Behind the Thorazine Shuffle, the Criminalization of Mental Illness

In Atlanta the prison dining room was glass-walled. We could sit there eating our meals and see up and down the sidewalk. Directly across the way was D-Building. When the doors to that dorm opened up a strange group of men would exit. They would seem to be in a hurry, but unable to coordinate their movements. Their heads would hang down and half expressions would ripple across their faces. They would run their hands over their heads over and over, and open and close their mouths while sticking their thick tongues out. Their gait was particularly peculiar, with stiff legs dragging their feet along, all the while seeming about to topple. We called this the “thorazine shuffle."

Later, I learned that it was something called tardive dyskinsesia, and was in fact a side effect of the medicines. Often the doses given to them were excessive, more for the purposes of control than for treatment, and they suffered the consequences in their bodies and minds.

At first, in the 80s, my encounters with these men were infrequent. As time went on though, and as mental treatment options were cut by the government, I began to meet more and more of them. Before I left, in 2009, some prisons were almost exclusively made up of inmates with mental health issues. The prisons, through government policy, had become the option of choice for the mentally ill, and mental illness itself had become de facto criminalized.

Last year a joint report by the National Sheriffs’ Association and the Treatment Advocacy Center, entitled More Mentally Ill Persons Are In Jails and Prisons Than Hospitals–A Survey of the States, found that there are three times more mentally ill people in prisons and jails than in mental hospitals. The situation in juvenile facilities is similar. An AP story from this year says that 52 percent of juvenile inmates have some form of mental illness. In Florida, as reported by the Palm Beach Post, juvenile authorities have come under harsh criticism for the overuse of strong antipsychotic drugs, and youth prison doctors have been accused of taking large payouts from drug companies to prescribe their products. Time reported last year that pharmaceutical companies had paid out the largest settlement in U.S. history, including the largest criminal fines, for pushing over-prescription to vulnerable populations, including kids in detention.

A March 8, press release from the MacArthur Foundation and the Substance Abuse and Mental Health Services Administration (SAMHSA) gives cause for some hope. The groups are, “collaborating on a $1 million effort targeting the behavioral health needs of youth in contact with the juvenile justice system.” According to these groups 60 to 70 percent of incarcerated juveniles meet the criteria for a mental health disorder, and 60 percent qualify for a substance abuse disorder. Thirty percent are thought to be so severely disabled that their “ability to function” is “highly impaired.”

SAMHSA’s Policy Academy Mechanism and the MacArthur Foundation’s Models for Change Action Network will collaborate to bring support to eight states, selected competitively, that are seeking to improve policies and practices that will better serve communities and youth. Their goals include reducing the over representation of minority youth in the juvenile system, incorporating better screening practices throughout the system, and recognizing “the role of evidence based practice, treatment, and trauma informed services.” The National Center for Mental Health and Juvenile Justice at Policy Research Associates and the Technical Assistance Collaborative will administer the projects.

Maybe society can finally begin to reverse the trend of criminalized mental illness that has taken root in the last few decades.