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Reducing Mass Incarceration: Lessons from the Deinstitutionalization of Mental Hospitals in the 1960S Bernard E

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Reducing Mass Incarceration: Lessons from the Deinstitutionalization of Mental Hospitals in the 1960S Bernard E University of Chicago Law School Chicago Unbound Coase-Sandor Working Paper Series in Law and Coase-Sandor Institute for Law and Economics Economics 2011 Reducing Mass Incarceration: Lessons from the Deinstitutionalization of Mental Hospitals in the 1960s Bernard E. Harcourt Follow this and additional works at: https://chicagounbound.uchicago.edu/law_and_economics Part of the Law Commons Recommended Citation Bernard E. Harcourt, "Reducing Mass Incarceration: Lessons from the Deinstitutionalization of Mental Hospitals in the 1960s" (John M. Olin Program in Law and Economics Working Paper No. 542, 2011). This Working Paper is brought to you for free and open access by the Coase-Sandor Institute for Law and Economics at Chicago Unbound. It has been accepted for inclusion in Coase-Sandor Working Paper Series in Law and Economics by an authorized administrator of Chicago Unbound. For more information, please contact [email protected]. CHICAGO JOHN M. OLIN LAW & ECONOMICS WORKING PAPER NO. 542 (2D SERIES) PUBLIC LAW AND LEGAL THEORY WORKING PAPER NO. 335 REDUCING MASS INCARCERATION: LESSONS FROM THE DEINSTITUTIONALIZATION OF MENTAL HOSPITALS IN THE 1960S Bernard E. Harcourt THE LAW SCHOOL THE UNIVERSITY OF CHICAGO January 2011 This paper can be downloaded without charge at the John M. Olin Program in Law and Economics Working Paper Series: http://www.law.uchicago.edu/Lawecon/index.html and at the Public Law and Legal Theory Working Paper Series: http://www.law.uchicago.edu/academics/publiclaw/index.html and The Social Science Research Network Electronic Paper Collection. DRAFT: 1/21/2011 © Bernard E. Harcourt = = obar`fkd=j^pp=fk`^o`bo^qflkW= ibpplkp=colj=qeb=abfkpqfqrqflk^ifw^qflk=lc=jbkq^i=elpmfq^ip=fk=qeb=NVSMpK== _Éêå~êÇ=bK=e~êÅçìêíN= = = få=~=ãÉëë~ÖÉ=íç=`çåÖêÉëë=áå=NVSPI=mêÉëáÇÉåí=gçÜå=cK=hÉååÉÇó=çìíäáåÉÇ=~=ÑÉÇÉê~ä=éêçÖê~ã= ÇÉëáÖåÉÇ=íç=êÉÇìÅÉ=Äó=Ü~äÑ=íÜÉ=åìãÄÉê=çÑ=éÉêëçåë=áå=ÅìëíçÇóK=qÜÉ=áåëíáíìíáçåë=~í=áëëìÉ=ïÉêÉ=ëí~íÉ= Üçëéáí~äë=~åÇ=~ëóäìãë=Ñçê=íÜÉ=ãÉåí~ääó=áääI=~åÇ=íÜÉ=åìãÄÉê=çÑ=ëìÅÜ=éÉêëçåë=áå=ÅìëíçÇó=ï~ë= ëí~ÖÖÉêáåÖäó=ä~êÖÉI=áå=Ñ~Åí=Åçãé~ê~ÄäÉ=íç=ÅçåíÉãéçê~êó=äÉîÉäë=çÑ=ã~ëë=áåÅ~êÅÉê~íáçå=áå= éêáëçåë=~åÇ= à~áäëK=mêÉëáÇÉåí=hÉååÉÇóÛë=ãÉëë~ÖÉ=íç=`çåÖêÉëëÔíÜÉ=Ñáêëí=~åÇ=éÉêÜ~éë=çåäó=éêÉëáÇÉåíá~ä=ãÉëë~ÖÉ=íç= `çåÖêÉëë=íÜ~í=ÇÉ~äí=ÉñÅäìëáîÉäó=ïáíÜ=íÜÉ=áëëìÉ=çÑ=áåëíáíìíáçå~äáò~íáçå= áå= íÜáë= ÅçìåíêóÔéêçéçëÉÇ= êÉéä~ÅáåÖ= ëí~íÉ= ãÉåí~ä= Üçëéáí~äë= ïáíÜ= Åçããìåáíó= ãÉåí~ä= ÜÉ~äíÜ= ÅÉåíÉêëI= ~= éêçÖê~ã= ìäíáã~íÉäó= Éå~ÅíÉÇ= Äó= `çåÖêÉëë= áå= NVSP= ìåÇÉê= íÜÉ= `çããìåáíó= jÉåí~ä= eÉ~äíÜ= `ÉåíÉêë= ^ÅíK= mêÉëáÇÉåí= hÉååÉÇóÛë=ãÉëë~ÖÉ=íç=`çåÖêÉëë=ï~ë=ëíê~áÖÜíÑçêï~êÇW= fÑ=ïÉ=ä~ìåÅÜ=~=Äêç~Ç=åÉï=ãÉåí~ä=ÜÉ~äíÜ=éêçÖê~ã=åçïI=áí=ïáää=ÄÉ=éçëëáÄäÉ=ïáíÜáå=~=ÇÉÅ~ÇÉ=çê= íïç=íç=êÉÇìÅÉ=íÜÉ=åìãÄÉê=çÑ=é~íáÉåíë=åçï=ìåÇÉê=ÅìëíçÇá~ä=Å~êÉ=Äó=RM=éÉêÅÉåí=çê=ãçêÉK=j~åó= ãçêÉ=ãÉåí~ääó=áää=Å~å=ÄÉ=ÜÉäéÉÇ=íç=êÉã~áå=áå=íÜÉáê=ÜçãÉë=ïáíÜçìí=Ü~êÇëÜáé=íç=íÜÉãëÉäîÉë=çê= íÜÉáê= Ñ~ãáäáÉëK= qÜçëÉ= ïÜç= ~êÉ= Üçëéáí~äáòÉÇ= Å~å= ÄÉ= ÜÉäéÉÇ= íç= êÉíìêå= íç= íÜÉáê= çïå= ÅçããìåáíáÉëKKK=`Éåíê~ä=íç=~=åÉï=ãÉåí~ä=ÜÉ~äíÜ=éêçÖê~ã=áë=ÅçãéêÉÜÉåëáîÉ=Åçããìåáíó=Å~êÉK= jÉêÉäó=éçìêáåÖ=cÉÇÉê~ä=ÑìåÇë=áåíç=~=Åçåíáåì~íáçå=çÑ=íÜÉ=çìíãçÇÉÇ=íóéÉ=çÑ=áåëíáíìíáçå~ä=Å~êÉ= ïÜáÅÜ=åçï=éêÉî~áäë=ïçìäÇ=ã~âÉ=äáííäÉ=ÇáÑÑÉêÉåÅÉKO= = mêÉëáÇÉåí=hÉååÉÇóÛë=~ëéáê~íáçå=çÑ=~=RM=éÉêÅÉåí=ÇêçéI=áí=íìêåë=çìíI=ìåÇÉêÉëíáã~íÉÇ=íÜÉ=ÉñíÉåí= çÑ= ÇÉáåëíáíìíáçå~äáò~íáçå= íÜ~í= ïçìäÇ= í~âÉ= éä~ÅÉK= qÜÉ= é~ëë~ÖÉ= çÑ= íÜÉ= `çããìåáíó= jÉåí~ä= eÉ~äíÜ= `ÉåíÉêë=^Åí=áå=NVSP=ïçìäÇ=ÄÉ=ÑçääçïÉÇ=Äó=íÜÉ=ä~êÖÉëí=áåëíáíìíáçå~ä=ãáÖê~íáçå=íÜ~í=Ü~ë=ÉîÉê=çÅÅìêêÉÇ= áå= íÜáë= ÅçìåíêóK= aìêáåÖ= íÜÉ= éÉêáçÇ= NVSR= íç= NVTRI= íÜÉ= áåé~íáÉåí= éçéìä~íáçå= áå= ëí~íÉ= ~åÇ= Åçìåíó= ãÉåí~ä=Üçëéáí~äë=ïçìäÇ=éäìããÉí=~=ëíìååáåÖ=RVKP=éÉêÅÉåíKP=qÜÉ=ãÉ~å=ÇÉÅêÉ~ëÉ=éÉê=óÉ~ê=çîÉê=íÜ~í= 