In his memoir In The Sanctuary of Outcasts, Neil White relates the story of his imprisonment in Carville, Louisiana, for check kiting. While the prison Neil is held in holds prisoners, it also is home to the National Leprosarium, where hundreds of those suffering from Hansen’s disease, also known as leprosy, were forcefully sent to live with no hope of leaving from 1921 to the 1950s (White 56, 109). Despite having committed no crime, these individuals were imprisoned for life alongside convicted felons for an uncontrollable condition — a condition to which 95% of humans have natural immunity (“Transmission”). Carville is not the only, nor the earliest, example of the criminalization of physical disease. In 1865, the Hawaii State Senate passed “An Act to Prevent the Spread of Leprosy,” establishing the Kalaupapa leprosy colony, where over 8,000 individuals were imprisoned (Hawaii State, Legislature, Senate). Unjust laws like this exist even today; in India, over 114 laws discriminate against those suffering from Hansen’s disease, despite the modern curability of the disease and the extraordinarily high natural immunity rate (Perappadan). Though incarceration for physical diseases has now been largely recognized as unjust and cruel, the criminalization of illness continues today in other forms. As a result of deinstitutionalization, societal stigmas, and a lack of appropriate support, the criminalization of physical diseases has transferred to mental illnesses, where those suffering from mental illness and addiction are victims of the criminal justice system at a disproportionately high rate.The deinstitutionalization of those with mental illness has led to their reinstitutionalization in the criminal justice system, where they are arrested and imprisoned at excessively high rates. In the 1960s, hospitals that acted as homes for the mentally ill were largely shut down nationwide as many believed they were inhumane and too costly to keep in operation (Yohanna). The U.S. mental hospital population dropped from 559,000 in 1955 to under 60,000 residents in 1998, a decrease of 90% (Wolff). While the mental hospitals presented problems of their own, the deinstitutionalization process left an extremely vulnerable population without government assistance, resulting in the loss of crucial medical care to which they no longer had access. As a result of deinstitutionalization, many individuals suffer more severe symptoms without treatment, leading them to become a target of the criminal justice system. Up to 40% of those suffering from mental illness will be in jail or prison at some point in their life, 8% of whom were arrested for offenses that resulted from their symptoms. According to a report from Cornell, these arrests are overwhelmingly not in the name of public safety: only 4% of violent crimes are committed by those with a mental illness, a disproportionately low percentage (Wolff). Instead, the arrests are an active detriment to public safety and the well-being of vulnerable populations, as those suffering from a mental illness are 16 times as likely to be killed in a police encounter—nearly 50% of victims of police violence suffer from mental health issues (“People with Untreated Mental Illness”). Additionally, not only does the lack of proper support lead to the reinstitutionalization of mentally ill populations in jail and prisons, but that very incarceration becomes a self-enforcing cycle. Even for those without previous mental illness, imprisonment increases the risk for depression by 50% within 12 months of incarceration. Solitary confinement increases the suicide rate by 500%—a staggering number when one considers the disproportionately high number of incarcerated individuals already at high risk for suicide (Wolff). Even for those whose imprisonment was justified, the incarceration of those suffering from mental illness is highly ineffective from a rehabilitation standpoint, as 52.3% are rearrested post-release, continuing the aforementioned cycle (Zgoba). Thus, it can be seen how the symptoms which the mentally ill already suffer from are exacerbated by their oft-unnecessary, targeted imprisonment.
The deinstitutionalization process has also led to increased substance abuse issues as individuals seek other ways to cope with more severe symptoms—another unresolved issue that increases the chance of incarceration. Mental illness and addiction are directly linked: according to the National Institute on Drug Abuse, 18.2% of those suffering from mental illness have a substance abuse disorder, and 37.9% of addicts suffer from a mental disorder (“Comorbidity”). Individuals suffering from addiction are unlikely to seek professional treatment, worsening their symptoms and condition; only 18% of addicts will ever be treated for substance abuse (Volkow). Most individuals suffering from mental illness and addiction will never receive treatment for either condition. Individuals refuse treatment for various reasons, ranging from societal stigmas to affordability; however, one of the most significant causes is the lack of available treatment. Nearly a quarter of those suffering from mental health issues stated their reason for not receiving treatment was that they did not know where to go to receive it, while almost 12% of those suffering from addiction without treatment stated the same reason (“Comorbidity”). This shocking abundance of untreated addiction in our nation is only worsened by how we address it. Instead of increasing access to treatment through healthcare or fighting societal stigmas through education, the United States chooses to treat addiction with incarceration through the criminal justice system. Every 25 seconds, an individual is arrested for simple drug possession – that’s 1.25 million arrests per year, one out of every nine arrests. In fact, police make 114% as many arrests for simple marijuana possession than for all committed violent crimes combined, according to Human Rights Watch (“US: Disastrous Toll”). Nearly 50% of prisoners nationwide have some form of substance abuse disorder (Volkow). Instead of helping these individuals by taking them to rehabilitation centers and trying to solve the root issue, the criminal justice system