For nearly 200 years (1790-1980), the care of the mentally ill was, in the United States, the primary responsibility of lunatic asylums. The grand idea of the asylums was gradually replaced by the modern psychiatric hospital, a state institution rife with overcrowding, minimal care, and even painful, mind-numbing electroshock therapy as depicted in One Flew Over the Cuckoo's Nest.
By the 1960s, nearly 500,000 mentally ill were residing in state hospitals. In the 1960s and 1970s, great hope was offered through the community mental health movement, which envisioned small, community-based residential care spread widely. Unfortunately, such services were not developed to the great degree needed. Further, major cutbacks in state funding for mental health services over the past five to six years has led to budgetary reductions of nearly $5 billion a year in state funding for mental health care (the states are the primary funders of mental health services).
By the 1980s, homelessness and the use of drugs and alcohol among the mentally ill became widespread -- in part because the massive hospitals were closed without a secure place for the patients in community care facilities. The advent of large number of homeless persons in the streets and SROs coincided with the fevered rise of the national "War on Drugs."
Today, the new asylums for the mentally ill are our local jails and state prisons, and not only have the public costs for their "care" risen as a result, but the conditions for the mentally ill have deteriorated. The three largest de facto psychiatric hospitals in the U.S. are the Cook County Jail (Chicago), the LA County Jail and the Rikers Island Jail in New York City.
To place the jails in this position is to guarantee failure for the facilities and the mentally ill inmates. Sheriff Tom Dart from Cook County was recently quoted as saying, "I can't conceive of anything more stupid by government than to do what we're doing right now."
Why so? The stigma against the mentally ill is at an all-time high, driven by the media's consistently inaccurate portrayals of the mentally ill as dangerous (in truth, in the great majority of cases the mentally ill are the victims of violence, not its perpetrators.)
Finally, the lack of large scale effective advocacy for change is notable and means that badly needed change will be harder to come by. It is time that the federal government, in coordination with states and advocates for the mentally ill, initiates dramatic changes.