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Rachel Pruchno Ph.D.

Return to the Dark Ages: Punishing People for Mental Illness

James Holmes should be treated, not punished.

Robert and Arlene Holmes acknowledge that some people view their son James as a monster. Certainly the rampage on July 20, 2012, that killed 12 people and injured 70 during the premier showing of The Dark Knight Rises in an Aurora movie theater was a monstrous act. But James is not a monster. He is a man who was suffering from untreated serious mental illness.

Holmes has pleaded not guilty by reason of insanity. He doesn't deny he was the shooter, but he and his attorneys claim he had been experiencing a psychotic episode. Now a sentencing trial will decide whether to execute him or imprison him for life.

Robert and Arlene Holmes believe both options are inappropriate. They want their son committed for life in an institution that would provide treatment for his mental illness. They want their sick child to get the help he needs.

They couldn't be more right. It's time to stop punishing people for having mental illness and start treating them instead. Our mental health system failed James Holmes, his family, and the public.

Sadly, the failure of our mental health system is all too familiar to me and to America's millions of parents whose adult children have serious mental illness.

My 22-year-old daughter, diagnosed with bipolar disorder and borderline personality disorder, has refused treatment for four years. She self-medicates with marijuana, methamphetamine, and alcohol. Occasionally, she gets caught using or possessing drugs and is thrown in a county jail.

While my daughter's story isn't nearly as horrific as that of James Holmes, at the root of both situations lies untreated mental illness.

According to the Treatment Advocacy Center, there are 3.8 million people in the U.S, with untreated serious mental illness. Nearly 750,000 adults are in jails awaiting trials or serving short sentences. An additional 1.48 million people fill our state and federal prisons. Among these 2.23 million incarcerated people, 14.5 percent of the men and 31 percent of the women suffer from serious mental illness.

America's jails have become warehouses for people with mental illness. According to The Treatment Advocacy Center, there are more severely mentally ill people in the Los Angeles County Jail, Chicago's Cook County Jail, or New York's Riker's Island Jail than there are in all of our country's psychiatric hospitals combined. In fact, there is not a single county in America in which the psychiatric facility serving that county houses as many individuals suffering from severe psychiatric disorders as the county jail.

My daughter's jailers are unlikely to know she's been diagnosed with serious mental illnesses. She, like nearly half of people with serious mental illness, has anosognosia, a lack of awareness of her illness. As such, it's impossible for her to report her condition accurately.

But even if my daughter's jailers knew about her illnesses, she wouldn't get the medical care she needs. Our nation's jails are underfunded and understaffed. They employ part-time doctors who are not trained to understand the complexities of life-long mental illnesses. Although access to needed mental health services by inmates is protected under the Eighth Amendment, the reality is that jails lack required expertise and resources.

In jail, my daughter has met many people like her. When she's released, she's gained new friends whose lives are as troubled as hers. She's added to her criminal record. But she hasn't gotten the treatment she needs for her mental illness.

Our incarceration facilities are ill equipped to meet the needs of people with serious mental illnesses. But then again, they were never meant to.

Sixty years ago, people with serious mental illness would have been treated in hospitals. Now, as a consequence of deinstitutionalization, when these people commit misdemeanors or minor felonies because their mental illness has gone untreated, they're dumped in jail. And, when their delusions compel them to kill, we imprison or execute them.

We're punishing the same behaviors we once tried to treat. That's not progress. It's a return to the Dark Ages.

This blog post was originally published as an op-ed piece in The Denver Post on January 17, 2015.


About the Author

Rachel Pruchno, Ph.D., is the Endowed Chair and a professor of medicine at Rowan University School of Osteopathic Medicine. Her memoir Surrounded by Madness is available at online bookstores.


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