Sexual abuse is shockingly common in the U.S. prison system. A recent survey conducted by the Bureau of Justice Statistics concluded that each year about 200,000 prisoners are victims of coercive sex.
Most of the those abused are psychiatric patients misplaced in prison. They make vulnerable targets — less able to defend themselves and less likely to be believed if they report infractions.
Prisons are clearly not an appropriate or safe place for psychiatric patients — but almost a million are behind bars for crimes that could have been avoided had they received proper community treatment. Prison has become the default disposition for patients who can’t make it on their own in the community. Usually they are incarcerated for non-violent, nuisance crimes that are the result of society’s neglect, not their evil intent.
The rate of overall institutionalization for psychiatric patients has remained fairly constant for the past 80 years, but the institution of choice has shifted them from hospitals to prisons. We have closed almost a million hospital beds, but have added the same number of cells for psychiatric patients. This makes no sense and it wasn’t supposed to be this way. The dollars saved by closing hospital beds were supposed to follow the patients — supporting them in community settings where they would have a richer and freer life.
Instead, the states have welched on their obligations to the mentally ill. Attempting to trim mental health budgets, they have irrationally spent the same dollars on inappropriate incarceration in prisons. The obvious solution now is to decriminalize the mental ill by funding adequate services for them. This is not rocket science. The U.S. lags far behind the rest of the developed world got this message two hundred years ago.
The rape survey data also informs the discussion begun in my last blog whether forced psychiatric treatment is ever justified.
Eleanor Longden and I agreed that on rare occasions it is necessary and appropriate to avoid a clear and present danger. Eleanor’s statement was particularly significant since she had herself been the victim of considerable inappropriate psychiatric coercion.
Some of the responses to the blog missed the point that prisons, not psychiatric hospitals, are now the locus of inappropriate coercion of psychiatric patients. It was even argued that prison was preferable to forced psychiatric treatment because it provided more protection of civil rights and was more justified because a crime had been committed.
I am convinced of the sincerity of these advocates for the mentally ill, but puzzled by their blindness to the realities of the current situation. They are now fighting the wrong fight against coercion, not recognizing that the risks have shifted.
Fifty years ago a million patients languished in snake pit hospitals, now they languish in much more dangerous and degrading snake pit prisons. Psychiatric patients do not do well in negotiating the perils and routines of prison life. Too often they wind up in extended solitary confinement, which can drive anyone crazy.
To get the full measure of the depths of degradation prison life can hold for psychiatric patients, you have to see and smell the rows of solitary cells where the smearing of excrement has become a last resort of desperation. And psychiatric patients are prime targets for sexual (and probably other forms) of violence.
Everyone interested in the welfare of psychiatric patients should join in the effort to end their barbarous imprisonment. The battle against inappropriate psychiatric incarceration has already largely been won — the much more urgent battle again inappropriate prison coercion needs all the help it can get.
Allen Frances is a psychiatrist and professor emeritus, Duke University. He blogs at the Huffington Post.
