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Jails are the new American asylums

We're answering mental illness with incarceration.

By Paul Heroux

In the wake of the Tucson tragedy, I wrote an op-ed in The Inquirer about mental illness and violence. Since then, much to my surprise, a lot of people have written to me pleading for help.

One woman expressed serious concern about a mentally ill cousin who has a long history of violence and recently tried to purchase two guns on the Internet, only to be disappointed when he received fake weapons. She said that because her cousin has not committed a gun crime, the police won't help her and don't know where to send her. She has no idea where to turn.

A father told me about his son who suffers from bipolar disorder, can't hold down a job, and might end up in jail. He, too, was searching for help.

These were just two of many stories I heard over the course of just a few days. These people are in such dire need of help with these issues that they shared very personal stories with me, a complete stranger.

Something different needs to be done to prevent not only high-profile violent incidents like the Tucson shooting, but also the less-known run-ins with the law that lead to the incarceration of thousands of mentally ill people every year.

When I was working for the Philadelphia Prison System, I examined the relationship between incarceration and mental illness. On a random day in 2007, I found that the most serious charge against 44 percent of the system's inmates was violence-related - often a charge of resisting arrest, meaning something less serious had probably precipitated the initial police involvement. The most serious charge against another 25 percent was drug-related. Both kinds of charges can be highly correlated with mental illness.

What was more revealing was the strong correlation between the number of incarcerations and diagnoses of serious mental illness. Among those who had been incarcerated in the city's system only once, I found that just over 10 percent were identified as having a serious mental illness. However, among those who had been incarcerated 16 times, more than 50 percent had been identified as having a serious mental illness. In fact, the prison system is one of the city's largest repositories of people with serious mental illnesses.

To put those numbers in context, while mental disorders are relatively common in the general population - affecting about 26 percent of Americans - only about 6 percent suffer from a serious mental illness, according to the National Institute of Mental Health.

Substance abuse is a catalyst for violence in people afflicted with mental illness, and, by one measure, 80 percent of those admitted to prison professed that they were either under the influence of a substance or had been during the 30 days prior to their incarceration. Absent substance abuse, research shows that rates of violence are not closely correlated with psychiatric disorders. In other words, crimes among those suffering from mental illness are highly preventable.

Too many people don't realize that "the mentally ill" are our family and friends, our neighbors and coworkers. People afflicted with mental illness are found in every demographic category. They are people just like the rest of us in virtually every way other than their mental illness, which makes their lives and problems that much more difficult than ours.

So how much help should be available to people suffering from mental illness? Should we make sure those services are sufficient and robust? Or should we make jail and prison our first line of defense?