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.