Author: Alisa Roth

Publisher: Basic Books (New York). 320 pp.

Type of work: Sociology, current affairs, history

Time: Mainly twentieth and twenty-first centuries

Locale: United States

Alisa Roth's investigation into America's criminal justice system reveals a shocking and systemic failure to adequately care for individuals with mental illnesses. Her work exposes the harsh realities faced by mentally ill individuals within the system, highlighting the neglect and abuse rampant in correctional facilities. Through a series of case studies and personal interviews, Roth unveils the urgent need for reform and alternative approaches to mental health treatment within the justice system.

Principal Figures

Jason Echevarria, a Rikers Island inmate who died from neglect after ingesting poisonous materials

Terrence Pendergrass, a Rikers Island corrections officer who ignored Echevarria’s requests for medical attention

Jamie Wallace, a prisoner at Donaldson Correctional Facility in Alabama who took his own life after being denied transfer to a mental health institution

Tom Dart, a reform-minded sheriff at the Cook County Jail in Chicago, Illinois

Sam Cochran, a retired police officer instrumental in creating the Crisis Intervention Team in Memphis, Tennessee

Steve Leifman, a Miami-Dade County judge who founded the Criminal Mental Health Project

The Evolution of Mental Health Facilities

In an 1882 report by the Boston Globe, Edwin R. Prescott, from Somerville, Massachusetts, was documented as having brutally murdered his mother-in-law. Prescott, plagued by mental distress, had unsuccessfully sought admission to the Danvers Asylum before the crime. Danvers State Hospital was initially celebrated for following the humane Kirkbride Plan, known for treating patients with kindness and allowing them to work therapeutically. However, overcrowding and resource limitations soon diluted its innovative vision. Roth's investigation reveals that such deterioration was not unique to Danvers but reflected a nationwide trend in state psychiatric hospitals.

From Asylums to Prisons

Roth explains how deinstitutionalization in the 1960s and 1970s emptied many state mental hospitals, with the hope that new medications and outpatient services would suffice. Yet, as societal support structures fell short, prisons became de facto mental health facilities. By 2017, Roth notes, up to half of all prisoners in the U.S. had mental illnesses. While jails like Rikers Island, Cook County Jail, and Los Angeles County Jail are the largest providers of mental health care today, Roth argues that these institutions often replicate the deplorable conditions of the asylums they replaced.

Case Studies of Systemic Failure

Roth's book is filled with harrowing accounts of mistreatment. In "Sanctioned Torture," she recounts the tragic story of Jason Echevarria at Rikers Island. Diagnosed with bipolar disorder, Echevarria died after being neglected by the staff, illustrating a broader pattern of neglect and abuse. Similar cases of abuse, such as a prisoner in Virginia who starved to death or a schizophrenic man in Florida who died from extreme water temperatures, underscore the systemic issues within these facilities.

The Human Cost of Neglect

The harsh conditions in prisons exacerbate mental health issues, often leading to self-harm and suicide among inmates. Roth describes how, despite preventive measures like special mattresses and fixtures, inmates continue to find ways to harm themselves. She shares the disturbing confession of a retired officer from Donaldson Correctional Facility, who witnessed colleagues giving self-harm tools to inmates. Such accounts reveal the dire need for change in how mental health is managed within correctional settings.

Jamie Wallace's Story

One of Roth's poignant case studies is that of Jamie Wallace, who struggled with multiple mental health disorders from a young age. His unstable family environment and subsequent incarceration only worsened his condition. Despite knowing he needed professional help, the prison system's...