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The last mental hospital.

¹Department of Psychiatry, Cambridge Hospital, Harvard Medical School, USA. jamesgilliganmd@att.net

The Psychiatric Quarterly

|April 11, 2001

Summary

The deinstitutionalization of public mental hospitals led to prisons becoming de facto mental health facilities. This shift, while aiming to treat violent individuals, is threatened by trends undermining mental healthcare access.

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Area of Science:

Psychiatry
Criminology
Public Health Policy

Background:

The historical development of public mental hospitals aimed to deinstitutionalize individuals with mental illness from correctional facilities.
Declining support led to the closure of many state mental hospitals, creating a gap in mental healthcare infrastructure.

Observation:

The closure of mental hospitals resulted in an increase of mentally ill individuals in prisons and jails.
Prisons have become the primary de facto mental health institutions for a significant portion of the mentally ill population.
There is a growing focus on providing psychiatric treatment within correctional settings for individuals with severe mental illnesses and personality disorders.

Findings:

The rise of prison psychiatry is partly driven by the failure to establish adequate community mental health resources post-deinstitutionalization.
A constructive aspect involves extending psychiatric care to violent populations with Axis I or Axis II disorders.
Four national trends are identified as threats to both the constructive goals of prison psychiatry and the prevention of further detrimental outcomes.

Implications:

Urgent policy interventions are needed to address the shortcomings in community mental health services.
Reforming correctional mental healthcare is crucial to avoid further criminalization of mental illness.
Future research should focus on mitigating the negative trends impacting mental healthcare within and outside the prison system.

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