Recovery From Schizophrenia: Psychiatry And Political Economy

THE PERSON WITH SCHIZOPHRENIA IN WESTERN SOCIETY 177JAILS AND PRISONSTo escape hunger many of the destitute and homeless people with psychosis stealor eat meals for which they cannot pay; to avoid cold, damp and the discomfortsof homelessness many sleep in public buildings or empty houses and are arrested.As Table 8.2 shows, 28 in the 1980s, an average of around eight per cent of theinmates of local jails in the United States were found to suffer fromschizophrenia. More recent figures show the proportion in jail to be similar. InBritain, the number of incarcerated mentally ill has been increasingly dramaticallyin recent years—from two to three per cent of male inmates in the decadesleading up to 1980, 29 to six per cent of male inmates in the early 1990s, 30 to sevento ten per cent of male inmates and 14–20 per cent of women prisoners in 1997 31(see Table 8.2), The problem of incarcerating the mentally ill, like the problem ofhomelessness, has become as bad in Britain as in the US in recent years.Some of the people with psychosis in jail are being held on serious charges,such as burglary, assault and arson—their crimes often a product of their mentalillness. 32 Substantial numbers of these inmates have proven too dangerous to betreated effectively in the community, but no long-term hospital care can be foundfor them. 33 Whatever the type of crime, in fact, many people suffering frompsychosis remain in jail because hospital care or effective community care is notavailable. In 1991, the jail in Flathead County, Montana, held 82 mentally illpeople because local psychiatric hospitals would not take them. 34 Even noncriminalpsychiatric patients are housed in jail for the sake of mere convenience.In Kentucky in 1987, 1417 people were jailed, merely awaiting a court hearing forinvoluntary hospitalization, 35 and three-quarters of a random sample of admissionsto Bryce Hospital, Alabama, in 1978 were confined in jail while awaitingadmission. 36In US state and federal prisons a similarly large proportion of the inmates sufferfrom psychosis. 37 In one study, five per cent of Oklahoma state prisoners werefound to be suffering from schizophrenia; 38 ten per cent of admissions to theWashington state prison system were suffering from psychosis, in another; 39 andseven per cent of Michigan prison inmates were suffering from psychosis, in athird. 40 A study of New York state prisons in 1987 detected severe psychiatricdisability among five per cent of the inmates. 41 A 1989 review concluded that sixto eight per cent of people in US prisons were seriously mentally ill and that thenumber was increasing. 42 The 1991 Epidemiologic Catchment Area Studydetermined the prevalence of schizophrenia in US prisons to be five per cent. 43In some states, patients with psychosis are even sent from mental hospitals toprison for treatment. In Massachusetts in 1979 approximately one patient everyfour days was transferred to prison because mental hospital staff considered theperson unmanageable. Judges, furthermore, send severely mentally ill offenders toprison in preference to hospital because they find that mental health facilitiesfrequently fail to provide adequate long-term hospital or community care fordangerous and highly disruptive patients. 44 The number of inmates of US jails and