Rice, et. al It is often argued that a person’s presence in a correctionalfacility, in itself, points to a level of social maladaption as toconstitute a possible mental disorder. One study found that only 5% ofpenitentiary inmates did not have some sort of mental disorder. This studycounted “.
. . psychosis, a problem of substance abuse or dependence, ora diagnosis of antisocial personality disorder” as “mental disorders. “1Other studies have aimed to show direct genetic (biological) causes ofaggression and violent tendencies by searching for an “aggression” geneamong prison inmates.
2 Segregation and victimization of mentally illinmates within prison-inmate culture has also been observed. Apart fromexpected levels of social malada ption among inmates there is a minoritypopulation of mentally ill inmates distinct and differentiated from thelarger inmate culture. These inmates are set apart from the general prisonpopulation and stigmatized for their Mental Illness, especially if it isquite apparent or visible. After studying populations of prisons and psychiatric hospitals inEurope, researchers in 1939 observed that “. . .
as the size of prisonpopulation goes up, the size of mental hospital population goes downproportionately, and vice versa, presumably because people move from onesystem to the other. “3 Applying this theory to the current situation,one would expect to find rising prison population, and in fact, this is thecase. 4 Whichever study one chooses to believe, the incidence of mentalillness in prisons is high. One recent study found that 35% of prisoninmates sentenced to periods less than two years qualified as mentally illcompared with 10.
3% of the general population5. Another study, whichtook into account severity as well as prevalence, found that 7. 2% ofinmates had severe mental illnesses6. In comparison, the number ofpatients in state psychiatric hospitals has fallen dramatically. In 1955,there were 559,000 patients in state psychiatric facilities. Today thereare under 100, 000.
7 Once adjusted for population growth, it can be seenhow drastic these numbers actually are. The terms “mentally disordered” and “mental illness” tend to beoverly broad generalizations that cover diverse and dissimilar phenomena. For the purposes of this discussion, “mental illness,” “mental disorder,”and “mental disability” will refer only to clinical psychoses, meaningnuerobiological conditions such as schizophrenia, bi polar disorder, majordepression, obsessive compulsive disorder and organic brain syndrome. Inaddition it will refer to developmental disabilities (persons who arementally retarded). It will exclude any other problems that may beperceived as mental, such as substance abuse and “antisocial personalitydisorder.
” It will also exclude the category, “mentally disordered sexoffender,” since sex offenders rarely suffer from any of the abovementioned clinical psychoses. 8 In the latter half of this century, the country has seen progressive”deinstitutionalization,” the steady dismantling of state psychiatrichospitals9. During the height of the civil rights reforms of the late1960’s and 70’s, concerns were raised about the abuse of involuntary civilcommitment, and the constitutional right to refuse treatment. Specifically,more people became aware of horror stories10 such as patients receivinginvoluntary lobotomies, and nondisabled people being detained.
Publicopinion soon after began to be reflected in courtrooms. In years past, clinicians have been delegated the authority todetermine whether or not an individual required psychiatrichospitalization, and also have had the authority to detain patients againsttheir will for indefinite periods of time. 11 In the 1979 landmark caseof Addington v. Texas,12 the Supreme Court set out to analyze whether itwas more appropriate for courts or clinicians to decide where involuntarycivil commitment was warranted. Specifically, the legal issue that wasraised was whether existing statutes authorizing clinicians to determinecommitment violated the Fourteenth Amendment right to due process,especially where loss of liberty is involved. The court ruled that “.
. . a’clear and convincing’ standard of proof is required by the FourteenthAmendment in such civil proceedings under state law to commit a personinvoluntarily in a mental institution for an indefinite period oftime. “13 This means that under the current rule of law, in order for apatient to be committed involuntarily, civil proceedings must take place,whereas before, the decision was up to the clinician’s discretion, andhence more easily implemented . In addition to the reformed process of detaining a ps ychiatricpatient, the standards for detention have become stricter as well.
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