Mental Health In America

The Shift From Institutionalization To Incarceration


By Alexandra Bixler

        The state of California granted the Smith family $2.5 million for the shooting of their son, Anthonie Smith, in July 2015. At the time of the incident, Smith was 18 years old and suffered from schizophrenia and bipolar disorder. Smith was killed by law enforcement during a schizophrenic episode.

        The tragedy began at 3 A.M. when Smith’s mother, Sybil Davis, contacted law enforcement after Smith assaulted a family member in their home. When the deputies arrived, the teenager struck officers Deylan Kennedy and Sharee Anthony, fleeing the scene. A few hours later, Kennedy and Anthony caught up to Smith, shooting him nine times. The pair claimed that, prior to the shooting, Smith lunged at them and reached into his waistband for a weapon. These statements were later proven false by salvaged video footage. Sybil Davis’ lawyer, John Harris, believed the jury utlimately sided with the Smith family due to footage which depicted Sharee Anthony firing the final shot when Anthonie was already on the ground.[1]

        “They had concocted a story … that turned out to be a lie – that right before that last shot, Mr. Smith lunged at them,” Harris said. “They also lied that he was reaching into his waistband for a weapon.”[2]

 Anthonie’s fate is just one example of the many ways the mentally ill are disenfranchised by the criminal justice system. According to Ron Honberg, a Senior Policy Advisor at the National Alliance on Mental Health,“We call 911 for other medical emergencies and they bring specifically trained medical technicians, but when it’s a mental-health crisis, we send the police.”[3]

Honberg’s assessment is the reality of America’s mental health care system, often leaving  police to pick up its broken pieces. Nearly half of Americans in need of mental health care that are not currently receiving it cited cost as their largest barrier. Additionally, psychiatrists and other mental health professionals are in short supply. In fact, only 44 million Americans live in areas where the prevalence of these services is considered adequate.[4] Both of these factors contribute to individuals in need being left untreated.

While these lack of resources harm the mentally ill, societal stigmas hinder their recovery as well. Stigmas that the mentally ill are “weak”, “lazy”, “attention-seeking”, or “lesser than” prevent individuals from seeking out needed treatment options. These stigmas become even more dangerous when they are adopted by medical professionals. According to the research conducted in the study Mental illness-related stigma in healthcare: barriers to access and care and evidence-based solutions, those with mental illness frequently report feeling undervalued and dismissed by the health professionals they come into contact with. The pervasiveness of this phenomenon suggests this is a systematic problem rather than a series of isolated incidents. Common themes of this mistreatment are: providing insufficient information, infantilization, excessive wait times and even being told that they will never get better. Patients who suffer from personality disorders such as borderline, antisocial, and schizotypal, often experience the most discrimination due to their perceptions as manipulative, difficult, and ultimately less-deserving of care.[5] 

Since the 1950s, the United States has led the gradual process of deinstitutionalization by favoring outpatient treatment options. As more patients were deinstitutionalized, the incarceration rate for mentally ill individuals drastically increased, demonstrating a disturbing trend of substituting adequate healthcare for imprisonment.  In the United States, people with severe mental illnesses are nearly three times more likely to be incarcerated than able to access consistent treatment.[6] Additionally, the six states with the worst access to mental health treatment (Alabama, Mississippi, Texas, Georgia, Arkansas and Florida) also have the highest incarceration rates in the nation.[7] According to the Bureau of Justice Statistics, 75% of females and 63% of males in local prisons have a mental health problem.[8] While institutions operating in early America received criticism for human rights abuses, deinstitutionalization did not stop the abuse of mentally ill individualsinstead transferring the abuse to another setting: prisons.

        Society’s current strategy for handling the mentally ill through the use of imprisonment is ineffective for several reasons. Firstly, inmates with backgrounds of trauma or poverty are not provided with the resources they need to improve their mental state.  Nearly 50% of mentally ill inmates report that they did not receive their medication in prison.[9] Additionally, prisons do not serve as a beneficial healing environment to the mentally ill. Inmates with mental illnesses are more likely to get in trouble for behavior they cannot control. This results in punishment, often in the form of solitary confinement. Solitary confinement deeply worsens the mental state of the mentally ill and healthy alike. Roughly 60% of inmates that experienced solitary confinement and had their cases reviewed had severe undiagnosed or untreated mental illnesses. Solitary confinement is also not effective; in fact, incarcerated individuals that experienced it are 20-25% more likely to commit a violent crime upon release.[10]  Discrimination also facilitates a hostile environment within prisons for the mentally ill. Less able to adhere to social norms, mentally ill inmates are 10% more likely to be the victim of prison violence, demonstrating an inability for inmates and prison staff alike to look after and understand the needs of the mentally ill.

