By Jennifer Zarour
EDITOR’S NOTE: The following blog post discusses instances of self-harm and suicide.
A serious problem plagues the criminal justice system in the United States: substandard treatment of Seriously Mentally Ill (SMI) individuals.
“SMI” is a legal designation which allows individuals to receive services that may improve their quality of life and increase their independence. Individuals must apply for this designation and meet certain criteria; for example, an applicant must experience “serious functional impairment that is directly related to an SMI qualifying diagnosis that substantially interferes [with] or limits their functioning in a family, school, employment, or community environment.”
As of 2022, data suggests that nearly nine million American adults are seriously mentally ill. However, as of 2023, there were only 36,150 state psychiatric hospital beds for SMI adults in the U.S.—that is 10.8 beds for every 100,000 people. The beds are available to two populations: forensic patients and civil patients.
A forensic patient is committed to a psychiatric hospital after entering the criminal legal system, while a civil patient is admitted without having been charged with a crime. The distinction is important due to the fact that the majority of available beds are occupied by forensic patients. As such, fewer and fewer beds remain available for civil patients.
However, forensic patients also struggle to find beds in state hospitals. According to a report by the Treatment Advocacy Center, “thousands of inmates with serious mental illness languish in jail for months, or even years, waiting for a state hospital bed to open. While incarcerated, such people often gain additional charges due to disruptive behaviors that are symptoms of their illness, get sicker as they spend extended periods of time without treatment, and even die from preventable and tragic causes such as dehydration.”
The unfortunate consequence is that many SMI adults are unable to receive treatment in state psychiatric hospitals, instead being left in the community without necessary treatment. In turn, many of these individuals are arrested and charged for incidents that occurred as a result of their mental illness(es) and eventually enter the state psychiatric hospital as a forensic patient. This creates a vicious cycle in which many SMI adults must be arrested in order to be hospitalized and receive necessary treatment.
Although it may be difficult to understand the severity of the crisis by simply looking at data and statistics, there are personal stories of individuals who have been thrown into the criminal legal system as a result of inadequate or entirely unavailable treatment. A very recent example from Arizona is the story of Joshua Fox.
Joshua Fox was a 23-year-old who had developed SMI symptoms as a young teenager. His parents tried for years to get him the help he needed but were ultimately unsuccessful. Behavioral treatment centers regularly turned Joshua away; the times he was admitted, Joshua was released without adequate treatment. Joshua’s symptoms became progressively more dangerous to himself and others around him, eventually leading to Joshua’s arrest and incarceration on domestic assault charges.
The time that Joshua spent in jail only traumatized him, contributing to a further decline in his mental health upon release. Joshua continued to struggle to find treatment. A total of seven behavioral health facilities turned Joshua away for a variety of reasons, which included: medical personnel deemed his self-reported symptoms not dire enough; the facility lacked a sufficient number of beds for civil patients; or facility staff believed his symptoms were related to underlying substance abuse issues rather than mental illness.
Joshua’s mental health only worsened as he remained unable to receive treatment. At just 20 years old, Joshua experienced an episode of psychosis so severe that he stabbed his father to death. Joshua was then arrested and returned to jail.
While in jail, Joshua attempted suicide multiple times, causing himself serious injuries. Joshua was eventually placed on court-ordered treatment and received much-needed medication, which improved his mental health. The jail in which Joshua was held compiled an extensive record of his mental health.
When Joshua was eventually sentenced to serve time in prison, the court ordered that his mental health records be sent from the jail to the prison and made a formal recommendation that Joshua receive psychiatric services in prison. However, upon transfer to the prison, Joshua’s records were not taken into consideration and he “was placed in a standard cell without supervision or psychiatric accommodations.” After only 30 hours in prison without supervision, Joshua died by suicide.
Joshua’s story is a very real and heartbreaking example of how the legal system has effectively criminalized mental illness due to the lack of resources and psychiatric capacity of hospitals to handle SMI individuals. Stories like Joshua’s are not uncommon in the criminal legal system, and sharing them helps to spread awareness about SMI individuals and their encounters with police, courts, and prisons.
Legal professionals handling criminal cases are uniquely capable of effecting change by developing more nuanced perspectives and approaching SMI defendants with a goal of rehabilitation rather than punishment. However, the root issue—a lack of resources for SMI individuals—remains rampant, and services are insufficient to properly manage such individuals before and after they enter the criminal legal system. To truly address this issue and make progress, the legal system has a responsibility to make resources more effective and accessible to those who need them.
Jennifer (she/her) is currently a 2L at Arizona State University’s Sandra Day O’Connor College of Law. Prior to law school, she graduated from the University of Arizona with a bachelor’s degree in law. She has interned in government positions and on both sides of criminal law. Her exposure to the criminal justice system through these experiences, in addition to her life experience as a minority, has shaped her legal interests in civil rights and social justice. Outside of school, Jennifer enjoys crocheting stuffed animals for her friends, watching dog grooming videos on YouTube, and searching for the best (and cheapest) iced coffee around.
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