“It’s always darkest before the dawn”

– Thomas Fuller

Hope House: A Pathway to a Secure Alternative to Incarceration

Half a Million People Housed in Mental Institutions

With a total US population of 165.9 million, the number of people in public psychiatric hospitals peaks at

560,000

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Caring for People Living with Mental Illness in the Community

President John F. Kennedy signs the Community Mental Health Act to provide federal funding for the construction of community-based preventive care and treatment facilities.₂ Due to spending on the Vietnam War and a faltering economy in the late 60s and 70s, the program was never adequately funded.₃

The Defunding of Mental Institutions Begins

The Social Security Act is passed, including a provision called the “IMD Exclusion.” This provision prohibits federal Medicaid payments for treatment in “Institutions of Mental Disease” larger than 16 beds.₄ As a result, de-institutionalization is accelerated, as states are incentivized to move patients out of state mental hospitals and into the community but alternative community resources are inadequate to serve the population.₅

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Homelessness Begins to Rise

Rates of homeless in the US begin to rise dramatically as individuals with mental illness are moved out of state hospitals back into the community, at the same time that single room occupancy housing units are closed.₆ Between 1987–1997, the number of homeless people in state shelters doubled and in some cases, tripled.

1980

Mental Health Systems Act

President Jimmy Carter signs the Mental Health Systems Act to restructure the community mental health program, create alternatives to institutionalization, and improve services for people with chronic mental illness.₇

1981

The Omnibus Budget Reconciliation Act

President Ronald Reagan signs the Omnibus Budget Reconciliation Act repealing Carter’s community health legislation and establishes state block grants, thereby shifting responsibility for the well being of people with serious mental illness to the states.₈

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Too Few Beds for Too Many Patients

Beginning in the 1990s, the remaining state psychiatric beds are increasingly used for justice involve people found incompetent to stand trial or not guilty by reason of insanity.₉

2005

A Crisis of Beds for People with Mental Illness

Only 50,509 state psychiatric beds remain for a US population of 292.5 million. Experts estimate a minimum of 146,250 beds would have been required for a population this size.₁₀

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Trans-institutionalization is Complete

People suffering from serious mental illness are 10 times as likely to be incarcerated than in a psychiatric hospital as the number of state psychiatric beds is reduced to about 35,000 for a US population of 322 million.₁₁

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15 When Mental Illness becomes a Death Warrant

The risk of being killed by a police officer for a person with untreated mental illness is 16 times greater than for other people approached or stopped by police officers. Once incarcerated, people with mental illness report higher rates of sexual victimization₁₂ than inmates without mental health problems, are twice as likely to have been injured in a fight, and commit suicide in disproportionate numbers to those without mental illness.₁₃

Hope House on Crotona Park, anticipated to open in 2018, will offer up to 2 years of treatment, life skills programming and job training in a secure, therapeutic residential facility as an alternative to incarceration for men and women with serious mental illness accused of certain felony level crimes.

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[1] Treatment Advocacy Center. (2014) The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey. Available from: http://www.tacreports.org/storage/documents/treatment-behind-bars/treatment-behind-bars.pdf

[2] Remarks by President John F. Kennedy, on a Bill for the Construction of Mental Retardation Facilities and Community Mental Health Centers, 31 October 1963. http://www.jfklibrary.org/Asset-Viewer/Archives/JFKWHA-236-002.aspx

[3] Michelle R. Smith, 50 Years Later, Kennedy’s Vision for Mental Health Not Realized, Seattle Times, Oct. 20, 2013. http://www.seattletimes.com/nation-world/50-years-later-kennedyrsquos-vision-for-mental-health-not-realized/

[4] Michelle R. Smith, 50 Years Later, Kennedy’s Vision for Mental Health Not Realized, Seattle Times, Oct. 20, 2013. http://www.seattletimes.com/nation-world/50-years-later-kennedyrsquos-vision-for-mental-health-not-realized/

[5] Legal Action Committee IMD Fact Sheet. http://lac.org/wp-content/uploads/2014/07/IMD_exclusion_fact_sheet.pdf

[6] The Coalition for Homelessness. Why Are There So Many Homeless? http://www.coalitionforthehomeless.org/the-catastrophe-of-homelessness/why-are-so-many-people-homeless/

[7] National Institutes of Mental Health, Mission. http://www.nih.gov/about-nih/what-we-do/nih-almanac/national-institute-mental-health-nimh

[8] Michelle R. Smith, 50 Years Later, Kennedy’s Vision for Mental Health Not Realized, Seattle Times, Oct. 20, 2013. http://www.seattletimes.com/nation-world/50-years-later-kennedyrsquos-vision-for-mental-health-not-realized/; Ronald Reagan and the Commitment of the Mentally Ill: Capital, Interest Groups, and the Eclipse of Social Policy, Alexander R. Thomas, Electronic Journal of Sociology, (1998). http://www.sociology.org/content/vol003.004/thomas.html#1b

[9] Treatment Advocacy Center. (2014) The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey. Available from: http://www.tacreports.org/storage/documents/treatment-behind-bars/treatment-behind-bars.pdf (Also see: http://www.motherjones.com/mojo/2014/04/record-numbers-mentally-ill-prisons-and-jails)

[10] Treatment Advocacy Center. (2014) The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey. Available from: http://www.tacreports.org/storage/documents/treatment-behind-bars/treatment-behind-bars.pdf (Also see: http://www.motherjones.com/mojo/2014/04/record-numbers-mentally-ill-prisons-and-jails)

[11] Treatment Advocacy Center. (2010) More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States. Available from: http://www.treatmentadvocacycenter.org/storage/documents/final_jails_v_hospitals_study.pdf

[12] Bureau of Justice Statistics. (2013) Sexual Victimization in Prisons and Jails Reported by Inmates. Available from: http://www.bjs.gov/content/pub/pdf/svpjri1112.pdf

[13] Treatment Advocacy Center. (2014) The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey. Available from: http://www.tacreports.org/storage/documents/treatment-behind-bars/treatment-behind-bars.pdf