Criminalization of the mentally ill.

In the great world of “they sayers,” they say that the more things change, the more things stay the same. Over a decade ago, Peplau (1994), affectionately known as the mother of psychiatric nursing, observed that the first great psychiatric revolution, and the beginning of contemporary psychiatric nursing, occurred when patients were moved from jails to asylums, and from asylums to hospitals. Regrettably, for a variety of reasons and life circumstances, countless consumers of traditional mental health services increasingly find themselves seeking mental health care under the auspices of jails, prisons, and correctional facilities – a phenomenon frequently referred to as the criminalization of the mentally ill. The deinstitutionalization movement that began in the 1960s, reached its peak in the 1970s, and continues today in some jurisdictions has often been blamed for the criminalization of the mentally ill. And although the philosophical underpinnings of deinstitutionalization were admirable, critics have declared that the “deinstitutionalization of seriously mentally ill individuals has been the largest failed social experiment in twentieth century America” (Torrey, 1995, p. 1612). Unfortunately, the persistent lack of appropriate mental health policy for individuals with chronic mental illness, coupled with insufficient community-based services, resulting in a lack of timely access to assessment and treatment, has resulted in a fragmented mental healthcare system. Many individuals with mental illness are not able to access appropriate and timely treatment; many have co-occurring substance abuse disorders and engage in criminal activities to support their drug habits; whereas others have long histories of committing crimes of survival (Human Rights Watch [HRW], 2003). Regardless of the scenario, they find themselves being bounced between courts, jails, and prisons – a process known as transinstitutionalization (Slovenko, 2003). Sadly, correctional facilities have become “front-line mental health providers” (HRW, 2003, p. 16), representing the “mental health institutions of the 21st century” (White & Whiteford, 2006, p. 302). A recent study by the United States Department of Justice reported that 479,000 local jail inmates (64% of their total population), 705,000 state prisoners (56% of their total population), and 78,000 federal prisoners (representing 45% of their total population) present with symptoms of serious mental illness (i.e., schizophrenia, bipolar disorder, and depression) (James & Glaze, 2006). And although these numbers are particularly staggering, similar trends have been reported in Canada and the United Kingdom as well. Conventional wisdom would dictate that prisons were never designed to meet the needs of individuals requiring treatment for mental illness, and controversy exists regarding how well-equipped prisons are to deal with the complex needs of mentally ill offenders. All too often,