The imprisonment binge of recent decades has resulted in over two million people currently in jails and prisons, nearly fifty percent of whom are African American. In the same decades that the prison population was multiplying exponentially, the proportion of prisoners suffering from serious mental illness was also expanding. There are now ten times as many prisoners with serious mental illness behind bars as there are in state and federal psychiatric hospitals. I have had the privilege of appearing as a psychiatric expert witness in class action lawsuits challenging the kind of harsh conditions of confinement and inadequate correctional mental health services that violate the Eighth Amendment’s prohibition of cruel and unusual punishment. The conditions challenged in class action lawsuits in the 70’s and 80’s included crowding and the increased violence, psychiatric breakdown, and suicides that it caused.

In the late 80’s, a historic wrong turn occurred. The violent...

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