Institutionalization vs.

Jensen 1
Community Immersion:

Institutionalization vs. Community Immersion

Daniel Jensen

Salt Lake Community College

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Community Immersion:

Abstract

This paper covers an important debate in the criminal justice system. The debate over how a

mentally ill patient should be handled has been ongoing for quite some time. Based off of my

research which you will find cited below, I have formulated an opinion that depending on the

severity of the mental illness, a patient should be institutionalized for at least a month or two as a

trial period to balance medication and prepare themselves for the outside world via group and

personal therapy.
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Community Immersion:

Mental Illness & Criminal Justice

Mental illness in relation to the criminal justice system has been somewhat of a grey area

since the first legal systems were put in place. The age-old question of what the best way to deal

with a mental patient is has been in circulation for decades, and the answer is anything but

simple. In the 1800s, people with severe mental illness were viewed as possessed or demonic and

needed to be saved by religion or confined from society. As psychology as a science progressed

in its research, state funded psychiatric hospitals were opened, but often these hospitals were

neglected and the patients abused. This resulted in deinstitutionalization of mental facilities

where only patients who posed a legitimate threat to society were kept confined in these

psychiatric hospitals. However, due to the vast amount of people who suffer from mental illness

and the fact that there are newly diagnosed patients every day, the United States needs to figure

out what the best way to help a mentally ill patient is, and the answer is not simple. In a nutshell,

the best place for a mental patient is without a doubt a community immersion program, but only

after a certain amount of time and trial. For the first few weeks and/or months after being

diagnosed, a mental patient should absolutely not be left to fend for themselves. In the first

months after diagnosis, it is beneficial for a mental patient to be in an institution so they can be

under close supervision, have access to group therapy with people who suffer from similar

illness, and have access to a therapist daily without having to worry about the cost, time, and

financial factors of being released to the public.

One of the main reasons it is important for a mental patient to be institutionalized for the

first few months after their diagnosis is the dangers of medication balancing. Most medications

used to help mental patients, especially with severe illnesses such as bipolar disorder or
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schizophrenia, are hard drugs that can cause major behavioral changes and can also be addictive

if abused. Being institutionalized is nothing short of necessary for this part of the process of

community immersion. The process of balancing medication is simply a matter of trial and error,

but when error means a psychotic episode in which the patient could hurt themselves or another

person, this process can be volatile. Being under close supervision such as one would be in an

institution is important to the health of the patient and all others around them throughout this

process. One of the most common medications for mental patients are selective serotonin

reuptake inhibitors or SSRIs. These are, as a general statement, the most effective drugs for

treating depression and bipolar disorders. However, when these drugs are not properly balanced

or abused, it can result in violent outbursts or depression. This is especially evident in bipolar

patients, for example. Often doctors will prescribe a cocktail of drugs to stabilize the moods of

mental patients such as those with bipolar disorder. Some doctors prescribe an anti-psychotic for

the manic episodes, or an anti-depressant to handle the depression side of the illness. During the

process of trying to find a balance in these medications, manic or depressive episodes can be

more pronounced and more common. When the patient is institutionalized during the process of

medication balancing, they are a much slighter threat to themselves and society. The patient can

be restrained during episodes, preventing them from injuring themselves or others. The

availability of psychiatrists and mental help combined with safety of confinement when

experiencing an episode during medication balancing can be the difference between

imprisonment and the right treatment.

Another major reason for institutionalizing mental patients, especially during the first few

months after being diagnosed, is the environment they are placed in and the influences within

that environment. When a patient is first diagnosed, their view of the world often changes, their
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medication is still being balanced, and they’re still dealing with the problems that led to the

diagnosis. All of these things combined make for a volatile and dangerous combination in a

person, no matter the illness. Outside influences have a major effect on the patient, especially

when suffering from a severe mental illness such as bipolar disorder or schizophrenia, which can

send the patient into a psychotic episode. When a patient is institutionalized for the process of

getting used to life with a mental illness and medication balancing, there are less outside

influences and dangers to contribute to their illness. Patients are surrounded by people who are

also suffering from a mental illness or disorder, and therefore feel less isolated and alone in the

world. There is also less of a reaction or backlash from having an episode in an institution

because the staff and patients are used to it, so when or if it does happen, the patient doesn’t feel

like an outlier or like they’re crazy. The benefits of a patient being surrounded by people with

similar problems are countless. Not only do they feel more normal and less left out of society,

but there are plenty of people for them to talk to about their issues without them looking at them

like some kind of monster. The environment of an institution is much better for the mental health

and recovery of a patient.

