The Mentally Ill Need Treatment, Not Cages

If you have ever played peekaboo with a baby, you have performed a magic trick. As you cover your face with your hands, the baby seems worried that you have performed a disappearing act. As a newborn, they have not reached the stage of cognitive development where they can process the idea of your face being hidden under your hands. Instead, they think it has simply disappeared from existence. This is why there is such joy in teasing a baby with this trick and it has become a common game. When you come out from under your hands you get to see this magical wide-eyed excitement and even better, you get to watch it over and over again as the baby never seems to catch on to your supernatural tricks.

But at around 18 months, the excitement starts to fade, and the baby seems less amused by your magician-like antics. They start to understand that your face is in fact hidden behind your hands and has not disappeared. This isn’t because they caught on to your mystical methods, but because they have developed a cognitive function they did not previously have. This cognitive development is object permanence, where we understand that objects continue to exist even when they cannot be seen, heard, touched, or sensed in any way.

When it comes to the issue mental health, it seems most of America has never developed this object permanence.

The reason why mental health is strongly stigmatized is because it does not manifest in visible, physical problems as other health issues do. It is literally and figuratively all in your head and because of that mental health diseases are so easily written off. It is because of this attitude and stigma that we find so many mentally ill in prisons.

The timeline for treating mental health is a long and fascinating one that starts in 400 B.C with Hippocrates, back when mental diseases ceased to be seen as a gods or spirits invading the body and instead were recognized as physiological disruptions. You would think that the treatment of such important illnesses would have improved exponentially since 400 B.C, but I would make the argument that they have not.

During the turn of the eighteenth century mental illness was a problem sweeping the nation creating a need for treatment institutions. These institutions were called asylums and once famously infiltrated by New York reporter Nellie Bly in her article “Ten Days in a Mad House”.

In 1887, Nellie Bly assumed the identity of Nellie Brown and feigned insanity until she was admitted into an asylum. She recorded her journey of being treated like an animal, being ignored by doctors and being held against her will. The only treatment Nellie and her co-detainees received was abuse.

“They looked at us curiously, and one came up to me and asked: ‘Who sent you here?’ ‘The doctors,’ I answered. ‘What for?’ she persisted. ‘Well, they say I am insane,’ I admitted. ‘Insane!’ she repeated, incredulously. ‘It cannot be seen in your face,” Nellie wrote in her expose, reinforcing the common misconception that illness only exist when it can be seen.

After the article “Ten Days in a Mad House” was published, the conversation of how we treat the mentally ill shifted. Since the nineteenth century, we have made remarkable strides in psychology, psychoanalytical treatments, and neuropharmacology. It was in the 1960’s when we stopped the custodial care of the mentally ill in asylums. Instead, we had hoped that with all the improvements in medication and treatments that the mentally ill would be able to live more comfortably in the outside world. Between then and today, America’s total state mental health hospital population fell from 558,000 to 43,000 — a decrease of more than 90 percent. These mental hospital attendees were basically left to themselves.

Unfortunately, we began replacing these asylums with prisons, which have now become our main provider of mental health care.

The National Institute for Corrections reports that in 2006, 705,600 mentally ill adults were incarcerated in state prisons, 78,800 in federal prisons and 479,900 in local jails. In addition, research suggests that “people with mental illnesses are overrepresented in probation and parole populations at estimated rates ranging from two to four times the general population.”

There are a number of reasons why the mentally ill are imprisoned. Often they are not able to hold a job, which means they are not able to afford treatment. Many times this crisis leads them to commit a crime. Though, more often than not, it is because they simply have nowhere else to go.

This only exacerbates our already devastating mass incarceration problem. There are currently 2.3 million people in prison with over 11 million people cycling through local jails each year. As if leading the world in having the highest number of people behind bars wasn’t already a moral stain on our country, we make it worse by allowing private prisons to make profit off these people, half of who are in jail for the crime of not having a good lawyer, drug related crimes, or (back to my main point) are mentally ill.

The never-ending failed war on drugs and its dedication to cycling people in and out of prison also ties back into treating prisons as health care systems for the mentally ill as addiction is a very serious public health issue. Instead of treating it as such, we have instead dehumanized and stigmatized addiction and mental illness so much to the point where it is punishable by jail time. Think about how absolutely absurd that is.

Our broken criminal justice system chews these people up and spits them out with crazy debt, no job prospects, no healthcare, no voting rights, and hardly any future. It is no wonder the nature of these events are so cyclic.

It is obvious that we need to reform our criminal justice system in more ways than one, but one of the first significant steps we have to make is to stop using it as a health care system for the mentally ill. The average cost of incarcerating a single person is around $30,000 a year, payed for by taxpayers money. With about 1.3 million mentally ill people behind bars in this country, we could take that astronomical amount of money and channel it into federally funded mental health facilities and enhance the programs and treatments to make them more readily available when people need them. We should also remove all barriers to Medicaid for those suffering with mental illness and promote early intervention. Finally, we need to invest more in public health and our health care system as a whole to be adequately equipped to care for the people in this country.

There are 57.7 million Americans living with mental illnesses. Some of these people will seek help and will be told “it’s just in your head.” Those same people will have a psychiatric crisis and end up behind bars because, in our current system, it is almost an inescapable fate. Let’s break the stigma against mental health. Let’s invest in social programs that are easily accessed for those suffering with mental illness. Let’s stop caging the sick and unwell as prisoners in both their minds and in real life. Most importantly, let’s remember that just because you can’t see it, doesn’t mean it’s not there.