An “obscure, multibillion-dollar segment of domestic detention” is explored by the New York Times magazine. A new study by the National Association of State Mental Health Program Directors says that more than 10,000 mentally ill Americans who haven’t been convicted of a crime are involuntary confined by psychiatric hospitals. They have been found not guilty by reason of insanity or have been arrested but found incompetent to stand trial. No one knows the exact number of such people. Not much is known about the confinement of “forensic” patients, people committed to psychiatric hospitals by the criminal-justice system. No federal agency is charged with monitoring them, and no registry or organization tracks how long they have been incarcerated or why.
In 1992, the Supreme Court ruled that a forensic patient must be both mentally ill and dangerous in order to be hospitalized against his will. In practice, “states have ignored [the ruling] to a pretty substantial degree,” says W. Lawrence Fitch, a consultant to the National Association of State Mental Health Program Directors and former director of forensic services for Maryland’s Mental Hygiene Administration. “People are kept not because their dangerousness is because of mental illness. People stay in too long, and for the wrong reasons.” Michael Bien, who helped bring a successful lawsuit against the California prison system for prisoners with psychiatric illnesses, agrees. “Under constitutional law, they’re supposed to be incarcerated only if they’re getting treatment, and only if the treatment is likely to restore sanity,” he says. “You can’t just punish someone for having mental illness. But that’s happening.”