Law enforcement and mental health experts point to a culture shift in the approach to mental health treatment in the 1960s for the drastic rise in inmates with mental illness.
In 1963, President John F. Kennedy signed into law the Community Mental Health Act, which moved away from involuntarily housing patients in asylums, sanitariums and state-run institutions. Community health care centers to better treat patients emerged.
But because of inadequate funding, in part due to the Vietnam War, the program wasn’t as effective as the administration had hoped, said Dr. Neil Gowensmith, assistant clinical professor at the University of Denver’s Graduate School of Professional Psychology.
“A lot of people were released from hospitals onto the streets without any safety net or mental health care in place and their symptoms re-emerged,” said Gowensmith, who has worked in forensics in various jails and hospitals.
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Then, in 1965, the federal government signed into law Medicaid to provide health care to low-income people. The program offered benefits for individuals treated at community healthcare centers. But it failed to assist individuals in psychiatric hospitals, which further pushed people out of those settings, national mental health organizations say.
In 1969, California passed a law prohibiting involuntary commitment to a mental health institution without a court hearing, resulting in the release of thousands of people onto the streets, according to the National Alliance on Mental Illness. The law set the precedent for the rest of the nation.
The initial shift away from institutions wasn’t without reason, Gowensmith said. Sanitariums were dismal places, “over-crowded, unsanitary and very dangerous.”
But funding continued to falter. In 1980, President Jimmy Carter signed the Mental Health Systems Act, which provided grants to community mental health centers in an attempt to strengthen the mental health care system. Soon after, President Ronald Reagan repealed the law, established block grants for the states and cut federal funding by 30 percent. The block grants were to be allocated for mental health and substance abuse care.
Following the Great Recession, states cut $4.35 billion in public mental-health spending between 2009 and 2012, according to mental health and state policy organizations.
Gowensmith and other mental health experts call what happened next “trans-institutionalization.” Communities were unable to cater to the broad needs of the mentally ill. Instead of receiving care, many were moved to different types of institutions — community hospitals, shelters and jails.
In the 1950s, about 500,000 people were in jails and prisons and a similar amount were in psychiatric hospitals, according to Gowensmith.
Today, fewer than 40,000 people are in psychiatric hospitals and more than 2.2 million are in jails and prisons.
“There are a lot of people who probably need psychiatric hospital care and the beds just don’t exist, so they fall through the cracks and in the arms of the police,” said Gowensmith. “Police don’t have a lot of options aside from arrest, and when a person is in jail, it’s like a funnel — your options get fewer and fewer as you go farther down the criminal justice funnel.”
Patrick Fox, chief medical officer for the Colorado Department of Human Services, said Colorado is still feeling the effects of the national campaign to de-institutionalize the mental health system.
Resources and funding must be available across the different systems of care, he said. When an inividual is released from one institution, such as a mental health hospital, it’s likely he or she will go into another, such as a community mental health center.
“In the broad sense,” Fox said, “if we want to think about the impact on the system as a whole, we need to remember that as people move across systems of care – from community mental health centers, to jail, into the state hospital for competency restorations, back to jail, back to the community — the resources necessary to keep those systems operating don’t flex as rapidly as the individuals do.”
Additionally, he said, money-saving efforts in the form of reducing hospital beds haven’t helped.
In Colorado, there is the 449-bed Mental Health Institute in Pueblo providing inpatient behavioral health services for adults, adolescents or geriatric patients who are court-ordered or found not guilty by reason of insanity.
At its peak in 1961, the hospital housed 6,100 patients.
The state’s second mental health hospital at Fort Logan predominantly serves low-income individuals. Ten years ago, Colorado Mental Health Institute Fort Logan had 173 beds. Now it has 94.
“It used to be a robust, thriving institution,” Gowensmith said of Fort Logan. “And now most of those buildings are shuttered and just in disrepair.”