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From Hospitals to Prisons: A New Explanation

Deinstitutionalization from state mental hospitals was largely over by 1980, but the percentage of prisoners with mental illness did not begin to skyrocket until 1990. The leading theories for the criminalization of mental illness cannot fully explain this gap.

This Essay offers a new theory: the Supreme Court in 1990 reduced the costs of incarcerating the severely mentally ill by approving the cheap and easy forced medication of prisoners. We show that this theory is supported by time-series and cross-sectional data.

Our theory has implications beyond simply raising the bar for forcible medication standards in the prison context. Prison reform litigation increases the costs of incarceration and puts pressure on states to decriminalize mental illness. A second deinstitutionalization may be coming.

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