Where Have All the Crazies Gone? To Prison, It Seems : Justice: When it comes to helping the criminally mentally ill, the system is broken and must be fixed. Untreated, too many do violence again.

Justice turns out to be blind to psychological disorders of the mind.

The California Department of Corrections has recently been sued by a coalition claiming that prisoners are failing to receive proper psychiatric care. The National Alliance for the Mentally Ill alleges that possibly a quarter of the California prison population is mentally disturbed. California prisons weren’t designed to serve as psychiatric institutions. Why, then, are there then so many crazies in our prisons?

Insanity admits degrees. Some are crazier than others. Yet the only choice before the law is either guilt or exculpation. According to the law, the guilty all are sane, since they had to know what they were doing to be held accountable for what they did--even if what they did was crazy, as it often is. Consequently, many of those legally convicted of their crimes are both guilty and insane.

Once in prison, criminals can refuse psychiatric evaluation and treatment because, according to the courts, they’re rationally responsible. After inmates serve their sentences, they are released--regardless of the state of mind they’re in. Nor can they be forced after their release to take whatever medication they may have willingly been taking in the prison. They’ve served their time; they’re free. Psychotropic medications carry with them side-effects and social shame, so many mentally disturbed offenders refuse them.

Criminals judged not guilty by reason of insanity are treated differently, sent to special mental institutions, where they are required to undergo psychiatric care and medication. Their stay is indeterminate, until they can convince psychiatrists they are sane enough to be released, as adjudicated by a court of law. The burden of proof is on the patient, not the court. Once committed to asylums, some criminals found not guilty by reason of insanity never leave.

As a result, defense attorneys would rather plead their clients guilty when the sentence is reasonably short rather than plead insanity. Otherwise, their clients might not ever gain their freedom, since many psychological pathologies simply can’t be cured. They can only be controlled.

This may be one reason why the population in California institutions for the criminally insane had declined, while the number of mentally disturbed inmates in California’s overcrowded prisons is exploding. In 1963, there were 4,500 patients in Patton State Hospital, which serves the criminally insane. In 1989, there were just a thousand. Where have all the crazies gone? Many have gone to prison.

Other factors, too, have shifted criminals from asylums into prisons. The legal test for insanity has changed. Mentally disturbed sex offenders go to prison now, instead of mental institutions, because the 1981 California Legislature found it unconscionable to classify elaborately planned sex crimes as acts of insane innocence--no more soft time for rapists and molesters, even though we know they’re nuts.

In some instances, the threat of going to state prison drove predisposed offenders to seek help from therapists, so the legislation helped, somewhat inadvertently. But the downside is that once the sex offender serves his sentence, he is free to go, more or less untreated. Once released, the sex offender cannot be forced to take medication or be psychologically supervised. He often commits the crime again, as does the violent criminal. Preventive detention is against the Constitution, as it ought to be. Yet prisons can’t prevent letting sexual predators and pathologically violent persons out on the streets again. Only mental hospitals can keep them under wraps.

This difference between legal guilt and mental illness produces a conundrum from which innocent victims often suffer. Consequently, taxpayers want revenge, not mental health for low-lifes. So the money goes to guards and walls, not air-conditioned mental wards. Take a look at Patton State Hospital the next time you’re on your way to Big Bear. It was built in 1893 and remains pretty much that way today.

Psychiatric care is admittedly expensive. Yet the cost of lawyers, courts, repeated apprehension and incarceration, not to mention the cost of crimes upon their victims, will often exceed the cost of psychiatric treatment.

All mentally disturbed criminals should be supervised, wherever they may be institutionalized. One way to accomplish this would be to merge California prisons and mental hospitals for the criminally insane into a single program, so that all mentally disturbed criminals are sent to proper treatment centers, regardless of their pleas. The way things are today, convicts can remain mentally disturbed within prison, until the day they’re released. This can only be corrected by giving the California Department of Mental Health more authority over prisoners. Otherwise, prisons will remain breeding grounds for untreated pathologies.

Psychiatrists should be allowed by law to segregate those in the prison population who are mentally disturbed and to require such prisoners be treated clinically. This would require broadening the current standards of insanity to include addicts, violent criminals and sex offenders.

Once these prisoners served their sentences, they might not necessarily be released, unless they could demonstrate their sanity sufficiently before a court of law to prove they no longer are a danger. Addicts and sexual predators who bargained for lesser charges might then find themselves subject to continuing psychiatric supervision in and out of prison--once psychiatrists found them seriously enough disturbed and the courts agreed.

When released into the community, mentally disturbed offenders would then be treated in community outpatient treatment centers, where they would continue to be supervised and medicated under the same conditional release program that now applies to the criminally insane. With proper therapy and medication, those returned to the society might live far more normal lives than they would have done in prison or on the streets again. And the rest of us will benefit from the improvement in their mental health.

Warehousing the mentally disturbed in prisons has obviously proved a failure, as more crazies are released out on the streets to commit crimes again. The Milwaukee cannibal might not have been paroled, nor would rapists and molesters go about unsupervised under a criminal-justice system that required psychiatric intervention in the prisons. Taxpayers might be reassured to know that pathological criminals must prove their sanity to be released. Something like this system has recently been enacted in Washington state.

Think, however briefly, about what it must be like to be violently crazy; think of what it must be like to be an addict or a sex offender with that old familiar yearning coming back time and time again. So much might be done for these sorry human beings by treating mentally disturbed offenders for the states their minds are in, instead of merely keeping them temporarily penned in.