National Scandal of Using Jails as Psychiatric Wards

The cruelty and medical neglect suffered by poor and homeless people who are incarcerated for being mentally ill is a national disgrace. It is unacceptable that the prison system has displaced the mental health system as the main institution for dealing with poor people with psychiatric disabilities.

by Paul Boden, Western Regional Advocacy Project (WRAP)


The criminal justice system has displaced the mental health system as the main institution for dealing with poor people with psychiatric disabilities in the United States. Federal cuts to mental health and affordable housing programs are responsible for this shameful reality.

During his tenure as president, Ronald Reagan instituted sweeping changes in domestic policy. The housing budget for the Department of Housing and Urban Development (HUD) was cut from $77 billion in 1978 to $18 billion in 1983 and the number of beds available in public mental hospitals dropped by 40 percent between 1970 and 1984.

This divestment has put millions of people on the street, many of whom are mentally ill and whose conditions worsen by having to live on the street. The danger and degradation of homelessness can also create psychiatric disorders such as Post Traumatic Stress Disorder.

Many local governments reacted to the very visible upsurge in those living on the streets with public space restrictions and ordinances that criminalize activities like sitting or lying on sidewalks, panhandling, and sleeping outside. These punitive policies are largely driven by the concerns of business interests, and go hand in hand with the increasing privatization of public spaces and services.

All of this has a particularly dramatic impact on people who have difficulty navigating the complex legal system. Once cited by police, a person who does not go to court or pay the fine ends up with a bench warrant permitting arrest on sight.

Arrest records can block access to housing services and benefits urgently needed to help stabilize someone who is homeless and disabled. Whether intentional or not, the bottom-line is that these laws are disenfranchising tens of thousands of mentally disabled homeless people.

Been here before

Mentally ill people have long been stigmatized by society. Often considered defective, they have been met with pity and revulsion, sometimes with reluctant charity, their “treatment” often horrific. People labeled insane have also been removed from public view, be it in attics, asylums, or jails.

Today, it is common knowledge that Riker’s Island Jail in New York City, Cook County Jail in Chicago, and Los Angeles County Jail are the three largest “psychiatric facilities” in the United States, even though there is rarely any real treatment occurring in these jails. The situation is so dire at Chicago’s Cook County Jail that the sheriff has threatened to file a lawsuit against the State of Illinois for allowing his jail to become a “dumping ground” for mentally disabled people.

It is less known that in every county across the country there are more mentally disabled persons in the county jail than there are in the psychiatric unit of the county hospital. Nationally, a severely mentally ill person is three times more likely to be in jail or prison than in a state mental hospital. The problem is even worse in states like California, Florida, Texas, and Nevada where a mentally ill person is four to ten times more likely to be in jail or prison than in a hospital.

There is a disturbing historic precedent for locking up mentally ill people at the current alarming rates. In the middle of the 19th century, jails were filled with indigent mentally ill people criminalized under so-called poor laws. “Poor laws” were imported from England during colonial times and used to control the movement of the poor and to distinguish those considered “deserving” from those deemed “undeserving” of aid. The “undeserving poor” were punished in jails and workhouses.

Our mental health and criminal justice policies are not all that different from the poor laws of the 1850s: poor mentally ill people are languishing in jails untreated due to discriminatory “quality of life” or “nuisance crime” laws. Instead of increasing treatment and housing options in the community, we are shutting down programs and substituting them with costly jails and prisons.

Despite reports ad nauseam about the human, financial, and social toll of this approach, the overriding social policies remain aimed at simply getting mentally ill people out of sight.

Taking it to the streets

The voices of those most impacted by these punitive measures — mentally ill homeless people themselves — are currently nowhere to be found in policy debates. To better understand the reality of those caught in the vicious cycle of insufficient treatment, homelessness, and jail at the street level, the Western Regional Advocacy Project (WRAP) and our partners conducted surveys with 336 self-identified mentally ill homeless people in seven cities — San Francisco, Los Angeles, Berkeley, and Oakland, California; Portland, Oregon; Denver, Colorado; Worcester, Massachusetts; and Houston, Texas. We also conducted a small online survey with 48 front-line service providers in San Francisco, Los Angeles, and Portland.

The findings from the two sets of surveys build on other recent data from the Department of Justice and mental health researchers. The findings reveal a discriminatory pattern that deserves closer public scrutiny.

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Results from the street outreach found:

  • 80 percent reported being stopped, arrested, or cited due to “quality of life” offenses.
  • 52 percent reported being harassed by private security (usually from private Business Improvement Districts).
  • 48 percent reported having ignored tickets issued against them.
  • 57 percent reported having bench warrants issued for their arrest.
  • 22 percent reported having outstanding warrants at the time of the survey.
  • 31 percent reported having been incarcerated.
  • 30 percent reported having lost their housing or being discharged from a program due to incarceration, while only 5 percent reported having been referred to a program when brought before court.

This closely mirrors the experiences of service providers in various cities. The survey found that 74 percent of service providers reported that at least 70 percent of their clients had been arrested due to “quality of life” offenses.

Ineffective, expensive, and cruel

Money is being spent on jails rather than services. Municipalities, business districts, and downtown tourist centers support “quality of life” or “nuisance crime” laws because they are deemed effective at ridding homeless people from sight and lead to more lucrative and less visibly impoverished downtowns. But enforcing these laws has become an enormously expensive process.

In 2009, a California jail bed ranged from $25,000 to $55,000 per year and a bed for acute mental health care in a psychiatric unit in a California jail cost $1,350 a day. A University of Pennsylvania study in 2002 found that homeless people with mental illness who were placed in permanent housing cost the public $16,282 less per person per year compared to their previous costs for mental health, corrections, Medicaid, and public institutions and shelters.

A report issued in 2009 by the Economic Roundtable found that the typical public costs for a homeless person in Los Angeles is five times greater than for a similar person in supportive housing ($2,897 per month vs. $605 per month) largely due to emergency room and criminal justice expenses.

The scale of this issue is enormous and the cruelty, disregard, and medical neglect suffered by poor and homeless mentally ill people is unacceptable. According to the Bureau of Justice statistics, as many as 64 percent of people in jails nationwide have mental health problems. In the 1980s and early 1990s, people with severe mental illness made up 6-7 percent of the jail population. In the last five years, this percentage has climbed to 16-30 percent.

Nationwide, there are three times as many people with mental illness in jails and prisons as there are in hospitals; 40 percent of people with severe mental illness have been imprisoned at some point in their lives; and 90 percent of those incarcerated with a mental illness have been incarcerated more than once.

We deal with this national shame as we so often deal with personal shame: We pretend it isn’t there and we try to hide it. It is time to bring it into daylight. The obvious answer is, of course, affordable housing and residential treatment, and ongoing outpatient treatment with practical social supports. None of this is on our current national agenda. But as a country, we must wake up to the reality that we treat mentally ill homeless people the way they were treated 150 years ago. Ignoring that truth is the real shame.

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