Mental Illness

“. . . Justice systems are built on the notion of free will and thus require an examination of the state of mind of the accused. . . .”

- M. E. Rice, et. al

It is often argued that a person’s presence in a correctional facility, in itself, points to a level of social maladaption as to constitute a possible mental disorder. One study found that only 5% of penitentiary inmates did not have some sort of mental disorder. This study counted “. . . psychosis, a problem of substance abuse or dependence, [or] a diagnosis of antisocial personality disorder” as “mental disorders.”[1] Other studies have aimed to show direct genetic (biological) causes of aggression and violent tendencies by searching for an “aggression” gene among prison inmates.[2] Segregation and victimization of mentally ill inmates within prison-inmate culture has also been observed. Apart from expected levels of social malada ption among inmates there is a minority population of mentally ill inmates distinct and differentiated from the larger inmate culture. These inmates are set apart from the general prison population and stigmatized for their mental illness, especially if it is quite apparent or visible.

After studying populations of prisons and psychiatric hospitals in Europe, researchers in 1939 observed that “. . . as the size of prison population goes up, the size of mental hospital population goes down proportionately, and vice versa, presumably because people move from one system to the other.”[3] Applying this theory to the current situation, one would expect to find rising prison population, and in fact, this is the case.[4] Whichever study one chooses to believe, the incidence of mental illness in prisons is high. One recent study found that 35% of prison inmates sentenced to periods less than two years qualified as mentally ill compared with 10.3% of the general population[5]. Another study, which took into account severity as well as prevalence, found that 7.2% of inmates had severe mental illnesses[6]. In comparison, the number of patients in state psychiatric hospitals has fallen dramatically. In 1955, there were 559,000 patients in state psychiatric facilities. Today there are under 100, 000.[7] Once adjusted for population growth, it can be seen how drastic these numbers actually are.

The terms “mentally disordered” and “mental illness” tend to be overly broad generalizations that cover diverse and dissimilar phenomena. For the purposes of this discussion, “mental illness,” “mental disorder,” and “mental disability” will refer only to clinical psychoses, meaning nuerobiological conditions such as schizophrenia, bi polar disorder, major depression, obsessive compulsive disorder and organic brain syndrome. In addition it will refer to developmental disabilities (persons who are mentally retarded). It will exclude any other problems that may be perceived as mental, such as substance abuse and “antisocial personality disorder.” It will also exclude the category, “mentally disordered sex offender,” since sex offenders rarely suffer from any of the above mentioned clinical psychoses.[8]

In the latter half of this century, the country has seen progressive “deinstitutionalization,” the steady dismantling of state psychiatric hospitals[9]. During the height of the civil rights reforms of the late 1960’s and 70’s, concerns were raised about the abuse of involuntary civil commitment, and the constitutional right to refuse treatment. Specifically, more people became aware of horror stories[10] such as patients receiving involuntary lobotomies, and nondisabled people being detained. Public opinion soon after began to be reflected in courtrooms.

In years past, clinicians have been delegated the authority to determine whether or not an individual required psychiatric hospitalization, and also have had the authority to detain patients against their will for indefinite periods of time.[11] In the 1979 landmark case of Addington v. Texas,[12] the Supreme Court set out to analyze whether it was more appropriate for courts or clinicians to decide where involuntary civil commitment was warranted. Specifically, the legal issue that was raised was whether existing statutes authorizing clinicians to determine commitment violated the Fourteenth Amendment right to due process, especially where loss of liberty is involved. The court ruled that “. . . a ‘clear and convincing’ standard of proof is required by the Fourteenth Amendment in such civil proceedings under state law to commit a person involuntarily in a mental institution for an indefinite period of time.”[13] This means that under the