"Our prisons and our jails are now our mental health institutions," Democratic presidential contender Hillary Clinton declared in a Wednesday speech on criminal justice reform.
Data on the incarceration of mentally ill Americans bears out Clinton's point. In the past 50 years, there's been a marked shift of mental health patients away from state-run institutions and to jails and prisons.
One recent report found that America's jails and prisons now house 10 times as many mental health patients as state institutions.
This shift, as Clinton noted in her remarks, began with good intentions. In the 1960s and 1970s, mental health practitioners began to move patients out of long-stay psychiatric facilities — the type that came to be associated with abuse and neglect — and into more community-based treatment centers.
"You and I know that the promise of de-institutionalizing those in mental health facilities was supposed to be followed by the creation of community-based treatment centers," Clinton said in her remarks. "Well, we got half of that equation — but not the other half."
As the number of hospital beds at state psychiatric hospitals has shrunk, advocates have become concerned that patients lack access to adequate treatment, and that the prison and jail system has become a stand-in for the psychiatric hospitals that are disappearing.
"Looking back, it is possible to see the mistakes, and a primary problem was that mental health policy makers overlooked the difficulty of finding resources to meet the needs of a marginalized group of people living in scattered sites in the community," Chris Koyanagi of the Bazelon Center for Mental Health concluded in his 2007 history of de-institutionalization.
The Department of Justice estimates that about 15 percent of state prisoners now "report symptoms that met the criteria for a psychotic disorder." Inmates with mental health problems are more likely to be charged with violating the facility's rules, with either physical fighting or verbal assaults. They are also more likely to have a history of substance abuse, be victims of physical or sexual abuse, and to have experienced homelessness in the year before their arrest.
Advocacy groups say prisons and jails are ill-equipped to provide mental health patients with the treatment they need. Inmates with serious mental health problems tend to have worse outcomes while incarcerated. Advocates cite previous studies showing that those with serious mental illness are disproportionately held in solitary confinement and frequently attempt suicide.