The last mental hospital

The public mental hospital system was created in part because many mentally ill people were being held in prisons and jails. Support for those hospitals waned over time, however, and by the time they had degenerated into "snake pits" a consensus was reached to close them down. Unfortunately, they were not replaced with adequate community mental health resources, so as the hospitals have emptied, the prisons and jails have filled, partly with the mentally ill. That is the destructive reason for the growth of prison psychiatry in this country: the prison has become the last mental hospital. The constructive one has been a new emphasis on bringing psychiatric treatment to a previously neglected population: people who have committed serious violence, whether because of Axis I mental illnesses or Axis II character disorders. Unfortunately, four inter-related, mutually reinforcing nationwide trends threaten to reinforce that destructive development and vitiate the constructive one.