Prince
Harry recently spoke movingly about the negative consequences for
himself of repressing his grief over the death of his mother when he
was twelve years old. Celebrities reveal their anxieties and
breakdowns. Such openness is important because it reduces personal
isolation and makes people feel that they will not be treated as
pariahs if they speak up. Openness
and discussion are important, but they skirt the heart of the
problem, which is that a proportion of people who are mentally ill
cannot look after themselves. The severity and incurability of a
mental illnesses are often underestimated and there may be
exaggerated expectations of preventing their onset by early
intervention. The precise causes and nature of mental illness remains
very much a mystery so a large number of people are always going to
become desperately ill. Schizophrenia, for instance, is to mental
illness what cancer is to physical illness. When Prince Harry talked
about psychological troubles, debilitating though these may be, they
are still not the same as full-blown psychosis or, in other words,
“madness”.
The
criminalisation of the mentally ill is one of the cruellest and most
easily avoidable tragedies of our era. The
prison systems have replaced psychiatric hospitals as the place where
people suffering from severe mental illness are most likely to find
themselves. It is a process that has been going on since the 1960s,
fuelled by a desire to save money, a belief that medication would
replace hospitalisation, and a liberal reaction against what was seen
as unnecessary incarceration. One
of the justifications for closing down the old asylum system was that
they were too much like prisons, but the paradoxical result has been
that psychiatric patients are now ending up in real prisons.
Between
1955 and 2016, the number of state hospital beds in the US available
to psychiatric patients fell by over 97 per cent from 559,000 to just
38,000. An expert noted despairingly that the biggest de facto
psychiatric institutions in the US today are Los Angeles County jail,
Chicago’s Cook County jail and New York’s Riker’s Island. Those
who are not in prison or hospital “become violent or, more often,
the victims of violence. They grow sicker and die. The personal and
public costs are incalculable,” says a report by the Treatment
Advocacy Centre in Virginia. Mentally ill people, usually poor and
unemployable because of their condition, are sometimes advised that
the only way they will get even the crudest treatment is by being
sent to prison.
The
same process is happening in Britain. The
number of beds available for mental health patients in the UK has
dropped by three-quarters since 1986-87 to about 17,000, while the
Centre for Mental Health says that 21,000 mentally ill people are
imprisoned, making up a quarter of the prison population.
For
many mentally ill people, the prospect of incarceration is becoming
probable in an unexpected reversion to 18th-century practice. Some
are left to wander the streets but most are looked after by their
families who may not have the resources to do so. Deceptively
progressive sounding words, like “deinstitutionalisation” in the
US and “care in the community” in the UK, are used to describe
the ending of the vast system that once catered for psychiatric
patients.
Some
of these institutions were hellholes, and others became unnecessary
because medication was available from the 1950s that controlled some
of the worst symptoms of mental illness. But the old system did at
least provide an asylum in the sense of a place of safety where
people who could not look after themselves were cared for. Supposing
“care in the community” had been more than an attractive slogan,
it might have provided something of a replacement for the old
asylums, but the care it provided was always inadequate.
The
reality of the new system was best described by the writer PD James,
an administrator in the NHS in London whose husband was a long-term
patient in a mental hospital. She wrote that since the 1970s
community care “could be described more accurately as the absence
of care in a community still largely resentful or frightened of
mental illness”.
Thomas
Winsor, the Chief Inspector of Constabulary, who complained that the
police are increasingly being used as the “first resort” for
people with mental health problems. He said that sometimes they ended
up spending the night in police cells even though they had committed
no crime because no hospital beds were available. He added that the
“inadequacy” of mental health provision should “disturb
everyone”.
Marjorie
Wallace, the founder and chief executive of Sane, a mental health
charity, explains that governments have every incentive to keep
mental patients out of hospital, since “providing a single bed
costs the same as ‘treating’ 44 people in the community”. She
welcomed Theresa May’s intention expressed in a speech earlier this
year to do something about “the burning injustice of mental health
and inadequate treatment”, but says that this will remain a utopian
vision unless there is more ring-fenced money for psychiatric
services which are already close to breakdown. The
present system has failed and the result is the creeping
criminalisation of mental illness.
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