10.4 Current Issues: Transcarceration
Brandon Hamann and Kate McLean
Transcarceration or “Reinstitutionalization”
One prominent social justice campaign of the mid-twentieth century that is less remembered today is the anti-psychiatry movement. This movement questioned the science behind psychiatry, the evidence underlying different mental health diagnoses, and the function of psychiatry as an effective form of social control (sometimes leveraged against political dissidents around the world.) Among other goals, the movement sought to reduce the use of involuntary commitment, particularly within state-run hospitals, where “treatment” was sometimes indistinguishable from incarceration. (An important, if disturbing, documentary from 1967, The Titicut Follies, reveals in gruesome detail how patients at the Bridgewater State Hospital in Massachusetts were dehumanized by staff.) Deinstitutionalization of individuals with no income, and no other caretakers, may have remained an impossible target, were it not for the advent of the first powerful neurotropic drugs in the 1950s, most notably thorazine – an antipsychotic used to treat schizophrenia.
The Community Mental Health Act (CMHA) of 1963 was the last piece of legislation signed by John F. Kennedy Jr. before his assassination less than one month later. The law sought to provide funding for a vast network of outpatient mental health centers “in the community,” thus allowing for the release of thousands of inpatients from state psychiatric hospitals. Unfortunately, while the latter institutions began rapidly shedding patients – and closing – in the years that followed, over half of the promised community centers never materialized. In turn, many individuals with severe mental illness found themselves precariously housed, homeless, and then sometimes incarcerated. Having few choices of where to go, many individuals with severe mental illness became destitute and/or destitute. Ultimately, some wound up in America’s jails and prisons, after committing offenses to support themselves, violating anti-homeless ordinances, or acting in ways deemed violent or dangerous by law enforcement. This phenomenon is referred to as “Transcarceration” or “Transinstitutionalization,” as individuals simply moved from one facility of involuntary confinement to another. At the dawn of the 1960s, the rate of confinement within state psychiatric hospitals was over 800 individuals per 100,000 population, while the incarceration rate was barely over 200 per 100,000; by the new millennium, these rates had flipped, with the population in prisons and jails exceeding 800 per 10,000 populations, and the rate of psychiatric hospital less than 500 per 100,000. (These trajectories are reflected in some stunning charts produced by the scholar Bernard Harcourt – see here.)
Today, many might argue that – whatever the deficiencies of state psychiatric hospitals – prisons and jails are more traumatizing institutions that are ill-equipped to t