incarcerates victims of addiction for possession—a crime that is victimless apart from the self. However, their incarceration is far from a victimless crime. A conviction, or even simply an arrest, for drug possession is life-ruining for many. Individuals, like Allen Searle, who was held in a Louisiana jail for 100 days pre-trial, explain that their arrest destroyed not just their own life but that of their loved ones as well: “[My job] was the only income for my family… [Their] water has been cut off since I’ve been in here. The lights were cut off…It doesn’t just affect us, it affects everyone around us”. Melissa Wright is no longer able to feed her children after being put on probation for possession: “Food stamps, you can’t get them for a year. So you go dig in a dumpster. My food stamps are for my kids, not me” (“US: Disastrous Toll”). Drug possession arrests are racially targeted, too: while Black Americans are less likely to have a substance abuse disorder than white Americans, they are 250% as likely to be arrested for simple possession—a statistic that rises to 400% for marijuana possession. Punishing addiction does nothing to fix the root issues of societal stigmas surrounding substance abuse and a lack of available treatment options; instead, it significantly worsens them. Criminalizing substance abuse issues increase stigmas, further preventing individuals from seeking treatment. The increased stigmas also lead to families and friends abandoning their loved ones suffering from substance issues, which takes away a core component of the support system; many experiencing this lack of crucial post-release support and love overdose, either intentionally or accidentally (Binswanger). Additionally, those imprisoned for drug-related offenses are highly likely to continue using substances upon release—often with a significantly higher fatality rate due to their decreased tolerance (Volkow). Up to 47% of those incarcerated for simple possession are rearrested, demonstrating the inefficacy of addressing substance abuse through the criminal justice system in its present state (“Recidivism”). Just as the incarceration of those suffering from mental illness creates a self-enforcing cycle of worsening symptoms and imprisonment, the related incarceration of those suffering from substance abuse disorder creates its own cycle of a lack of treatment and worsening addiction. To break these cycles, decisive action is needed to initiate necessary reforms.A proposed bill that suggests internal reforms to address the current issues concerning the incarceration of those suffering from mental illness and/or addiction is attached below. It focuses on two main areas: restructuring policing systems and reforming prison infrastructure. To address the overwhelming violence faced by the mentally ill at the hands of the police, two steps are taken toward encouraging a safer, more appropriate response to non-violent offenses: when dealing with any mental health-related offense, a division of the police, specially trained in safe intervention tactics, should be deployed to defuse the situation peacefully and with minimal stress for the offender and any potential victims. This type of police force, commonly referred to as a Police-Mental Health Collaboration (PMHC), has been shown to decrease violence, save money and resources, decrease stigmas, and even increase access to crucial healthcare (“Learning”). Additionally, no officer should bring a weapon when responding to non-violent offenses to avoid unnecessary violence. Prisons must also be reformed for those suffering from mental illness and addiction. Instead of imprisoning these vulnerable groups in traditional prisons that encourage isolation and have insufficient healthcare resources, specially designed prisons ought to be built for non-violent offenders suffering from mental illness and addiction with a focus on care, connection, and rehabilitation. Staffed by specialized personnel and utilizing open spaces and more lenient visiting policies, these prisons should encourage rehabilitation by expanding access to healthcare resources, like medications, psychiatrists, and professionals trained in addiction rehabilitation. Encouraging connection and healthcare for the incarcerated will decrease societal stigmas by humanizing those in the eyes of each other, as well as their loved ones, and removing barriers to treatment. By restructuring how the criminal justice system treats those with mental illness and addiction, we can take steps toward addressing the deeper issues of societal stigmas and treatment access that have, in part, led to the disproportionate overabundance of their incarceration.
REHABILITATION FOR THOSE SUFFERING FROM MENTAL ILLNESS AND ADDICTION THROUGH CRIMINAL JUSTICE REFORM
Bill Summary: This bill is designed to reform the criminal justice system to remedy the disproportionate incarceration of those suffering from mental illness and addiction. It seeks to shift the present focus from punishment to rehabilitation by restructuring police forces, reclassifying drug-related criminal offenses, replacing the legal consequences of drug-related criminal offenses, reconsidering medical resources in prisons, and reforming prison infrastructure.
WHEREAS, disease has been continuously criminalized and punished for thousands of years, with the focus shifting from physical illness to mental illness in the past century.
WHEREAS, deinstitutionalization has led to the disproportionate abundance of those suffering from mental illness in federal and state prisons.
WHEREAS, incarceration has been shown to have a direct negative impact on the mental health of prisoners due to isolating factors like solitary confinement and restrictive visiting policies.
WHEREAS, those suffering from mental illness cannot receive the treatment they need in prisons due to a lack of available medication and sufficiently trained personnel.
WHEREAS, very few individuals suffering from addiction refuse to seek treatment as a result of societal stigmas.
WHEREAS, the criminalization of drug use has been shown to worsen these stigmas.
WHEREAS, police forces disproportionately target communities of color in arresting and prosecuting drug-related offenses.
