors who, under Selective Service, volunteered for assignment as mental hospital attendants. The majority are still in service and, with Selective Service approval, these serious young Methodists, Quakers, Mennonites and Brethren have been filling out questionnaires and writing “narratives” for use in the preparation of instructional material for mental-hospital workers.
The fact is that beatings are merely the extreme end product which thrusts upon overworked, poorly trained and shamefully underpaid employees the burden of controlling hundreds of patients whom they fear and despise. Far more frequent than beatings are the endless cruelties involved in the use of constraints. Although some hospitals have managed to dispense with physical restraints entirely and others permit their use only on written order from doctors, the all-too-widespread practice is to leave the decision to tie down a patient or throw him into solitary up to the harassed and fearful attendant.

All too often the end result can be described in the terms used in a report form an Indiana state hospital:

“During my three months there I never saw the ward doctor give any but a cursory physical examination. He usually would stop but for a moment at the bedside of new patients. He was nicknamed ‘The Butcher’ by the nurses, after his manner of lancing boils. He seldom came to the ward to declare and expired patient dead. He would be called on the phone by the nurse when a patient was thought to have expired. Usually he would say ‘Oke’ and that would be the end of it. On outwards, patients are prepared for and set to the morgue without ever a doctor appearing on the ward.”

From a Pennsylvania state hospital a report reads:

“On one occasion a young patent with a fractured hip was sent to us (2-West, male infirmary) and we got him up into a wheelchair for several days, not knowing what was wrong with him. No doctor corrected our mistake until five weeks later.”

From Utah comes the report:

“A patient became ill and his rectal temperature was fond to be 105.4. The doctor who was called replied “He gets a high temperature every once in a while, so don’t worry about it.’”
Such instances of callousness and incompetence — and the records are replete with hundreds more — cannot, of course, be excused in men licensed ad physicians and pledged to the Hippocratic oath.

It started in 1943 when a group of conscientious objectors stationed at Cleveland State. Before these men the conchies laid a stack of affidavits a foot high, affidavits covering conditions such as those I have describes and other horrors even worse.

At first the stories were met by officials with shocked cries of “it ain’t so.”

For what happens to the mentally-sick in our present hellhole hospitals is not the sad experience of some other fellow. Ever minister, every doctor and every leader of any community organization knows that mental illness can strike down members of his immediate circle. Given the facts the people will rally to put an end to concentration camps that masquerade as hospitals and to make cure rather than incarceration the goal of their mental institutions.”

The Imprisoned Mentally Ill and Deinstitutionalization

Between 1980 and 1995, the total number of individuals incarcerated in American jails and prisons increased from 501,886 to 1,587,791, an increase of 216 percent. During this time, the general population increased by only 16 percent.

Have the mentally ill contributed more than their expected share to the increasing population of jails and prisons?

Several lines of evidence suggest the answer is yes. First, in 1939, Lionel Penrose, study showed that prison and psychiatric hospital populations were inversely correlated, As one rose, the other fell. This has become known as the balloon theory — push in one part of a balloon and another part will bulge out. In 1991, George Palermo and his colleagues published an extensive analysis of the balloon theory utilizing data on U.S. mental hospitals, jails, and prisons for the 83 years between 1904 and 1987. They found the theory to be valid and concluded:

The number of the mentally ill in American jails and prisons supports the thesis of progressive transinstitutionalism. The authors believe that the statistical evidence derived from the national census data corroborates their clinical observation that jails have become a repository of pseudooffenders — the mentally ill.

California was the first state to aggressively undertake deinstitutionalization, implementing the Lanterman-Petris-Short (LPS) Act in 1969, which made it much more difficult to involuntarily hospitalize, or keep in the hospital, persons who are mentally ill. In 1972, Marc Abramson, a psychiatrist in San Mateo County, published data showing that the number of mentally ill persons entering the criminal justice system doubled in the first year after the Lanterman-Petris-Short Act went into effect. Abramson said, “As a result of LPS, mentally disordered persons are being increasingly subjected to arrest and criminal prosecution.” Abramson also coined the term “criminalization of mentally disordered behavior” and in a remarkably prophetic statement said, “If the mental health system is forced to release mentally disordered persons into the community prematurely, there will be an increase in pressure for use of the criminal justice system to reinstitutionalize them. Those who castigate institutional psychiatry for its present and past deficiencies may be quite ignorant of what occurs when mentally disordered patients are forced into the criminal justice system.”

Similar observations were made throughout California in the years following implementation of the Lanterman-Petris-Short Act. A 1973 study in Santa Clara County indicated the jail population had risen 300 percent in the four years after the closing of Agnews State Psychiatric Hospital, located in the same county. In 1975, a study of five California jails by Arthur Bolton and Associates reported that the number of severely mentally ill prisoners had grown 300 percent over 10 years. In California’s prisons, the number of mentally ill inmates also rose sharply in the 1970s. One prison psychiatrist summarized the situation:

We are literally drowning in patients, running around trying to put our fingers in the bursting dikes, while hundreds of men continue to deteriorate psychiatrically before our eyes into serious psychoses. … The crisis stems from recent changes in the mental health laws allowing more mentally sick patients to be shifted away from the mental health department into the department of corrections. … Many more men are being sent to prison who have serious mental problems.

1955: In the United States, the number of people institutionalized for mental illness peaks at 560,000.

1961: Sociologist Erving Goffman’s book, Asylums, comes out. Goffman claims that most people in mental hospitals exhibit their psychotic symptoms and behavior as a direct result of being hospitalized.

1962: Ken Kesey’s best-selling novel, One Flew Over the Cuckoo’s Nest is based on his experiences working in the psychiatric ward of a Veterans’ Administration hospital. Kesey is motivated by the premise that the patients he sees don’t really have mental illnesses; they simply behave in ways a rigid society is unwilling to accept. In 1975, Kesey’s book will be made into an influential movie starring Jack Nicholson as anti-authoritarian anti-hero Randle McMurphy.

Mid-1960′s: Many seriously mentally ill people are removed from institutions. In the United States they are directed toward local mental health homes and facilities. The number of institutionalized mentally ill people in the United States will drop from a peak of 560,000 to just over 130,000 in 1980. Some of this deinstitutionalization is possible because of anti-psychotic drugs, which allow many psychotic patients to live more successfully and independently. However, many people suffering from mental illness become homeless because of inadequate housing and follow-up care.

Advocates for deinstitutionalization believe that people with mental illness will voluntarily seek out treatment at these facilities if they need it, although in practice this will not always be the case.

1980′s: An estimated one-third of all homeless people are considered seriously mentally ill, the vast majority of them suffering from schizophrenia.

1992: A survey of American jails reports that 7.2 percent of inmates are overtly and seriously mentally ill, meaning that 100,000 seriously mentally ill people have been incarcerated. Over a quarter of them are held without charges, often awaiting a bed in a psychiatric hospital.

Yet all too often, mental illness is viewed first as a security issue (the prisoner is not following the rules!), and only secondarily–if at all–as a medical issue.