The prison systems in the US and UK have replaced psychiatric hospitals as the place where people suffering from severe mental illness are most likely to find themselves. It is a process that has been going on since the 1960s, fuelled by a desire to save money, a belief that medication would replace hospitalisation, and a liberal reaction against what was seen as unnecessary incarceration. Between 1955 and 2016, the number of state hospital beds in the US available to psychiatric patients fell by over 97 per cent from 559,000 to just 38,000. An expert noted despairingly that the biggest de facto psychiatric institutions in the US today are Los Angeles County jail, Chicago’s Cook County jail and New York’s Riker’s Island. Those who are not in prison or hospital “become violent or, more often, the victims of violence. They grow sicker and die. The personal and public costs are incalculable,” says a report by the Treatment Advocacy Centre in Virginia. Mentally ill people, usually poor and unemployable because of their condition, are sometimes advised that the only way they will get even the crudest treatment is by being sent to prison.
The same process is happening in Britain. One of the justifications for closing down the old asylum system was that they were too much like prisons, but the paradoxical result has been that psychiatric patients are now ending up in real prisons. The number of beds available for mental health patients in the UK has dropped by three-quarters since 1986-87 to about 17,000, while the Centre for Mental Health says that 21,000 mentally ill people are imprisoned, making up a quarter of the prison population.