States have the power to enact different variants of the insanity defense, which allows defense attorneys to argue that their defendant is too mentally ill and detached from reality to understand the nature of their crimes. This defense can greatly impact the outcome of criminal cases involving a defendant suffering from a psychotic disorder. However, Kansas, Montana, Idaho and Utah do not have this defense. Disregarding and belittling mental illness as irrelevant to a criminal case is a frightening reality, especially to defendants like Andrea Yates. Yates suffers from severe postpartum psychosis and has a history of multiple suicide attempts. In June 2001, Yates entered a catatonic state with the belief that her children were possessed by the devil, proceeding to kill all five of them. Initially, the state of Texas ignored Yates’ claim to insanity. Her legal team argued that because she was extremely medicated during her trial, the jury didn’t get to see her true mental state, thus hurting their argument. However, Yates’ plea was later accepted during a retrial and she now resides at a high-security mental hospital.[11]

Texas, along with most states in America, have the M'Naghten Rule, the most antiquated of current insanity defense policies. It requires the insane to demonstrate specific evidence with proof of cognitive dysfunction. The second most common code is the Model Penal Code in 22 states, which offers a wider definition of insanity. The Model Penal Code also considers a defendant’s ability to conform to legal standards, maintain impulse control, and understand their crimes.[12] The Model Penal Code is significantly more helpful to defendants that are classified as insane, as hospitalization is considered a more viable option than it is in states under the M’Naghten Rule or states with no insanity defense at all. The Model Penal Code is typically favored by those who want to reform America’s “tough on crime” policies. “Tough on crime” is no longer resonating with voters, however; in fact, 3⁄4 of Americans believe America’s criminal justice system “needs significant improvements.” Despite this public opinion, reformers still face backlash from powerful lobbying groups that benefit from mass incarceration.[13] Recently confirmed District Attorney Rachael Rollins of Suffolk, MA claimed that she will not prosecute 15 petty offenses. The National Police Association’s website, claiming to be against “anti-police officials,” have now threatened to disbar her.[14]

As police shootings and injustices involving the mentally ill continue to escalate, many municipalities have instilled additional mental health training within their local police departments. These 40-hour CIT programs are designed to increase empathy towards the mentally ill. Officers have to take a certain amount of candy pills a day to help them understand how easy it is for someone to forget their medication. They also have to experience auditory simulations to understand what it may be like to be schizophrenic. This reminds officers that schizophrenic civilians may be ignoring what the officer is saying due to their inability to focus rather than out of insubordination. Officers also must respond to a certain amount of crisis calls from the mentally ill to better their understanding. While the effectiveness of these programs vary, Lt. Richard Cavanaugh of Montclair, New Jersey stated that when his officers received a call about a woman yelling obscenities and calling herself the Queen of the Nile, they responded to her with empathy and respect. Another woman attempted suicide, but when confronted by sympathetic police officers she willingly agreed to go to the hospital to receive medical care.[15] 

Some police forces have hired a psychiatrist to ensure that trained mental health professionals can adequately respond to mentally ill behavior. The Albuquerque Police Department’s psychiatrist works with law enforcement to medicalize and humanize citizens. These psychiatrists are also responsible for creating better care plans for at-risk individuals.[16] While employing a psychiatrist may sound expensive, as their average salary is $200,000 a year, Co-responding Police-Mental Health Programs: A Review suggests that a psychiatrist’s presence on a police force can lead to savings as hospital and jail resources are no longer being wastefully utilized. Additionally, legal protections are slowly increasing for civilian allies that want to hold law enforcement accountable. As of July 2017, 60% of Americans have permission to legally record police due to federal jurisdiction.[17]

        While progress is being made regarding the treatment of the mentally ill community, discrimination, inadequate care, and outdated laws still stand in the way of widespread change. Law enforcement reforms can limit police brutality, but allocating more funding to mental health is the most efficient way of preventing cases like Anthonie Smith’s from happening again.





[1] Rokos, Brian. “$2.5 Million Awarded to Mother of Moreno Valley Man Killed by Sheriff's Deputies.” Press Enterprise, Press Enterprise, 29 Nov. 2018

[2] ibid.

[3] Sullivan, John, et al. “Nationwide, Police Shot and Killed Nearly 1,000 People in 2017.” The Washington Post, WP Company, 6 Jan. 2018

[4] Kliff, Sarah. “Seven Facts about America's Mental Health-Care System.” The Washington Post, WP Company, 17 Dec. 2012

[5] Hamilton, S, et al. “Qualitative Analysis of Mental Health Service Users' Reported Experiences of Discrimination.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Aug. 2016

[6] Varney, Sarah. “In U.S., There's 3 Times as Much Mental Illness in Prison than in Hospitals.” MedCity News, MedCity News, 29 Mar. 2017

[7] “Access to Mental Health Care and Incarceration.” Mental Health America, 14 Nov. 2017

[8] Glaze, Lauren E, and Doris J James. “Mental Health Problems of Prison and Jail Inmates.” Bureau of Justice Statistics (BJS)

[9]Connell, Nadine M, and Jennifer M Reingle Gonzalez 2014. “Mental Health of Prisoners: Identifying Barriers to Mental Health Treatment and Medication Continuity.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 2014

[10] Eilperin, Juliet. “Obama Bans Solitary Confinement for Juveniles in Federal Prisons.” The Washington Post, WP Company, 26 Jan. 2016

[11]McLellan, Faith. “Mental Health and Justice: The Case of Andrea Yates.” The Lancet, World Report, 02, Dec. 2006.

[12] “The Insanity Defense Among the States.” Findlaw, 2018,

[13] “Overwhelming Majority of Americans Support Criminal Justice Reform.” Vera, 25 Jan. 2018

[14] Fleming, Rory, et al. “Beware of the Backlash Against Reform Prosecutors.” The Crime Report, 8 Jan. 2019

[15] Herbst, Diane. “Mental Illness and Policing: What Is Mental Health Training and Why Do Police Need It?” - Mental Health Treatment Resource Since 1986, 2018

[16] Morris, Nathaniel. “Police Encounter Many People with Mental-Health Crises. Could Psychiatrists Help?” The Washington Post, WP Company, 23 July 2018

[17]Ford, Matt. “A Major Victory for the Right to Record Police.” The Atlantic, Atlantic Media Company, 10 July 2017