Ever since reading Going Up the River: Travels in a Prison Nation by Joseph T. Hallinan in my early 20’s, I’ve been fascinated by prison and have read about it often. And with prisons being the largest supplier of mental health care in the United States, I knew I needed to read Insane: America’s Criminal Treatment of Mental Illness by Alisa Roth (Basic Books, 2018) when I learned about it- partly because of this fascination, and partly for semi-personal reasons.
In Insane, Ms. Roth details the challenges the prison system faces being the provider of mental healthcare for its millions of prisoners. Funding is short, so providers- whom it’s difficult to hire for various reasons, including safety and lower-than-civilian-jobs salaries- are constantly lacking. Therapy is challenging when it can only be given out in the open, with no privacy. Fewer providers mean services don’t get rendered in time; meds don’t get handed out in time; diagnoses don’t get made for months, sometimes years. Officers get little-to-no training in how to deal with severely mentally ill prisoners. Overcrowding exacerbates symptoms and strains already strained resources. If you’re unaware of just how overburdened the prison system is in regards to mental healthcare, you’ll have a pretty good idea after reading this book.
This isn’t to say that there aren’t places trying, and Ms. Roth points that out throughout the book. It’s just that this is a monumental task, and the country does almost next to nothing in order to keep these mentally ill patients treated so that they don’t end up in prison in the first place. (Our garbage healthcare system, tied to employment, shares a lot of this blame, as does the lack of therapists and psychiatrists- and I’d say the problem of affordable higher education is also an issue there.)
This is a deeply distressing, heavy book, full of information that I wish everyone knew and cared about. We’re all just one slightly different brain chemical away from ending up as a patient on the wrong side of the law- and that’s if we’re lucky, because far too often in the US, mentally ill people end up being shot by the police. A dear friend of mine had a son who suffered from schizophrenia and one of her greatest fears was always that he would end up being shot by the police during an episode. I learn so much about mental illness from her, and I think of her son and her continued fight to improve mental health care in this country every time I read a book like this. The two of them are a continued reason why I pick up these kinds of books; what Ms. Roth is doing, shining a light on the conditions faced by inmates who are often incarcerated due to the affects of their illnesses, is so necessary, and it’s such a service to the mental health community.
Insane isn’t an easy read. It’s a tough subject matter, and a lot of what she talks about will probably scare you or make you uncomfortable. It should. But you should use this information to become better informed and a better advocate for the mentally ill. Because stigma is bullshit and mental illness is illness- like cancer, or heart disease, diabetes, or epilepsy. It deserves research, resources, treatment options- treatment BEFORE tragedy, as my friend Laura says. And mentally ill people deserve dignity and respect, which Ms. Roth definitely affords them all throughout this remarkable book.