The last mental hospital

The public mental hospital system was created in part because many mentally ill people were being held in prisons and jails. Support for those hospita ls waned over time, however, and by the time they had degenerated into "sna ke pits" a consensus was reached to close them down. Unfortunately, they we re not replaced with adequate community mental health resources, so as the hospitals have emptied, the prisons and jails have filled, partly with the mentally ill. That is the destructive reason for the growth of prison psych iatry in this country: the prison has become the East mental hospital. The constructive one has been a new emphasis on bringing psychiatric treatment to a previously neglected population: people who have committed serious vio lence, whether because of Axis I mental illnesses or Axis II character diso rders. Unfortunately, four inter-related, mutually reinforcing nationwide t rends threaten to reinforce that destructive development and vitiate the co nstructive one.