1 Professor and Chair, Department of Political Science, and Julius Kreeger Professor of Law, University of Chicago. I am deeply grateful to Carol Steiker for organizing and hosting this remarkable symposium, to Charles Ogletree for commenting on a draft of this essay at the symposium, to Philip Heymann, Mark Kleinman, Adriaan Lanni, Louis Michael Seidman, Jeannie Suk, and Andrew Taslitz for extremely helpful comments and discussion on the draft, and to Chris Berk and Alyssa Kate Ogawa for extraordinary research assistance. 2 Quoted in William Gronfein, “Incentives and Intentions in Mental Health Policy: A Comparison of Medicaid and Community Mental Health Programs,” 26 J Health & Social Behavior 3, 192-206 (1985), at p. 196; see also Henry Foley and Steven Sharfstein, Madness and Government, Wash D.C.: American Psychiatric Association (1983), at page 166. 3 Gronfein, “Incentives and Intentions,” 1985 at p. 196 (Table 1). DRAFT: January 21, 2011 Harcourt: Lessons from Deinstitutionalization éÉêáçÇ=ïçìäÇ=êÉ~ÅÜ=~äãçëí=V=éÉêÅÉåíKQ=aìêáåÖ=íÜÉ=åÉñí=ÑáîÉ=óÉ~êëI=Ñêçã=NVTR=íç=NVUMI=íÜÉ=Çêçé=áå= áåé~íáÉåí=éçéìä~íáçåë=ïçìäÇ=ÅçåíáåìÉI=Ççïå=~åçíÜÉê=OUKV=éÉêÅÉåíKR=^ää=áå=~ääI=Ñêçã=NVRR=íç=NVUMI= íÜÉ=åìãÄÉê=çÑ=éÉêëçåë=áåëíáíìíáçå~äáòÉÇ=áå=ãÉåí~ä=ÜÉ~äíÜ=Ñ~ÅáäáíáÉë=ÇÉÅäáåÉÇ=Äó=TR=éÉêÅÉåíKS= = qêìíÜ=ÄÉ=íçäÇI=ÇÉáåëíáíìíáçå~äáò~íáçå=Ü~Ç=ÄÉÖìå=É~êäáÉêI=áå=~Äçìí=NVRRI=ïáíÜ=~å=É~êäó=çåëÉí= Çêçé= çÑ= ~Äçìí= NR= éÉêÅÉåí= çîÉê= íÜÉ= éÉêáçÇ= NVRR= íç= NVSRK= jçêÉçîÉêI= íÜÉ= ãçëí= êÉäá~ÄäÉ= êÉëÉ~êÅÜ= ~ííêáÄìíÉë=íÜÉ=ëÜ~êé=ÇÉÅäáåÉë=çîÉê=íÜÉ=éÉêáçÇ=NVRR=íç=NVUM=íç=ëÉîÉê~ä=ä~êÖÉê=Ñ~ÅíçêëI=åçí=ãÉêÉäó=íÜÉ= é~ëë~ÖÉ=áå=NVSP=çÑ=íÜÉ=`çããìåáíó=jÉåí~ä=eÉ~äíÜ=`ÉåíÉêë=^ÅíI=åçê=íÜÉ=ê~éáÇ=~ÅÅçãéäáëÜãÉåí=çÑ= Ñìääó=ÑìåÇÉÇ=Åçããìåáíó=ãÉåí~ä=ÜÉ~äíÜ=ÅÉåíÉêë=Äó=NVSRK=^=Ñ~ê=ä~êÖÉê=ëÉí=çÑ=ëçÅáÉí~ä=ÅÜ~åÖÉë=ïÉêÉ=~í= éä~óI=áåÅäìÇáåÖ=íÜÉ=êÉçêÖ~åáò~íáçå=çÑ=íÜÉ=éëóÅÜá~íêáÅ=éêçÑÉëëáçåI=ëÜáÑíáåÖ=îáÉïë=çå=ãÉåí~ä=áääåÉëëI=Å~êÉ= ~åÇ=íêÉ~íãÉåíI=íÜÉ=~ÑíÉêëÜçÅâ=çÑ=tçêäÇ=t~ê=ffI=ÅÜ~åÖáåÖ=ëí~íÉ=éçäáÅáÉëI=ÑáëÅ~ä=ÅêáëÉëI=~åÇ=~ãÄáíáçìë= ÑÉÇÉê~ä=áåíÉêîÉåíáçåëKT=fÑ=çåÉ=ïÉêÉ=íç=å~êêçï=íÜÉëÉ=Ñ~Åíçêë=ÇçïåI=Ä~ëÉÇ=çå=íÜÉ=äÉ~ÇáåÖ=ëçÅá~ä=ëÅáÉåíáÑáÅ= ÉîáÇÉåÅÉI=íÜêÉÉ=ïçìäÇ=ëí~åÇ=çìíW=ÑáêëíI=íÜÉ=ÇÉîÉäçéãÉåí=~åÇ=ìëÉ=çÑ=éëóÅÜá~íêáÅ=ãÉÇáÅáåÉë=~ë=íêÉ~íãÉåí= Ñçê=ÉîÉå=ëÉîÉêÉ=ãÉåí~ä=áääåÉëëX=ëÉÅçåÇI=íÜÉ=ÇÉîÉäçéãÉåí=çÑ=ÑÉÇÉê~ä=ëçÅá~ä=ïÉäÑ~êÉ=éêçÖê~ãë=EëìÅÜ=~ë= jÉÇáÅ~áÇ= ~åÇ= jÉÇáÅ~êÉF= íÜ~í= ÅêÉ~íÉÇ= Ñáå~åÅá~ä= áåÅÉåíáîÉë= íç= ÅÜ~ååÉä= Å~êÉ= Ñçê= íÜÉ= ãÉåí~ääó= áää= íç= ~äíÉêå~íáîÉ=ëÉííáåÖëX=~åÇI=íÜáêÇI=ÅÜ~åÖáåÖ=ëçÅáÉí~ä=éÉêÅÉéíáçåë=çÑ=ãÉåí~ä=áääåÉëëI=ÅçìéäÉÇ=ïáíÜ=éìÄäáÅ= ~ï~êÉåÉëë=çÑ=íÜÉ=éêçÄäÉãë=~åÇ=~ÄìëÉë=ÉåÇÉãáÅ=íç=íÜÉ=ëóëíÉã=çÑ=áåëíáíìíáçå~äáòÉÇ=Å~êÉI=íÜ~í=êÉëìäíÉÇ=áå= éçäáíáÅ~ä=~åÇ=äÉÖ~ä=ÅÜ~ääÉåÖÉë=êÉÖ~êÇáåÖ=íÜÉ=Å~êÉ=~åÇ=ëí~íìë=çÑ=íÜÉ=ãÉåí~ääó=áääK== _ìí=ÉîÉå=íÜçìÖÜ=íÜÉ=ÜáëíçêáÅ~ä=êÉÅçêÇ=áë=ÅçãéäÉñI=çåÉ=ëáãéäÉ=Ñ~Åí=êÉã~áåëW=qÜáë=Åçìåíêó=Ü~ë= ÇÉáåëíáíìíáçå~äáòÉÇ=ÄÉÑçêÉK=^ë=ïÉ=íÜáåâ=~Äçìí=ã~ëë=áåÅ~êÅÉê~íáçå=íçÇ~ó=~åÇ=Üçï=íç=êÉÇìÅÉ=çìê=éêáëçå= éçéìä~íáçåëI= áí= áë= ìëÉÑìä= íç= êÉÅ~ää= ëçãÉ= äÉëëçåë= Ñêçã= íÜ~í= ÜáëíçêóK= tÜ~íI= áÑ= ~åóíÜáåÖI= Å~å= ïÉ= äÉ~êå= Ñêçã=ÇÉáåëíáíìíáçå~äáò~íáçå=áå=íÜÉ=NVSMë\=jçêÉ=éêÉÅáëÉäóI=ãáÖÜí=~åó=çÑ=íÜÉ=ÑçêÅÉë=íÜ~í=ÜÉäéÉÇ=ëÉí=çÑÑ= ~åÇ= ëÜ~éÉ= ÇÉáåëíáíìíáçå~äáò~íáçå= áå= íÜÉ= NVRMë= ÅçåíêáÄìíÉ= íç= ~= êÉÇìÅíáçå= çÑ= çìê= éêáëçå= éçéìä~íáçå= íçÇ~ó\=^äíÉêå~íáîÉäóI=~êÉ=íÜÉêÉ=~ëéÉÅíë=íç=ÄÉ= ~îçáÇÉÇ= Ñêçã= çìê= É~êäáÉê= ÉñéÉêáÉåÅÉ= ïáíÜ= ÇÉáåëíáíìíáçå~äáò~íáçå= çê= ï~óë= íç= ÇÉÅ~êÅÉê~íÉ= áå= ~= ãçêÉ= ëìÅÅÉëëÑìä= ã~ååÉê= íçÇ~ó\= qÜÉëÉ= ~êÉ= íÜÉ= èìÉëíáçåë=íÜ~í=ãçíáî~íÉ=íÜáë=Éëë~óK= lÇÇäóI=êÉä~íáîÉäó=äáííäÉ=Ü~ë=ÄÉÉå=ïêáííÉå= çå= íÜÉ= é~ê~ääÉä= ÄÉíïÉÉå= ãÉåí~ä= Üçëéáí~ä= ÇÉáåëíáíìíáçå~äáò~íáçå=~åÇ=íÜÉ=ÅçåíÉãéçê~êó=éêçÄäÉã=çÑ=ã~ëë=áåÅ~êÅÉê~íáçåK=b~êäó=çåI=íÜÉêÉ=ïÉêÉ= 4 8.59 percent to be exact. Id. 5 Id. 6 Id. at 192. 