Television shows such as Criminal Minds, Law & Order, and Bones commonly create a fear-based rendition of the “criminally insane”. Unfortunately, these programs often overlook the harmful effects of these narratives in the context of the mass persecution and incarceration of the mentally ill. Research estimates one in two Americans living with severe mental illness face arrest over the course of their lives. A study conducted by the Washington Post in 2017 cited 25% of fatal police shootings involved a person with mental illness. Insane: America’s Criminal Treatment of Mental Illness examines how a flawed criminal justice system emphasizes punishing the mentally ill over treatment and rehabilitation. Roth mobilizes the history of mental healthcare, the personal perspective of mental healthcare workers in the prison system, and narratives of individuals living with mental illness. Framing her argument in logic, Roth suggests that, despite their good intentions, laws and prison standards fail to understand the nuance and complexity necessary to rehabilitate and treat offenders with serious mental illness.
Roth first contextualizes her mental healthcare critique within a broader historical debate: should mental healthcare exist within regular healthcare systems or specialized facilities? Roth marks the growth of pharmacology, the movement towards community-based mental healthcare, and the development of Medicare and Medicaid as noteworthy in her historical narrative. These events later set the stage for the present degradation of the mental healthcare system and its eventual replacement by prisons and jails. The 1954 FDA approval of chlorpromazine and the drug’s ability to control psychosis provided new insights into medicating mental illness. The eventual overuse of these drugs by mental healthcare workers to treat mental illness depicted mental illness as incurable and stagnant. Within the same period, political policy began to direct resources towards financing community-based care in specialized mental healthcare facilities which sought to replace state hospitals that functioned within the regular healthcare system. However, the failure to materialize these new community-based care options left many mentally ill patients without care options. In 1965, the creation of Medicare and Medicaid incentivized states to move patients from psychiatric hospitals to nursing homes or outpatient care. The overuse of new pharmacology to treat mental illness, the failure to instate community-based care options, and the development of Medicare and Medicaid coalesced into the deinstitutionalization movement, essentially abandoning those in need of mental healthcare.
The emphasis on public safety spending on health care units in jails and prisons as opposed to funding public mental health care punctuates Roth’s historical analysis of mental health care. Contextualized by the deinstitutionalization movement, personal accounts of those working in the prison system highlight this inequity’s impact. Within these narratives, Roth expertly portrays the inherent flaws of the mental healthcare provided in prisons. In prisons, deputy duties include feeding prisoners, enforcing suicide prevention methods, escorting prisoners to therapy sessions, extracting prisoners from their cells, and making sure prisoners consistently take their medications. Despite this crucial interaction between deputies and inmates, deputies remain uninformed of inmate’s diagnoses due to HIPAA restrictions. “ We as deputies, we know how to arrest people,” one deputy explained to Roth. “We don’t know how to take care of people with mental illness” (101). Often, deputies aid in admitting prisoners into inpatient psychiatric units. Little room exists in these psychiatric units, like in LA County Prison where only 55 beds accommodate roughly 15,000 prisoners. With such limited space, prisoners experiencing psychosis rarely access these facilities and the treatment they provide. Instead, mentally unstable prisoners usually endure time in the prison’s general population. They face solitary confinement, “outdoor time” in dog kennel-like cages, and abuse from other inmates.
Insane demonstrates how prison regulations and conditions destabilize the mentally disabled, failing to not only rehabilitate the incarcerated but in many cases worsening the mental conditions of those already lost in psychosocial instability. As lieutenant Mike Burse tells Roth, “If you are mentally ill, this [jail] is a horrible place” (92). For example, many mentally unstable prisoners exhibit Scatolia, the act of playing with feces, a behavior seldomly exhibited in the outside world but commonly observed in prisons and jails. Narratives about prisoners released from solitary confinement experiencing heightened panic, stimulus hypersensitivity, and social anxiety solidify the correctional facilities’ pathogenic nature.
Recounting the experiences of a variety of individuals with mental illness, Roth portrays a plethora of unique individuals from different backgrounds. In a state of psychosis, one schizophrenic man from Texas permanently blinded himself when police officers failed to watch him in jail. Another schizophrenic and bipolar man, incarcerated for stealing five dollars’ worth of food in Virginia, died of starvation in prison after enduring months of abuse from correctional officers. In Florida, correctional officers forced a man who spread feces in his cell into a boiling shower where he subsequently died. Despite the differences between each narrative and each individual, similar themes of arrest, incarceration, and death reveal the tragic danger of living with mental instability in the United States. The book encapsulates its most heart wrenching, memorable points within these narratives, allowing Roth to humanize a misunderstood, demonized population.
In her exploration of these depressing narratives, Roth occasionally fails to include a more in-depth, holistic analysis of the solutions to the problems she identifies. Her analysis of the Crisis Intervention Team training accurately depicts current programs aimed at training law enforcement to safely interact with the mentally ill. However, her examination fails to address and analyze other intersectional components (race, the criminalization of drugs, etc.) impactful in the interactions between the mentally ill and law enforcement that CIT training fails to encompass. Furthermore, Roth expertly portrays the flawed and underfunded nature of the healthcare provided in prisons. Still, a description of how to most effectively use these funds and fix these programs might provide a complete analysis of the mass incarceration of the mentally ill. For example, while her analysis of The Restoration Center and the Criminal Mental Health Project exemplifies successful programs implemented in jails these programs do not apply to prisons. This may also point to the need for future research dedicated to this area of study. If anything, Roth’s analysis skillfully blueprints current problems for future sociologists, journalists, mental healthcare workers, and policymakers. Individuals working to end the abuse of the mentally ill and providing them effective rehabilitation will find a helpful critique of the current criminal justice system in Roth’s work.