A Shift from Asylums to Jails and Prisons: A Look at the Criminalization of Mental Health Conditions

A shift from asylums to prisons and jails has become a trend throughout the United States for those with mental health conditions. As Smith points out, there was an “increase of community mental health and deinstitutionalization movements in the 1970s” (2012). After investigative reporter Geraldo Rivera’s expose documentary on the grotesque conditions of mentally (dis)abled children at Willowbrook State School, it became important that patients should be held in facilities with as least restriction as possible. Due to deinstitutionalization after these movements without accommodating with adequate community services, many of those with mental health conditions who were previously institutionalized became homeless. This trend was seen across the nation. Butterfield acknowledged this trend when he writes, “homelessness was the most public sign of the problem. But for growing numbers of people, the price of mental illness was arrest” (1998). Once homelessness became the new problem for those with mental health conditions, not long after did the criminalization of the mental health condition occur. Borenstein explains twenty percent of inmates with psychiatric illness were homeless during the year before their incarceration” (2014). He examines how the deinstitutionalization of the mentally ill became a homeless story, which later transformed into a jail story. Butterfield identifies “jail, by default,” as “the nation's largest mental institution” (1998). This shift from asylums to jails and prisons occurred in concurrence with the criminalization of those with mental health conditions. The problem is complicated by society’s discomfort with advocating for criminals, the overcrowding of the prison system, and little to no discharge plan to inmates upon release.

Bark brings up that “in 1934, the ratio of prisoners to mental hospital patients was 0.4; now, it is 3:1” and that the “states with the highest ratios also have the highest rates of imprisonment and the lowest expenditures on mental health.” (2014). This means that not only are prison the new asylums, but these “criminals” are not given the help they need and deserve because it does not fit into the budget. Borenstein observes that “the number of mentally ill people in U.S. jails and prisons grew to 283,000 in 1999 as the number of patients in state and county mental hospitals declined from 600,000 in 1950 to 72,000 in 1994” (2014). The numbers speak for themselves. He goes on to discuss that the jail population included 30,000 inmates in need of psychiatric care, many of whom could have avoided incarceration if they had access to appropriate mental health services” (2014). Keeping this in mind, it is important to ask one’s self: Who is responsible for the incarceration of those suffering from mental illness? What is society’s role in the criminalization of those with mental health conditions?

The result of deinstitutionalization and the trend of homelessness is the criminalization of those with mental health conditions. Are mentally ill inmates criminals or victims themselves? Crawford, a social worker working with assaultive male inmates in prison, points out the divisiveness of prisons as they create disunity, while the establishment and development of subgroups among the prison population widen the divide between staff and inmate (2012). This division is widened by the criminalization of inmates with mental health conditions. Is the physical environment of prisons and jails hindering the recovery process for the mentally ill within the criminal justice system? Gutheil identifies that the physical environment in which the patient is situated can have an effect on the patient’s recovery (1992). The move from asylums to jails and prisons is still institutionalization. Community-based serviced should provide an alternative to institutionalization and should combat the stigmatization and criminalization of those with mental health conditions. Again, we must ask ourselves: Are mentally ill inmates criminals or prison patients? The criminalization of those with mental health conditions complicate treatment programs with dependence on medication within the prison system with litter to no discharge plan for continued medication, leading to higher recidivism rates amongst this population.

To change the way society sees criminal advocacy, we must shine a light on the humanity of these inmates and become comfortable with the concept that criminal status is in opposition to victimization. Revisiting the idea of criminals as victims of society, Arundell, a social worker who works on treatment for adolescent sexual offenders learned from his sessions that a majority of those in the program were victims of sexual abuse themselves before becoming sexual offenders (2012). The theme of criminals as victims is prominent with the mentally ill prison population. Victims of their own minds, those with mental health conditions are a vulnerable population even outside of prison. A forensic social worker, Orloff, recognizes that “a person is more than the worst thing he or she has ever done, and thus,” criminalization should be looked at from a social work perspective. Like Arundell, Orloff also “found that a huge percentage of my clients had been victims of trauma or were survivors, and many were re-enacting their trauma” (2012). Society’s marginalization of criminals and arrestees depreciates the autonomy of these individuals and has an impact on their family and the community, which they are a part of. Society’s role must change and advocacy on behalf of criminals is essential to our nation’s progress in the future for those with mental health conditions and racial groups who are disproportionately represented, as well as the United States of America as a whole.

