Involuntary Hospitalization or Incarceration: Why Our Choices Are So Limited

A severe mental illness can be a death sentence, but not for the reasons you might think. Individuals living in the United States with untreated mental illness are 16 times more likely to be killed during a police encounter than any other civilian approached or stopped by law enforcement. The reality is, police officers are often the “first responders” to individuals with severe mental illness–answering calls about “disturbances”, suicidal ideation, or crimes committed– but are ill-prepared for dealing with these complex psychiatric cases.

According to the Treatment Advocacy Reports, 1 in 5 inmates in America have a serious mental illness; even more have diagnosable mental illness. First responders (including police) are reluctantly taking over the role many believe that should involve psychiatrists or other mental health professionals. The justice system in turn is tasked with solving the social problems that occur as a consequence of a severe mental illness. It is abundantly clear that prison is not the answer for solving serious mental health issues. Rather, reports compiled by organizations such as the WHO show that incarceration will only exacerbate these problems. Still, law enforcement see few options apart from arrest and/or incarceration when dealing with mentally ill individuals; when they are tasked with balancing individual well-being against public safety.

The alternative to incarceration is involuntary hospitalization. The misconception held by some mental health and legal professionals is that involuntary hospitalization can be the best thing for people with severe mental illness; and protects those with severe mental illnesses from ending up in the justice system. However, there is inconclusive evidence of the effectiveness of involuntary hospitalization. Ironically, one of the reasons why there is an overrepresentation of persons with serious mental illness in the justice system is because of deinstitutionalization. Following the arrival of antipsychotics in the 1950s, the public view became that it was not necessary to detain individuals with mental illness since treatment of psychiatric symptoms was available. By the 1990s the number of psychiatric inpatients had been reduced from 550,000 in 1950 to 30,000. Nonetheless, the issue became that individuals with serious mental illness, who were disproportionately homeless or extremely low-income, could not afford access to these new treatments. As a result, the number of individuals with untreated serious mental illness within the prison population increased.

At the end of what seems to be a very complex issue is a very simple solution. The medical profession has reached a point where effective treatments are available for individuals with mental illness. Medical facilities provide access to mental health professionals beyond psychiatrists; facilities have social workers, counsellors, psychologists, occupational therapists, even specialists with specific training to treat addiction. The only remaining issue is funding. How can those who need access to mental health services get that access when the cost is so high? Well, recent research has shown that publicly funding psychiatric medication may save taxpayers money. A Desmarais study recently found that people who receive less mental health services unsurprisingly incurred higher criminal justice costs, which averaged $95,000 per person. In comparison, the study showed that people who received more mental health services had lower arrest rates bringing the criminal justice costs down to $68,000 per person

The answer is to provide better access to mental health services for people who need it the most. Simply pushing mental health issues away has caused these issues to be dealt with in inappropriate, and often detrimental, ways that are not only unhelpful but economically burdensome to society. Our choice does not need to be between involuntary and incarceration as the means to combating serious mental illness.