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Book Review   |    
H. Richard Lamb
Psychiatric Services 2009; doi:
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by Travis C. Pratt; Thousand Oaks, California, Sage Publications, Inc., 2009, 153 pages, $31.95 paperback, $69.95 hardcover

Dr. Lamb is professor of psychiatry, University of Southern California Keck School of Medicine, Los Angeles.

With at least 350,000 persons with severe mental illness in our jails and prisons, the mental health field is very much in need of the knowledge and perspective of criminologists. Their perspective can only help us in our efforts to deal with criminalization of persons with severe mental illness, one of the most important social issues of our time. Thus this slender volume by an expert on crime and delinquency and the criminal justice system focuses on an area that is one of our greatest challenges.

The author's main thesis is that society's emphasis on social support is inversely related to its emphasis on social control. As the State has placed increasing emphasis on its social control function by increasing the power and scope of the criminal justice system, the State has deemphasized its public responsibilities in providing social support in areas such as community mental health and inpatient treatment. Another issue emphasized by the author is the war on drugs, in which the criminal justice system plays a leading role. Given that such a large percentage of persons with severe mental illness have severe substance abuse and dependence problems, many tens of thousands have found their way into our jails and prisons via their problems with drugs and alcohol.

The author points out that the State's shift in emphasis from social service to social control has resulted in responsibilities, in addition to punishment, beyond the capabilities of the correctional system. For instance, prisons are simply ill equipped to effectively treat persons with severe mental illness. Society needs to be reminded of this fact, and the author forcefully does that. This statement needs to be qualified, however; if the person has committed a serious crime, such as murder or armed robbery, there is no alternative but to incarcerate that person, no matter how severe the mental illness.

In addition to the struggle in society between those who would stress social control and those who would stress social support is the issue of cost. In the case of persons with severe mental illness, there has been an attempt to show, as an argument for decriminalization, that treatment in the mental health system would cost less than incarcerating these persons in jails and prisons. The argument considers all the costs associated with the criminal justice system, such as the courts, law enforcement, public defenders, and so on. However, this is difficult to prove, and, in fact, high-quality mental health care, including therapeutic psychiatric hospitalization, is expensive.

An additional issue is the belief on the part of many persons, both in and outside of the mental health system, that hospitals and involuntary mental health treatment often are not necessary. Ironically, this belief often leaves jail and prison as the only alternative for those who need involuntary, structured care.

Clearly, the main points of this book are valid. Society has a public responsibility to provide treatment to persons with severe mental illness, and this should be done in facilities designed not for punishment but for treatment.

The reviewer reports no competing interests.




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