7 Gerald Grob explores these and more factors in remarkable detail in his lengthy and masterful work, From Asylum to Community: Mental Health Policy in Modern America, Princeton University Press 1991. Other important contributions include, among others, William Gronfein, “Incentives and Intentions,” 1985 (exploring the role of Medicaid and Medicare, and larger government interventions); William Gronfein, Psychotropic Drugs and the Origins of Deinstitutionalization, 32 Social Problems 5, 439 (1985) (exploring the role of medication); Joseph Morrissey, “Deinstitutionalizing the Mentally Ill: Processes, Outcomes, and New Directions,” 147-76, in Walter Gove, ed., Deviance and Mental Illness, Beverly Hills: Sage Publications 1982 (exploring professional reorganization and rivalries); Paul Lerman, Deinstitutionalization and the Welfare State, New Brunswick: Rutgers University Press 1982 (exploring the shifts in the welfare states); Andrew Scull, Decarceration: Community Treatment and the Deviant--A Radical View, Englewood Cliffs, NJ: Prentice-Hall 1977 (exploring the fiscal crisis effects). 2 DRAFT: January 21, 2011 Harcourt: Lessons from Deinstitutionalization ëçãÉ= ïêáíáåÖë= áå= íÜÉ= ä~íÉ= NVTMë= çå= ÇÉÅ~êÅÉê~íáçå= íáÉÇ= íç= íÜÉ= éêáëçå= ~Äçäáíáçå= ãçîÉãÉåí= íÜ~í= ÉñéäçêÉÇ=íÜÉ=éêçÄäÉã=íÜêçìÖÜ=íÜÉ=äÉåë=çÑ=ãÉåí~ä=ÜÉ~äíÜ=ÇÉáåëíáíìíáçå~äáò~íáçåIU=Äìí=Ñçê=íÜÉ=ãçëí= é~êíI=íÜçëÉ=áåíÉêîÉåíáçåë=ïÉêÉ=åçí=ä~ëíáåÖK=^=åìãÄÉê=çÑ=ëÅÜçä~êë=~í=íÜÉ=íáãÉ=éêÉÇáÅíÉÇ=íÜ~í=éêáëçå= ÇÉÅ~êÅÉê~íáçå=ïçìäÇ=Ñçääçï=áå=íÜÉ=ÑççíëíÉéë=çÑ=íÜÉ=ÇÉáåëíáíìíáçå~äáò~íáçå=çÑ=ãÉåí~ä=Üçëéáí~äë=Ea~îáÇ= oçíÜã~å=ï~ë=éêçÄ~Ääó=íÜÉ=ÄÉëí=Éñ~ãéäÉ=çÑ=íÜáëFI=Äìí=íÜÉó=ïÉêÉ=éêçîÉå=ïêçåÖK=jçêÉ=êÉÅÉåíäóI=íÜÉêÉ= Ü~ë=ÄÉÉå=ÉãéáêáÅ~ä=~åÇ=íÜÉçêÉíáÅ~ä=ïçêâ=Çê~ïáåÖ=é~ê~ääÉäë= ÄÉíïÉÉå= íÜÉ= äÉîÉäë= çÑ= ãÉåí~ä= ÜÉ~äíÜ= áåëíáíìíáçå~äáò~íáçå= áå= íÜÉ= ãáÇJíïÉåíáÉíÜ= ÅÉåíìêó= ~åÇ= éêáëçå= áåÅ~êÅÉê~íáçå= íçÇ~óIV=íÜçìÖÜ=íÜ~í= êÉëÉ~êÅÜ=Ü~ë=åçí=Çê~ïå=é~ê~ääÉäë=êÉÖ~êÇáåÖ=ÇÉJáåëíáíìíáçå~äáò~íáçåK=pçãÉ=êÉëÉ~êÅÜÉêëI=ëìÅÜ=~ë=j~êáÉ= dçííëÅÜ~äâI= Ü~îÉ= ÄÉÖìå= íç= ãÉåíáçå= ÇÉáåëíáíìíáçå~äáò~íáçå= áå= íÜÉ= ÅçåíÉñí= çÑ= íÜÉ= ÅìêêÉåí= ÉÅçåçãáÅ= Åêáëáë=~åÇ=áíë=áãé~Åí=çå=ã~ëë=áåÅ~êÅÉê~íáçåINM=~åÇ=ëÉîÉê~ä=óçìåÖÉê=ëÅÜçä~êëI=ÉëéÉÅá~ääó=^ååÉ=m~êëçåëI=~=
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