The future of institutions as long-term residences for persons with mental illness is certainly an integral part of the discussion about mental health policy. Usually those discussions focus on state budgets and Medicaid reimbursement and compliance with Olmstead. But, I was intrigued with a recent piece on Scott Hensley's blog on npr.org “A Peaceful War on Mental Institutions”—coverage of a different chapter in the history of mental institutions.

I never realized that many conscientious objectors in World War II were assigned to mental institutions in lieu of military service. Their experiences are documented in a recent piece on NPR ("WWII Pacifists Exposed Mental Ward Horrors") and in two books—Acts of Conscience: World War II, Mental Institutions, and Religious Objectors (by Stephen Taylor and published by Syracuse University Press) and The Turning Point: How Men of Conscience Brought About Major Change in the Care of America's Mentally Ill (by Alex Sareyan and published by American Psychiatric Press).

As I read this tale of the evolution of human conditions within our mental institutions, I was first struck by how much had changed. Then my thoughts wandered to the millions of Americans with mental illness in our corrections system. If we had the same undercover reporting of conditions of these citizens, would the photos be far different?

For more information on mental health in the corrections context, check out:

• Three Times as Many People With Serious Mental Illness in Prisons Than in Psychiatric Hospitals
• Consensus Panel Develops Performance Measures for Correctional Mental Health

We are soon to have a number of states release county and state prisoners early—in order to reduce corrections budgets. While I’m all for ending our practice of incarcerating Americans for lack of available metnal health and addiction treatment, I think the current wave of early releases may actually end up costing us more without some planning.
The ‘Exhibit A’ for my conclusion is a recent report in Psychiatric Services on Bazelon Center's Blueprint for Community Reentry.

The piece has some grim statistics—approximately 16% of all prison and jail inmates have a serious mental illness, and more than half have a clinical diagnosis, a treatment history, or symptoms of mental illness. Within 18 months of release, 64% of those with mental illnesses are rearrested—more than twice the rate of those without mental illnesses. Entitlements such as Medicaid and Medicare, veterans benefits, and Social Security income support enable individuals to obtain mental health care, housing, and other services. Without assistance, released inmates often wait months for benefits—a major factor in their high recidivism rate. However, only a third of inmates receive benefits restoration planning that is essential to preventing reincarceration.