Politics & Policy

Psychiatric Beds for Death Row

In California and elsewhere, the acutely psychotic can’t get treatment — unless they commit a grave crime.

‘San Quentin Plans Psychiatric Hospital for Death Row Inmates” announced the Los Angeles Times on June 10. The 40-bed psychiatric hospital, which will open October 1 within the prison, will house 37 condemned men who are reported to be “so mentally ill that they require inpatient care, with 24-hour nursing.” As an example, the story cited Justin Helzer, who in 2000 killed five people, was found guilty, and was condemned to death. He also had schizophrenia and refused medication. While on death row in 2010, “he blinded himself by jabbing pens through the sockets of his eyes,” and three years later he hanged himself.

How did 37 men with severe psychosis get to death row, you may ask. The saga began in the 1950s when California had more than 37,000 patients in the state psychiatric hospitals. Since the state’s population was one-third what it is today, that would be the equivalent of 111,000 beds in state psychiatric hospitals. With the introduction of effective antipsychotic medication, California began to empty the hospitals, first under Republican governor Goodwin Knight then under Democratic governor Pat Brown. By the time Governor Ronald Reagan took office, the hospitals had been half emptied, contrary to the claims of many critics who place blame for deinstitutionalization on Reagan.

Since Reagan’s time, the emptying of California’s state hospitals has continued so that today there are only 4,600 beds, which is, adjusted for population, 4 percent of the beds that existed in 1955. And 90 percent of those 4,600 beds are reserved for “forensic” patients, mentally ill individuals who have been charged with a crime. There are almost no beds in psychiatric hospitals for individuals with severe psychiatric disorders who need hospitalization for medication stabilization. It is probably easier in California today to gain admission to Stanford University than to gain admission to a public-hospital psychiatric bed.

Emptying the hospitals was not the biggest mistake, however. The biggest mistake was the failure to make sure that the severely mentally ill individuals being released from hospitals would receive ongoing medication — for without ongoing medication, relapse is virtually inevitable for these individuals. In this task, California has failed miserably: On any given day, half of all individuals with severe psychiatric disorders are untreated. Many end up homeless on the streets of San Francisco and Los Angeles. Many others commit minor crimes, often associated with their untreated mental illness, and end up in California’s jails. Others commit major crimes and end up in California’s prisons. Among the major crimes are homicides — mentally ill individuals are responsible for about 10 percent of homicides. A few of these individuals end up on death row.

In summary, first we discharged individuals with severe mental illness from state psychiatric hospitals. Next, we failed to provide follow-up treatment for half of them. Many of these individuals committed crimes associated with their untreated mental illness; we put these individuals into jails, prison, or the few remaining forensic beds in state hospitals. A small number ended up on death row. And now we are going to provide state-of-the-art psychiatric care for them just before the state puts them to death. Is there something wrong with this picture?

In 1963, President John F. Kennedy gave a speech to Congress in which he proposed having community mental-health centers replace the state psychiatric hospitals. In describing his plan, he said:

When carried out, reliance on the cold mercy of custodial isolation [of the state hospital] will be supplanted by the open warmth of community concern and capability. Emphasis on prevention, treatment, and rehabilitation will be substituted for a desultory interest in confining patients in an institution to wither away.

Mentally ill individuals no longer have to worry about “withering away.” Today they worry about being put to death. We define psychotic individuals as having a severe inability to think logically; surely our state mental-illness-treatment system qualifies as psychotic.

— E. Fuller Torrey, M.D., is the founder of the Treatment Advocacy Center and author of American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System.

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