The Hidden Tragedy of Our Criminalized Mentally Ill examines the fate of people with mental illness who tangle with a treacherous and unforgiving criminal justice system.Mary Beth Pfeiffer shows how people suffering from schizophrenia, bipolar disorder, depression and other mental illnesses are incarcerated simply because there is no viable alternative and then how they are punished again behind bars for behavior that is psychotic rather than criminal.

Pfeiffer's stories are moving and tragic. Among them:

-- The psychiatric odyssey of a 39-year-old Iowa woman with a history of 25 hospitalizations who blinded herself while locked in solitary confinement.

-- The suicides of an 18-year-old youth who was abandoned for eight weeks in a tiny cell in a California juvenile prison and a 21-year-old New York woman who had been repeatedly punished with confinement to the prison "box".

-- The deaths of two Florida men at the hands of untrained police who panicked in the face of psychosis.

-- The path that led to a jail cell and breakdown for a 24-year-old Texan whose only crimes were to be mentally ill and drug-addicted.

Pfeiffer's book is an indictment of a society that fails to provide decent mental health care to its most vulnerable citizens and then incarcerates them for often petty crimes, leaving them sicker and more damaged by the experience.

On mental health care in America:
On mental illness, and jails and prisons:
On the American incarceration ethic:
On incarcerated juveniles:

On mental health care in America:

From 1990 to 2000, the number of state psychiatric beds, which numbered over a half million in 1955, declined from 98,000 to 59,000; private psychiatric beds dropped 45,000 to 27,000.

-- Survey reports from the U.S. Substance Abuse and Mental Health Services Administration

From 1992 to 2003, emergency rooms saw a 56 percent increase in people experiencing psychiatric crisis -- often people who were unable to access less expensive community services.

-- Based on Centers for Disease Control (2005) figures

"America's mental health service delivery system is in shambles."

--President Bush's New Freedom Commission on Mental Health, 2002

In 2006, the National Alliance for the Mentally Ill gave the nation a "D" in a

report card on mental health care.

-- Grading the States, 2006

Two-thirds of people with mental illness in America receive no treatment at all.

-- U.S. Surgeon General, 1999.

Almost one-third of scant state psychiatric beds were devoted to criminal justice uses in 2001, including people found not guilty by reason of insanity, undergoing pre-trial evaluation or hospitalized while in prison.

--National Association of State Mental Health Program Directors Research Institute

The death rate among people with mental and substance-use disorders has nearly tripled in America, rising from 5.7 per 100,000 in 1979 to 15.5 per 100,000 in 1995. This coincides with a decline in psychiatric hospital beds, from 4 per 1000 Americans in 1960 to 1.3 per 1000 in 1994.

--Psychiatric Services, July 2000.

On mental illness, and jails and prisons:

An estimated three hundred thirty thousand of the 2.2 million people in American jails and prisons are mentally ill.

--Based on a 1999 survey of people with mental illness by the Bureau of Justice Services, U.S. Department of Justice, updated using 2005 incarceration figures

Mentally ill inmates spend 15 more months on average in state prison, at a cost to the system of an additional $5.7 billion in 2005.

--Based on Bureau of Justice Services research, computed using an average annual cost per inmate of $22,650; actual cost for mentally ill inmates can be much higher.

While the share of mentally ill inmates in prisons is about 16 percent, the share in solitary confinement units is usually much higher: Oregon, 28 percent; California, 32 percent; Washington, 29 percent; Massachusetts, 33 percent.

--State correctional agencies.

In the decade through 2004, 44 percent of New York's prison suicides occurred in isolated confinement, where just 7 or 8 percent of the prison population was housed. In 2005, 69 percent of California's prison suicides took place in solitary confinement, where just 5 percent of the population was kept.

-- Correctional Association of New York, USA Today.

The average time that inmates are kept in solitary confinement is 5.2 years in Texas, 4.2 years in Massachusetts and 3 years in New York. The average stay in punitive solitary confinement in Canada is one week.

--Human Rights Watch, Massachusetts Department of Corrections, Correctional Association of New York, Correctional Service Canada.

On the American incarceration ethic:

In the last decade of the twentieth century, four hundred prisons were built and forty mental hospitals were closed in America.

-- The Sentencing Project, 2002

America had the world's highest per capita incarceration rate in 2005: 714 per 100,000 people, followed at a distant second by Russia, Belarus, and Bermuda, which were tied at 532.

--International Centre for Prison Studies

America spent $60 billion in 2001 to run some five thousand state, local, and federal lockups.

--Vera Institute

Per capita prison spending tripled in the last two decades of the twentieth century while spending on higher education rose by a third. Spending by state mental health agencies rose by just a fifth.

-- Mother Jones magazine: "Debt to Society"; National Association of State Mental Health Program Directors Research Institute. All figures are inflation-adjusted.

On incarcerated juveniles:

The number of juveniles entering adult jails and prisons in America tripled from 1990 through 2004. America had more children in adult prisons than any other country in the world in 1998, and five times as many as India.

-- The National Council on Crime and Delinquency, Amnesty International

"The vast majority of youths with mental health needs are made worse instead of improved by the correctional environment" in California's juvenile prisons, where 71 percent of males have three to five psychiatric diagnoses.

--Farrell v. Hickman, Mental Health Remedial Plan, 2005; The Assessment of the Mental Health System of the California Youth authority, 2001.

Half of 110 incarcerated juveniles who committed suicide from 1995 to 1999 were housed in isolation at the time of their deaths.

--National Center on Institutions and Alternatives, 2004.

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