When a person has a mental-health crisis in America, it is almost always law enforcement—not a therapist, social worker, or psychiatrist—who responds to the 911 call. But most officers aren’t adequately trained to deal with mental-health emergencies. And while laws intended to protect civil liberties make it exceedingly difficult to hospitalize people against their will, it is remarkably easy to arrest them.
As a result, policing and incarceration have effectively replaced emergency mental-health care, especially in low-income communities of color. In many jails, the percentage of people with mental illness has continued to go up even as the jail population has dropped. Today, nearly half the people in U.S. jails and more than a third of those in U.S. prisons have been diagnosed with a mental illness, compared to about a fifth in the general population.
When the justice system steps into mental-health care, the results are often deadly. According to a Washington Post database, nearly one-quarter of fatal police shootings involve a person with mental illness. Once inside a jail or prison, the mental-health care a person receives generally ranges from inadequate to abusive; suicide rates are disturbingly high. America’s criminal-justice system has a mental-illness crisis, and to fix it we need to understand how we got here.
One popular explanation blames “deinstitutionalization”: the emptying of state psychiatric hospitals that began in the 1950s. When the hospitals were shut down, the story goes, patients were discharged with no place to get psychiatric care. They ended up on the streets, eventually committing crimes that got them arrested. As a result, jails and prisons essentially became the new asylums. It’s an idea with roots in a theory developed in the 1930s by a British psychiatrist, Lionel Penrose, who argued that there was an inverse relationship between the number of people held in prisons and those in asylums. Today, the “Penrose hypothesis” is largely regarded by scholars and historians as an oversimplification of the problem, yet variations of it are regularly repeated in the media. The truth is far more complicated.