WHEREAS, the high recidivism rates of those suffering from mental health and addiction demonstrate the ultimate inefficacy of the criminal justice system’s current approach to rehabilitation.
THEREFORE BE IT ENACTED, police forces ought to contain a specialized, highly-trained division dedicated to mental health intervention.
THEREFORE BE IT FURTHER ENACTED, police weapons should not be on the person when responding to non-violent, mental health-related offenses.
THEREFORE BE IT FURTHER ENACTED, drug-related offenses involving simple personal possession ought to be decriminalized or, at the very least, deprioritized as a policing priority.
THEREFORE BE IT FURTHER ENACTED, individuals convicted for mental health and/or drug-related offenses ought to be sent to prisons specifically designed to rehabilitate those suffering from addiction and mental health disorders, as outlined below.
THEREFORE BE IT FURTHER ENACTED, the aforementioned prisons ought to have specialized, government-funded medical centers equipped with appropriate medications, a psychiatry department, and professionals trained in addiction rehabilitation.
THEREFORE BE IT FURTHER ENACTED, these prisons should be constructed with prisoner connection in mind to increase empathy and stigma. This goal can be achieved through a variety of ways, including, but not limited to: open spaces within prisons, increased visiting hours, allowing for more physical contact between prisoners and visitors, etc.
Works Cited
Binswanger, Ingrid A et al. “Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors.” Addiction science & clinical practice vol. 7,1 (2012): 3. doi:10.1186/1940-0640-7-3
“Comorbidity: Substance Use and Other Mental Disorders.” National Institute on Drug Abuse, U.S. Department of Health and Human Services, 15 Aug. 2018, nida.nih.gov/research-topics/trends-statistics/infographics/comorbidity-substance-use-other-mental-disorders. Accessed 4 Jan. 2023.
Hawaii State, Legislature, Senate. Relating to Kalaupapa Month. www.capitol.hawaii.gov/sessions/session2020/bills/SB2370_.HTM. Accessed 29 Dec. 2022. 2020th Legislature, Senate Bill 2370.
“Learning: Police-Mental Health Collaboration (PMHC) Toolkit.” Bureau of Justice Assistance, US Department of Justice, bja.ojp.gov/program/pmhc/learning#reduced-costs. Accessed 7 Jan. 2023.
“People with Untreated Mental Illness 16 Times More Likely to Be Killed by Law Enforcement.” Treatment Advocacy Center, www.treatmentadvocacycenter.org/key-issues/criminalization-of-mental-illness/2976-people-with-untreated-mental-illness-16-times-more-likely-to-be-killed-by-law-enforcement-. Accessed 29 Dec. 2022.
Perappadan, Bindu Shajan. “114 Discriminatory Laws in India against People Afflicted by Leprosy.” The Hindu, THG Publishing, 30 Jan. 2019, www.thehindu.com/news/cities/Delhi/114-discriminatory-laws-in-india-against-people-afflicted-by-leprosy/article26123887.ece. Accessed 29 Dec. 2022.
“Recidivism of Federal Drug Trafficking Offenders Released in 2010.” United States Sentencing Commission, 12 Jan. 2022, www.ussc.gov/research/research-reports/recidivism-federal-drug-trafficking-offenders-released-2010. Accessed 29 Dec. 2022.
“Transmission.” Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 10 Feb. 2017, www.cdc.gov/leprosy/transmission/index.html. Accessed 3 Jan. 2023.
“US: Disastrous Toll of Criminalizing Drug Use.” Human Rights Watch, 12 Oct. 2016, www.hrw.org/news/2016/10/12/us-disastrous-toll-criminalizing-drug-use. Accessed 29 Dec. 2022.
Volkow, Nora. “Punishing Drug Use Heightens the Stigma of Addiction.” Nora’s Blog, National Institute on Drug Abuse, 9 Aug. 2021, nida.nih.gov/about-nida/noras-blog/2021/08/punishing-drug-use-heightens-stigma-addiction. Accessed 29 Dec. 2022.
White, Neil. In the Sanctuary of Outcasts: A Memoir. New York City, Harper Perennial, 2010.
Wolff, Megan J. “Fact Sheet: Incarceration and Mental Health.” Weill Cornell Medicine, 30 May 2017, psychiatry.weill.cornell.edu/research-institutes/dewitt-wallace-institute-psychiatry/issues-mental-health-policy/fact-sheet-0. Accessed 29 Dec. 2022.
Yohanna, Daniel. “Deinstitutionalization of People with Mental Illness.” AMA Journal of Ethics, Oct. 2013, journalofethics.ama-assn.org/article/deinstitutionalization-people-mental-illness-causes-and-consequences/2013-10. Accessed 29 Dec. 2022.Zgoba, Kristen M., et al. “Criminal Recidivism in Inmates with Mental Illness and Substance Use Disorders.” The Journal of the American Academy of Psychiatry and the Law, Feb. 2020, jaapl.org/content/early/2020/02/12/JAAPL.003913-20. Accessed 29 Dec. 2022.