From: rpattree2@gmail.com   
      
   Scientific American   
      
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   MIND & BRAIN   
   See InsideScientific American Mind Volume 25, Issue 2   
   Criminals Need Mental Health Care   
   Psychiatric treatment is far better than imprisonment for reducing recidivism   
   Mar 1, 2014 |By Robert Byron   
   **   
      
   Despite what you see on television, a verdict of "not guilty by reason of   
   insanity" is exceedingly rare. Most defendants with mental illnesses end up   
   incarcerated--studies reveal that fully half of all prisoners have at least   
   one mental disorder. That is    
   one million people in the U.S. alone, and the prison system does very little   
   to successfully treat them. As a result, the recidivism rate among released   
   convicts is especially high for those with serious disorders.   
      
   Forensic hospitals, on the other hand, which hold and treat offenders found   
   not guilty by reason of insanity, have a very high success rate in preventing   
   disordered individuals from returning to crime. In an analysis of data from   
   California, New York and    
   Oregon, Victoria Harris, a forensic psychiatrist at the University of   
   Washington, reported in 2000 that people at these institutions reoffended at a   
   "much lower" rate than untreated mentally ill offenders. Psychiatrist Jeremy   
   Coid and his colleagues at    
   St. Bartholomew's Hospital in London found in 2007 that forensic patients in   
   the U.K. were 60 percent less likely to reoffend than released inmates and 80   
   percent less likely to turn to violence.   
      
   These and other recent studies show that treatment works, and yet we continue   
   to put offenders with mental disorders in prisons for complex reasons,   
   including our society's views toward mental illness--especially addiction--and   
   the high cost of    
   psychiatric care for inmates. Still, solutions are within reach. A Connecticut   
   program, for example, allows some veterans who have committed crimes to seek   
   psychiatric treatment instead of serving time. Public knowledge of and support   
   for such programs    
   are essential to breaking the cycle of crime that the current prison system   
   perpetuates.   
      
   Prisons as Mental Institutions   
   The prison system functions in substantial part as the successor to our   
   shuttered mental institutions. In 2009 epidemiologist Jacques Baillargeon of   
   the University of Texas Medical Branch at Galveston and his colleagues rightly   
   described this situation    
   as a "national public health crisis" and found that it arose from a baleful   
   synergism of developments. First, the invention of antipsychotic medication in   
   the 1960s led to a movement to close the many psychiatric hospitals then   
   extant. These closed    
   institutions were supposed to be replaced by community facilities, but in   
   reality most were not. At the same time, health insurers restricted coverage   
   for mental health treatment, and finally, the "war on drugs," begun in the   
   1980s, increased drug-   
   related arrests and brought in mandatory and fixed sentences. More offenders   
   with psychiatric and substance abuse problems, often one and the same, were   
   incarcerated for many years without treatment and then released into a   
   community that had nothing for    
   them: no jobs, no treatment, no housing. This led to drifting, homelessness,   
   further mental decline and the chronic reoffending we see today.   
      
   In 2012 Jason Schnittker, a sociologist at the University of Pennsylvania, and   
   his colleagues reported that legislatures have criminalized "many common   
   psychiatric disorders," especially substance abuse--which psychiatry's   
   diagnostic handbook, theDSM-5,    
   categorizes as a true psychiatric disorder. This criminalization of drug   
   addiction means, as Schnittker puts it, that "some inmates end up in prison at   
   least partially because of their psychiatric disorders."   
      
   Most of these mentally ill inmates are not treated for their conditions in   
   prison. And their numbers are rising. Schnittker reports that for the past 40   
   years, the rate of incarceration has quintupled, from 149 per 100,000 in 1980   
   to 749 per 100,000 in    
   2009. As people go in, other people come out. Nationally, 700,000 inmates are   
   released every year, which means, according to the National Institutes of   
   Health, that more than 350,000 disordered offenders return untreated to   
   society. In most accountings,    
   most of these people will reoffend.   
      
   Clearly, this system does not work. Strikingly, though, it runs in parallel   
   with a system that does work, namely the system of forensic hospitals, which   
   is where defendants end up who are found not guilty by reason of insanity.   
   This outcome is difficult    
   to achieve: the legal defense must demonstrate that the offender had no   
   control over his or her actions or did not comprehend the present reality of   
   the deed done (for instance, shot at a police officer because he thought the   
   officer had been threatening    
   him on television). A small fraction of 1 percent of all criminal defendants   
   are acquitted by reason of insanity.   
      
   Forensic hospitals confine people as prisons do but achieve radically   
   different results. Both function by way of the criminal justice system, but   
   prisons cause disordered offenders to break the law more--even more than   
   offenders without a disorder--   
   whereas forensic hospitals treat offenders as patients who can and do recover   
   and who return to society as people who can be expected, for the most part, to   
   be law-abiding citizens.   
      
   Cured of Criminality   
   The radical difference in outcomes from these two systems is illustrated by   
   the experience in Connecticut, where I practice law. In its 2010 Annual   
   Recidivism Report, Connecticut's Criminal Justice Policy and Planning Division   
   analyzed 16,241 inmates    
   released during 2005. Of these, 1,514 were classified as severely disordered,   
   including people who had "chronic schizophrenia or bipolar disorders with   
   frequent psychotic exacerbations, who need medication and assistance with   
   activities of daily living, [   
   as well as persons] with borderline personality disorder with frequent   
   suicidal gestures or episodes of self-mutilation." Others were even worse off,   
   suffering from "acute psychosis, severe depression, suicidal ideation ... and   
   overwhelming anxiety."   
      
   Although the rate of recidivism for the overall cohort of 16,241 inmates was   
   high--67.5 percent within three years--the rate for those with severe   
   disorders was even greater. The department did not indicate by how much, only   
   that it was "significantly"    
   higher.   
      
      
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