The article “Justice Finds No Middle Ground for Mentally Ill Defendants,” appeared in The Day on July 2. A more profound issue, perhaps, is the criminalization of mental illness, which is rooted in deinstitutionalization and the failure of our nation to provide community-based services for individuals with mental illness following the demise of public psychiatric hospitals.

At the threshold of the 21st century, a disturbing trend has become evident. As the number of hospitalized adults decreased during the second half of the 20th century, the number of prison inmates with serious mental illness was on the rise. In fact, the federal Bureau of Justice Statistics (BJS) reports that the number of inmates in jails and prisons with mental illness quadrupled in just six years — from 283,000 in 1998 to 1.25 million in 2006. This surge coincided with the closure of the last of the hospitals.

While the lofty goal of deinstitutionalization was community integration, in general the necessary resources were never provided. The result is clear. In the United States, half of inmates with mental health problems have been convicted of nonviolent offenses, primarily low-level drug and property offenses. Statistics reflected in the BJS report show that those most at risk for imprisonment are people who cannot get treatment — those who are poor, homeless, or experiencing addictions. In such circumstances, individuals are more likely to commit a crime. Prisons currently house three times more people with serious mental illness than do psychiatric hospitals. Mike Fitzpatrick, executive director of NAMI, says jails and prisons “have become the new mental hospitals.”

Despite the sometimes harsh conditions found in psychiatric hospitals, they provided the full complement of psychiatric, medical and residential services. In direct contrast to psychiatric hospitals, however, prisons are ill-equipped to provide the full range of services needed. Individuals with mental illness receive treatment that often consists of little more than medication, which may be poorly administered or monitored. Prisons cannot offer the long-term intensive supportive and therapeutic environment needed for recovery, and discharge planning for housing and employment is minimal.

Prison systems rarely provide correctional officers with mental health training. As a result, officers do not understand the behavioral symptoms of mental illness and will punish offenders with mental illness for symptoms like being noisy, refusing orders, self-mutilating or attempting suicide. This leads to a vicious cycle of isolation and ever-worsening symptoms.

In Connecticut, officers at only two state prisons — those housing the majority of inmates with mental illness, Garner and Northern — receive a mere eight hours of mental health training. A bill passed in the most recent state legislative session required the Department of Corrections to develop a four- to eight-hour-per-year mental health training program for all corrections staff working with inmates who have a mental illness, but this and other provisions of the bill were not funded.

The magnitude of the problem is evident upon examination of prison statistics in Connecticut, where the adult population of people incarcerated with moderate to severe mental illness has increased from 2,200 in 2000 to 3,700 in 2005, or from 12 percent to 20 percent.

While the lack of resources and the resulting rise in the rate of incarceration have been a betrayal of the initial promise of deinstitutionalization, a few bright spots remain. Connecticut offers jail diversion programs in all 20 arraignment courts in the state, but only about 40 percent of people with serious mental illness can be diverted, in large part due to the lack of community housing and services.

According to Thomas Kirk, commissioner of the Connecticut Department of Mental Health and Addiction Services, “... people with psychiatric disabilities who commit minor crimes that are directly related to their illness ... are better served if we divert them into treatment. As they improve with treatment it enhances the quality of community life for everyone and reduces demand on the correctional system.”

Crisis Intervention Teams offer a pre-arrest jail diversion opportunity by providing 40 hours of specialized training in psychiatric and substance abuse disorders, including crisis de-escalation techniques, to police officers who volunteer. The New London and Norwich teams have been highly successful in their efforts to link people with treatment in lieu of arrest, but are constantly hampered by lack of funding.

The 2003 Presidential New Freedom Commission on Mental Health concluded that our nation's mental health system is “fragmented and in disarray,” and recommended that the government “address mental health with the same urgency as physical health.” But until our leaders make it a priority to create and fund a community mental health system, our prisons will remain the nation's de facto mental institutions.