With the overcrowding of prisons, the budget for prisons becomes tight, and a new trend of privatization of prisons allowed for cost cutting by using “a restricted formulary of older generation psychotropics and generic agents that are less expensive” (Daniel 2007). Labeling victims of mental health conditions, who need treatment, as criminals denies them an opportunity to be advocated for because advocating for criminals is less socially acceptable. Healy’s use of the historical perspective to link social work and human rights (2008) reminds us that because, although stigmatized, the mentally ill and criminals deserve to have their rights realized. Stigmatization, criminalization, and stereotyping threaten these human rights. Wight, a social worker in a prison setting working with male inmates on substance abuse treatment writes that he is, “reminded again not to stereotype the men [he] work[s] with” (2012). In line with Wight’s unbiased approach to working in prisons, Beers, a victim services social worker acknowledges: “it is imperative that anyone working in this field deal with their own personal biases and issues. It is difficult to be an advocate when you have not done this” (2012). Advocacy on behalf of the criminalized is not simple, and many are deterred from such an initiative. But the necessity of advocacy and treatment/recovery plans are essential to the criminal/client/patient’s success.

Borenstein assesses that “in contrast to psychiatric facilities, jails are not required to provide a discharge plan” (2014). This drastically complicates the problem. Some people rely on social welfare, which is something stigmatized by society, just as mental illness is stigmatized. Abramovitz points out that there are three forms of welfare: social, fiscal, and corporate (2001). Yet only social welfare is stigmatized. Perhaps this is because it is associated with the poor and disenfranchised. Abramovitz also points out that social welfare is the most vulnerable to budget cuts. How can society marginalize people who need assistance? This is especially the case with those with mental health conditions. Crawford observes in Canada, something that is also true for the United States: “Every time I walk into that prison, I see the poor and the disadvantaged, the physically and mentally ill, the alcohol and drug addicted, the uneducated, the abused… I don’t just see criminals, and I don’t just see how they need to change. I wonder about our social, economic, and political system.” He says this of “a country that has so much wealth but so little interest in distributing it fairly” (2012). The United States and Canada both disproportionately sentence the poor and disenfranchised, and among them, those with mental health conditions.

Daniel advises “innovative and comprehensive treatment programs in prisons, coupled with state-of-the-art diversionary measures for mentally ill arrestees and prisoner community reentry programs” to attempt to “prevent a high rate of recidivism and morbidity of prisoners and to facilitate their adjustment in the community” (2007). Borensteinsuggests “prevention, early intervention, adequate resources, and police training to help them recognize people with psychiatric illnesses” and says, “when state governments fail to pass meaningful mental illness legislation, the shame continues” (2014). In concurrence with Borenstein, Bark also concludes “litigation is likely to improve mental health services in prisons and to keep people who are mentally ill out of prisons” (2014). Advocacy and legislation must advance and demand the protection of those with mental health conditions.


Abramovitz, M. (2001). Everyone is still on welfare: The role of redistribution in social policy. Journal of Social Work 46, 297-308.

Arundell, R. (2012). Chapter 35: Residential Treatment for Adolescent Sexual Offenders. In Mary Grobman Editor (4th edition), Days in the Lives of Social Workers (257-261). Pennsylvania: White Hat Communications.

Bark, N. (2014). Prisoner Mental Health in the USA. International Psychiatry: Guest editorial, 11(3). Retrieved from http://www.rcpsych.ac.uk/pdf/PUB_IPv11n3.pdf#page=3.

Beers, S. (2012). Chapter 37: Victim Services. In Mary Grobman Editor (4th edition), Days in the Lives of Social Workers (269-274). Pennsylvania: White Hat Communications.

Borenstein, D. (2014). Shame on Government. Psychiatric News from the American Psychiatric Association. Retrieved from http://psychnews.psychiatryonline.org/doi/10.1176/pn.36.3.0003.

Butterfield, F. (1998). Asylums behind bars: a special report; prisons replace hospitals for the nation’s mentally ill. New York Times, A1. Retrieved from http://www.antoniocasella.eu/archipsy/Butterfield_nyt_5march1998.pdf.

Crawford, M. (2012). Chapter 34: A Hard Day’s Night: Working with Assaultive Men in Prison. In Mary Grobman Editor (4th edition), Days in the Lives of Social Workers (251-256). Pennsylvania: White Hat Communications.

Daniel, A. E. (2007). Care of the mentally ill in prisons: challenges and solutions. Journal of the American Academy of Psychiatry and the Law Online,35(4), 406-410. Retrieved from http://www.antoniocasella.eu/archipsy/Daniel_2007.pdf.

Gutheil, I. (1992). Considering the physical environment: Essential component of good practice. Journal of Social Work 37(5), 391-396.

Healy, L. (2008). Exploring the history of social work as a human rights profession. Journal of International Social Work 51(6), 735-748.

Orloff, L. (2012). Chapter 36: Forensic Social Work: Mitigating Death Penalty Cases in a Capital Defense Unit. In Mary Grobman Editor (4th edition), Days in the Lives of Social Workers (263-267). Pennsylvania: White Hat Communications.

Smith, K. (2012). Chapter 24: Partial Hospitalization. In Mary Grobman Editor (4th edition), Days in the Lives of Social Workers (187-193). Pennsylvania: White Hat Communications.

Wight, T. (2012). Chapter 33: Prison Substance Abuse Treatment. In Mary Grobman Editor (4th edition), Days in the Lives of Social Workers (245-250). Pennsylvania: White Hat Communications.

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