Mentally ill inmates: Modern-day Bedlam

Bob Joondeph, director of Disability Rights Oregon

Bob Joondeph, director of Disability Rights Oregon

Opinion / Editorial by Bob Joondeph, published in The Oregonian, December 17, 2008

Joondeph is executive director of Disability Rights Oregon.

When Captain Craig Ward, who manages the Union County Jail, referred to the behavior of an inmate with mental illness as “bedlam,” he was spot on. (The Oregonian, Mentally Ill Inmates Strain Rural Jails, Dec. 14.)

The word “bedlam” is defined as: “a place, scene, or state of uproar and confusion.” It originated as the popular name for first insane asylum in London: The Hospital of St. Mary of Bethlehem. Bedlam Hospital started taking people with mental illness in 1357. Conditions were awful. According to a visitor, the noise was “so hideous, so great; that they are more able to drive a man that hath his wits rather out of them.” Violent or dangerous patients were manacled and chained to floors or walls. Londoners could visit Bedlam and pay a penny to stare at the inmates. According to The Catholic Encyclopedia:”one could peer into their cells and laugh at their antics or violent fights. Visitors were permitted to bring long sticks with which to poke and enrage the inmates.”

Fortunately, we have made great progress in our understanding of mental illness since the heyday of Bedlam. Through early identification, the devastating effects of major mental illness may be avoided. Through counseling, medications, social supports and individualized therapies, those who experience major mental illness can and do recover and return to productive membership in society.

But left unidentified and untreated, these disorders may prevent a person from working and undermine family and social supports. While mental illness does not itself render a person more dangerous than others, poverty, isolation and substance abuse may lead to criminal behavior and time in jail or prison. Everyone (the person, the victim, their families, the jail, the community) would be better off if that person had received assistance early on. Yet, for decades, we have severely underfunded mental health and chemical dependency services.

Now, as The Oregonian pointed out, the Governor’s Recommended Budget continues this tradition by calling for a 90% cut in non-Medicaid adult community mental health funding.

Under pressure from the federal government, Oregon is taking steps to correct the deplorable conditions at Oregon State Hospital. And yet we continue to look the other way while our jails are asked to carry on the tradition of Bedlam Hospital. Mental health treatment can and should be provided to inmates. Community mental health services need to provide more screening, treatment, housing and supports. Cutting these services will not only contribute to more human suffering and homelessness but will also generate higher back-end costs to taxpayers due to avoidable prison, jail and hospital days.

What can we realistically do? For starters, we should seek efficiencies by regionalizing community mental health services, including housing and acute care. We should continue to integrate the delivery of mental health services with physical health. We should demand greater accountability for the use of public resources through reporting of clear, measurable outcomes. We should assure that all Oregon inmates are properly screened for mental illness and have access to adequate treatment. And we should provide the funds to get this done.

To do less is to direct Captain Ward and his colleagues throughout Oregon to operate modern-day Bedlams.