The third and likely most prevalent benefit of institutionalizing a mental patient after

diagnosis is the availability of therapists, psychiatrists, medication, and other services that a

mental institution provides. When already immersed in the community, these services can be

hard to come by. Mental health specialists can be difficult to set up an appointment with, if the

patient feels they need to see someone it is often immediately necessary and can cause even more

distress to the patient by not being available at the time of need. In a psychiatric hospital or

mental institution care is available 24-hours a day. If a patient encounters an issue or has an

episode, a medical professional can be by their side within minutes to administer the necessary
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care. This is vital to the mental health of the patient and important to learning the correct balance

of medication for their particular illness. Being able to administer medication on-site as soon as

an episode breaks out can reduce the severity of the episode in a major way. In addition to the

availability of medicine, the availability of psychologists and mental health professionals in an

institution is a massive benefit to the patient. Being able to talk to someone about your episode or

be talked down from one is vital to a mentally ill patients health, both mental and physical. If an

episode is allowed to persist because the patient can not find someone with the skills or

certifications to talk them down and/or medicate them it can be extremely dangerous to the

patient as well as the people surrounding them. With professional care and medication minutes

away while in an institution, the likelihood of a violent or harmful episode drops by a

considerable amount.

In conclusion, there is no black and white answer to the correct way to handle a mental

patient. Mental illness does not come in a package with specific things that do or don’t happen

over time. Illnesses such as depression, dementia, schizophrenia, and bipolar disorder all have a

range of severity that heavily influences the kind of care needed for a particular patient. In very

mild cases, usually symptoms and effects of a mental illness can be treated by a weekly visit to a

therapist and some mild medication. However, often mental illness becomes very severe and

presents itself in a way you can’t ignore and these are the cases that require institutionalization in

my opinion, at least for a short period of time. When a mental illness is severe enough the patient

can become a major threat to the health of themselves and others, especially within the first

months of diagnosis. Overall, mild cases of mental illness can be relieved by institutionalization,

but it is not entirely necessary. Severe cases of mental illness require institutionalization in my
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opinion, at least for the first few months until the patient’s medication is balanced and they are

not in such a fragile state as to need 24-hour surveillance and support from others.
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Works Cited

U. (2009, December 01). Addressing Mental Illness in the Criminal Justice System. Retrieved April

28, 2018, from https://www.justice.gov/archives/opa/blog/addressing-mental-illness-criminal-

justice-system

Amadeo, K. (2018, March 14). Learn About Deinstitutionalization, the Causes and the Effects.
Retrieved April 28, 2018, from https://www.thebalance.com/deinstitutionalization-3306067

Chow, W. S., & Priebe, S. (2013, June 18). Understanding psychiatric institutionalization: A

conceptual review. Retrieved April 28, 2018, from

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-169

Frances, A. J., M.d. (2013, March 10). Prison Or Treatment For the Mentally ill. Retrieved April 28,

2018, from https://www.psychologytoday.com/us/blog/saving-normal/201303/prison-or-

treatment-the-mentally-ill

Goldberg, J., M.d. (2018, April 06). Medications for Bipolar Disorder. Retrieved April 28, 2018,
from https://www.webmd.com/bipolar-disorder/guide/medications-bipolar-disorder#1

Sight, U. F. (2012, June 27). Unite For Sight. Retrieved April 28, 2018, from
http://www.uniteforsight.org/mental-health/module2