Incarceration rates for the mentally ill have been on the rise for the past 40 years, a result, experts say, of the movement to empty psychiatric institutions and place people in less restrictive settings. But for millions, discharge never lead to sustained community-based care. And several decades into this well-intended experiment, a new study has found, some of the unintended consequences appear to be getting worse.

The Treatment Advocacy Center, an Arlington, Va.-based group that promotes greater access to mental health treatment for individuals with severe psychiatric illnesses, Tuesday released the results of a national survey of the mentally ill populations in state and county lock ups across the country, as well as the treatment policies that drive those numbers.

The center found that there are now ten times the number of individuals with serious mental illness in state prisons and county jails than in the nation’s remaining state mental hospitals. That gap is significantly larger than it was just four years ago. when the group did a similar study and found the number of mentally ill individuals in prisons and jails outnumbered that found in state mental hospitals, three to one.

Today, in 44 states, the largest institution housing people with severe psychiatric disease is now a prison or jail.

The group’s review of state and county correctional system policies for mental health treatment found some possible reasons why. In most states, treatment for mental illness is extremely difficult to obtain and inmates leave jail sicker than when they entered, due in part to an over reliance on solitary confinement. 

The report had harsh words for some local correctional systems. It criticized the District over suicides at the D.C. Jail, and said that despite the city’s efforts to improve services, “the main beneficiaries appear to have been the private contractors who operate group homes and outpatient services,” the quality of which the study deemed, “mediocre, as can be measured by the abundance of untreated seriously mentally ill individuals among the homeless population and the high percentage of mentally ill inmates.”

In Maryland, the largest public institution for individuals with psychiatric illnesses is the 900-bed Patuxent Institution in Jessup. The largest state mental hospital, Spring Grove Hospital Center with 380 beds, holds fewer mentally ill inmates than the Baltimore County Jail, which has 2,200 inmates. The Treatment Advocacy Center criticized Maryland for requiring mentally ill inmates to go through a civil commitment process before getting involuntary treatment.

In Virginia, Eastern State Hospital in Williamsburg, with 300 beds, is the largest remaining state psychiatric hospital. The Greensville Correctional Center in Jarratt, the largest state prison, holds 3,006 inmates, about 15 percent of whom, or 451 are estimated to be mentally ill. The report said the dearth of treatment options behind bars “is consistent with a longstanding failure in Virginia to prioritize treatment for the sickest mentally ill patients.”

The federal prison system was not part of Tuesday’s study, but the Bureau of Prisons is facing lawsuits over its use of solitary confinement for the mentally ill at the U.S. Penitentiary Administrative Maximum Facility (ADX) in Florence, Colo., a.k.a. the Alcatraz of the Rockies. Many of the plaintiffs in one of the lawsuits, Cunningham v. Federal Bureau of Prisons, are District inmates.

The report was released a couple weeks after a congressional hearing, where law enforcement officials from other parts of the country talked about their experiences working the front lines of the nation’s mental health system. Cook County Sheriff Tom Dart, as recounted in the blog of mental health advocate and former Post reporter Pete Earley, blamed “dramatic and sustained cuts in mental health funding” for criminalizing mental illness and turning prisons and county jails into mental health hospitals.