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The New Asylums: Jails Swell With Mentally
CHICAGO—The sound of clanging steel doors and agitated voices in the Cook County Jail bullpen was deafening. Amid the din, Robert Miller, who would turn 19 the next day, wept quietly. Anger and sullenness were common here. Uncontrolled crying was a sign of a bigger problem.
Mr. Miller was being held on a drug-possession charge and was waiting for his day in court. But his anguish caught the attention of a woman on the other side of the bars. Elli Petacque Montgomery, the jail's chief clinical social worker, listened as Mr. Miller spoke and shuddered. The teenager, who disputes the drug charge, said he had tried in vain to get help for his disabling episodes. Twice, he said, he had attempted suicide.
Battling Mental Illness in Lockup
A man held on to fencing while awaiting processing at Cook County Jail.
Ms. Montgomery scribbled notes on a clipboard. At the jail, she routinely sees people with conditions ranging from severe depression to schizophrenia.
"It's going to be a long day," she said.
America's lockups are its new asylums. After scores of state mental institutions were closed beginning in the 1970s, few alternatives materialized. Many of the afflicted wound up on the streets, where, untreated, they became more vulnerable to joblessness, drug abuse and crime.
The country's three biggest jail systems—Cook County, in Illinois; Los Angeles County; and New York City—are on the front lines. With more than 11,000 prisoners under treatment on any given day, they represent by far the largest mental-health treatment facilities in the country. By comparison, the three largest state-run mental hospitals have a combined 4,000 beds.
Put another way, the number of mentally ill prisoners the three facilities handle daily is equal to 28% of all beds in the nation's 213 state psychiatric hospitals, according to the National Association of State Mental Health Program Directors Research Institute Inc.
"In every city and state I have visited, the jails have become the de facto mental institutions," says Esteban Gonzalez, president of the American Jail Association, an organization for jail employees.
Correctional systems define mental illness differently. Generally, the term is used to describe prisoners who require medication for serious issues ranging from major depressive disorders to schizophrenia and bipolar disorders. Also included are inmates with diagnoses that warrant overnight stays in a mental hospital or who demonstrate serious functional impairment.
Families of Violent Patients: 'We're Locked Out' of Care (6/7/2013)
To get a snapshot of how the U.S. is grappling with such an explosive societal issue, The Wall Street Journal surveyed all 50 states about issues of mental health within their prison populations. Of the 22 states that provided detailed responses, their mental-health patient ratios ranged from one in 10 inmates to one in two. Inmates in all 23 responding states account for 55% of the prisoners in the U.S. under state jurisdiction.
In Oregon, the trend is particularly acute. Officials there estimate that half the state's 14,000 prison inmates suffer from some type of mental-health issue.
Several states with large inmate populations, like Michigan and Illinois, reported to the Journal that about 8% to 10% of their inmates suffered from serious mental illnesses, such as schizophrenia. Smaller states, like Montana, said as many as 15% of their inmates suffered from serious mental illness.
Roughly 5% of all adult Americans suffer from a serious mental illness, according to a 2012 report by a division of the U.S. Department of Health and Human Services.
Caring for such distressed inmates is costly. National Alliance on Mental Illness, one of the leading advocacy research groups, estimates that prisoners with mental illness cost the nation $9 billion annually.
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