Winston Churchill wrote that one can better understand the values of a nation by visiting its jails. I believe the same can be said of our institutions that focus on the healing of our mentally ill. It is for this reason that I was dismayed by the views of one of the architectural judges when describing the correctional facility in Rankin Inlet: “this prison would make a better psychiatric hospital than at least 95 percent of the facilities that are in use as psychiatric hospitals today.” What does this say about our values toward those who are mentally ill?
Kevin Turner writes passionately about his concerns regarding the stigma associated with mental illness and psychiatric hospitals. But it has not always been that way.
Our values of the late 19th century were such that we viewed mental illness as a health issue. The “moral movement” believed that a cure was the best in accommodation. Thomas Kirkbride, the founding member of the American Psychiatric Association and the superintendent of the Pennsylvania Hospital, designed the first hospital dedicated to healing the mentally ill in 1859. It was considered to be an architectural wonder. The hospital was spacious, airy, normative, and featured large windows, wide corridors, and the best in architectural detailing. The building reflected the values of a society that believed that mentally ill individuals should and could be healed.
It was so effective that it became the template for numerous mental health hospitals across North America. The general public lined up to see and visit these avant garde buildings. They invoked societal and civic pride.
Times and values change. Industrialization and rationalization in the early 20th century gave us confidence that we could cure mental disease through the use of occupational and industrial therapy. The mentally ill became objectified. Modern treatments included hydrotherapy, insulin coma, lobotomies, and electroconvulsive therapy. Eventually those techniques were deemed unethical or ineffective. In addition, overcrowding and understaffing post-World War II led to a primary emphasis on custody rather than therapy.
The development of antipsychotic drugs during the 1960s reduced the need for constant supervision of patients. Mental healthcare shifted from long-term stays in psychiatric institutions to the treatment of acute episodes in psychiatric units of general hospitals. However, a lack of investment in community services resulted in the majority of discharged patients receiving less care than while institutionalized, if any at all.
Increased homelessness and deviant behavior among the mentally ill population resulted in the criminalization of mental illness and a staggering growth in prisons. The numbers associated with trans-institutionalization are sobering. Ultimately, there has been no change in the rate of institutionalization (per 100,000) since 1960s. Individuals with mental sickness have simply moved from inadequate hospitals to inadequate jails. I agree with Kevin that jails should not be the locale for healing mentally sick individuals, but I am not sure we have a choice.
Over 30,000 mentally ill individuals are booked and incarcerated in Cook County, Illinois, jails every year. There are currently 1 million mentally ill who are incarcerated in United States jails. The expression of our society reveals that we have a fear of criminal behavior, whether or not it is induced by mental illness. We do not want our taxes raised to build more hospitals, we want criminals off of our streets, and we do not want socialized medicine (I should clarify that we Canadians love our socialized medicine).
The reality is that we need to treat individuals who are sick, be it physical or mental, and whether they can afford it or not. We need to cure sick people irrespective of locale, be it a prison or a hospital, and they should be cured irrespective of stigma.
Some can be treated at home or on the street, some can be treated in hospitals, and unless we are prepared to forgive individuals who commit crimes due to mental illness, we will need to treat some individuals who are incarcerated in jail. We have no choice, we have an obligation.
Churchill would be proud.
Read the opposing view by Kevin Turner here.
Robert Boraks is an Architect and a Principal of Parkin Architects. His designs include acute care hospitals, jails, psychiatric hospitals, and jails that are designed to help cure mentally ill inmates.