How did jails and prisons end up being the front line of mental-health care provision? Roth rightly critiques the knee-jerk reaction that blames this development solely on the closure of failing mental hospitals in the 1970s and ‘80s. The people moldering in the “snake pits” of old were predominantly elderly, white, female, and suffered from serious, chronic mental illnesses; after the passage of Medicare in 1965, their care was shifted to nursing homes. Meanwhile, overall funding to provide inpatient psychiatric care steadily declined in the late twentieth century, leaving patients and families with fewer and fewer resources to call upon. For the sickest and poorest Americans, jails and prisons became the default option for care. “People with mental illness have simply been caught up—albeit sometimes in disproportionately higher numbers than the rest of the population—by the same forces that have driven the rise of mass incarceration, among them the War on Drugs, broken windows policing, and mandatory minimum sentencing,” Roth writes. Once in the correctional system, they are treated not as sick people but as criminals, often with disastrous results.
– Democracy: A Journal of Ideas