Why Mental Health Hospitals and Jails are now the Same Thing
And Why This Situation Only Gets Worse
An article was published on NPR today. You can find it here. In short, it explains how state psychiatric hospitals are becoming more like jails, because a large percentage of their patients are coming from jails. One of the statistics the authors shared was that roughly 90% of the state psychiatric beds were filled with forensic (those coming from jails) patients.
The care that patients receive in state psychiatric hospitals is better than what they receive in most jails. However, the cost difference is enormous. For instance, the average cost of keeping someone in jail might be $100-$300 per day, depending on the jail. Meanwhile, the cost of keeping someone in a state psychiatric hospital is more than $1,000 per day. In my state (which publishes these costs on their website), the cost of a state psychiatric stay is $2,000 per day (ten to twenty times more than the cost of a jail stay). This is all at taxpayer expense.
What do you get for this additional cost? The main difference is that you have group and (sometimes) individual therapy. These are services that are often not provided in jails because they lack the budget to pay for them. Jails primarily treat mental illness with medication, because it’s cheaper and can be administered quickly (as opposed to therapy which takes 45-60 minutes and requires the inmates to leave their cells). State hospitals also tend to have nicer facilities, better quality food, and extracurricular activities (e.g. gardening, art classes, etc).
In the context of our current series on the relationship between wealth concentration (and economics in general) and mental health, this is highly relevant. What we’ll see as the series unfolds is that a lot of these people are mentally ill because of high levels of wealth concentration (and associated sequelae). Our society fails to tax wealth, leading to wealth concentration and mental illness. This also means that the government is broke, and can’t afford to pay for mental health treatment. Since it can’t afford treatment when people need it, patients become increasingly psychotic and violent, resulting in incarceration, and the necessary treatment (provided much too late at this point) becomes astronomically expensive. A typical stay in a state hospital is 90 days…at $2,000 per day, a routine stay costs $180,000 per patient.
We can take this a step farther. Note in the NPR article that the state psychiatric hospital did not respond to a request for a comment.
Eric Wandersleben, director of media relations and outreach for the department, declined to respond to detailed questions submitted before publication and, instead, noted that responses could be publicly found in a governor’s working group report released in late 2024.
It’s obvious why Mr. Wanderslenben does not want to comment. What is he supposed to say? “We don’t have enough state hospital beds because politicians keep cutting funding for mental health.” He’s not going to throw his own boss under the bus.
What would his boss say if he were asked for comment? Probably nothing. But what he’s probably thinking is, “there is no room in the budget to increase the number of state hospital beds, expand treatment options in jails, or to improve community mental health treatment.” That’s what I would be thinking if I were in his position. And why is there no room in the budget? I think you know where I’m going with this. Because we don’t tax wealth, state budgets (which rely in-part on the Federal budget) are tighter and tighter every year.
The results of this are fewer social safety nets, more depression, more psychosis, and more suicide. If we do not do something about the economic problems, this situation will only continue to get worse. Stay tuned to weekly videos for a deeper explanation and suggestions for how we fix these problems.