Butler psychiatrist: Prison wrong place for people living with mental illness

PROVIDENCE — Far too frequently, people living with severe mental illness wind up in prison, where treatment is typically inadequate, if it exists at all. A criminal-justice system weighted in favor of “suffering and vengeance” is to blame – and only reform of that system can result in a humane approach to some of the most vulnerable people in society.

So argues Butler Hospital and Brown University psychiatrist Dr. Christine Montross in her new book, “Waiting for an Echo: The Madness of American Incarceration.”

Montross discusses her book and the issues it raises in this week’s episode of “Story in the Public Square,” the national PBS TV and SiriusXM Radio show.

Today, Montross works as an inpatient psychiatrist on intensive treatment units she describes as “psychiatric versions of the ICU.” The patients she sees are severely ill.

“They are actively hearing voices or seeing visions, have paranoid beliefs, are really manic or are actively trying to hurt themselves or other people,” she said. “And what I see over and over again, and what really prompted this look into our prison system, was that my patients often come in contact with police and they often serve time in jail or prison.

“And when they do, frequently it's not due to some sort of criminal intent or scheme. It's really due to a manifestation of their symptomatology. So they're shouting in the Starbucks or they're charging through [airport security] because they believe they need to get on a plane to save the world. In those moments, the police are called and my patients are often taken to jail.”

Some for a short while, others for years. And although Montross credits some correctional systems with providing a respectable degree of care, she maintains that the very nature of a prison, with its first job of confinement and control, can thwart even the best efforts. And for many, imprisonment exacerbates symptoms and deepens crisis.

.oembed-frame { width: 100%; height: 100%; margin: 0; border: 0; }

How many people living with mental illness are behind bars today?

“About 20% of the people in American jails and about 15% of people in prisons have severe mental illnesses,” Montross said. “And when I say that, I mean schizophrenia, schizoaffective disorder, bipolar disorder, major depression. It adds up to about 350,000 people who are incarcerated in America.”

The path here, the psychiatrist said, began decades ago when state psychiatric hospitals, many of which had become inhumane warehouses, were closed.

“There was a promise of funding for community mental health centers in an attempt to take people out of these institutions that were draconian institutions at the time,” Montross said. “The problem was that the promised funding never materialized. So you had people who were mentally ill who needed a high level of care, and suddenly they were out in the community without adequate medication, without housing, without food provided to them.

“So then you see people starting to sleep in doorways, sleep in parks, beg for food, beg for money, and suddenly police are called in those instances.”

The solution, in Montross’s view?

“The question is: Do we want suffering and vengeance or do we want safety and justice? Right now, we're excellent at suffering and vengeance, but it does not yield the results we want. It's expensive. Our recidivism rates are very high. And I would say it's morally demeaning to us as a country to treat our prisoners this way.

“If we want safety and justice, we have to have more humane facilities. We have to have rehabilitation and education within them. We have to shift our mindset away from suffering and vengeance and toward using periods of incarceration constructively so that people emerge better able to be our neighbors and to be taxpaying citizens in our country.”

“Story in the Public Square” broadcasts each week on public television stations across the United States. A full listing of the national television distribution is available at http://bit.ly/3tIPuzD. In Rhode Island and southeastern New England, the show is broadcast on Rhode Island PBS on Sundays at 11 a.m. and is rebroadcast Thursdays at 7:30 p.m. An audio version airs Saturdays at 8:30 a.m. & 6:30 p.m. ET, Sundays at 3:30 a.m. & 11:30 p.m. ET on SiriusXM’s P.O.T.U.S. (Politics of the United States), channel 124. “Story in the Public Square” is a partnership between the Pell Center and The Providence Journal.

This article originally appeared on The Providence Journal: Butler psychiatrist: Prison wrong place for people living with mental illness

___

(c)2021 The Providence Journal (Providence, R.I.)

Visit The Providence Journal (Providence, R.I.) at www.projo.com

Distributed by Tribune Content Agency, LLC.