Jail or hospital for mentally ill?

A recent comparison study in the US has once again highlighted the need to eliminate stigma and improve treatment accessibility for individuals with serious mental illness.

Comparing prison and hospital populations across the US, this study found it is three times more likely for a person with a serious mental illness to be in prison than in the hospital.

The study, published in May by the Treatment Advocacy Center, made their estimate based on the published data that 16 percent of individuals in prisons have a serious mental illness.

Numbers varied from state to state and there was a correlation between a state’s spending on mental health and the likelihood of people being incarcerated rather than hospitalized.

Arizona and Nevada had the highest likelihood of mentally ill individuals being in jail – it is nine times more likely in these states to be in prison than hospital if you have a mental illness.

You may wonder what relevance this information has for Canadians. I have not seen an equivalent study for our own country, but the Canadian Mental Health Association did report the number of mentally ill individuals in our prisons had more than doubled between the mid 1990s and mid 2000s. I also think a similar mindset and approach to mental health issues exists in Canada.

In both countries, deinstitutionalization has resulted in more individuals with serious illness left to fend for themselves with few supports. Economic and political realities have also resulted in physician shortages and lack of sufficient community-based services for the mentally ill in both Canada and the US.

Continued stigma surrounding mental illness pushes these issues out of the forefront as those who are ill often can’t or don’t want to advocate on their own behalf and mental illness isn’t a catchy fundraising topic for non-profit agencies.

Meanwhile, hospital space continues to drop and prison populations continue to climb. Communities don’t know what to do with mentally ill people living on the streets and so they are often placed in jail. According to this study’s author, this seems to be slowly becoming the way the mentally ill are dealt with.

In this study, researchers made several recommendations for reversing the situation in the US. I believe these would also be useful here in Canada. Initiatives such as the creation of separate mental health courts giving offenders a choice between adhering to a treatment plan or going to jail would likely result in some constructive results. Mental health courts do actually already exist in a couple of Canadian provinces including Ontario.

I believe we would be better served to help ensure the seriously mentally ill among us have access to appropriate and affordable treatment options. It would be far less costly both in terms of human suffering and tax dollars for sick people to be treated rather than locked away.


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