A component of the 1965 Medicaid Act, the Institutions for Mental Diseases (“IMD”) Exclusion was supposed to be a remedy for the brutal, dysfunctional mental healthcare system run through state hospitals. In the years since Medicaid was created, the IMD Exclusion has instead barred thousands of those in need of intensive, inpatient treatment from receiving it. As a result, many severely mentally ill individuals are left without adequate care and without a home. They struggle in the street where they are otherized by those in their community and are susceptible to confrontational episodes with law enforcement. Many are ultimately incarcerated, where they are thrust into an abusive environment known to exacerbate mental health issues.This Note's central contention is that the IMD Exclusion creates an access gap for the poorest Americans who suffer from mental illness. Subsequently, prisons and jails fill that gap to the detriment of those individuals. The Note will proceed first by explaining the IMD Exclusion and how it applies to state-run medical care services and facilities. This Note will discuss the nationwide movement, in the 1950s through the 1960s and ‘70s, to deinstitutionalize notoriously abusive state psychiatric hospitals, a movement that culminated in the passage of the Medicaid Act in 1965, along with the IMD Exclusion. This Note will then shift focus to criticize the practical effects of the IMD Exclusion and its extensive role in the mass incarceration issue today. In doing so, this Note will identify the major weaknesses of the IMD Exclusion and explain how these weaknesses create an access gap for mentally ill persons, while simultaneously making them more vulnerable to contact with the police and the criminal justice system.

中文翻译：

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患者到囚犯的管道：IMD 排除对美国大规模监禁的不利影响

作为 1965 年医疗补助法案的一部分，精神疾病机构 (“IMD”) 排除被认为是对通过州立医院运行的残酷、功能失调的精神保健系统的补救措施。自 Medicaid 成立以来的几年里，IMD 排除反而禁止了成千上万需要强化住院治疗的人接受它。结果，许多严重的精神病患者没​​有得到足够的照顾，也没有家。他们在街上挣扎，被社区中的人排斥，并且容易与执法部门发生对抗事件。许多人最终被监禁，他们被推入一个已知会加剧心理健康问题的虐待环境。本说明 的中心论点是，IMD 排斥为患有精神疾病的最贫穷的美国人造成了访问差距。随后，监狱和监狱填补了这一空白，损害了这些人的利益。该说明将首先解释 IMD 排除及其如何适用于国营医疗服务和设施。本说明将讨论 1950 年代至 1960 年代和 70 年代的全国性运动，旨在将臭名昭著的虐待性精神病医院非机构化，该运动最终导致 1965 年通过《医疗补助法案》以及 IMD 排除。然后，本说明将把重点转移到批评 IMD 排除的实际影响及其在当今大规模监禁问题中的广泛作用。在这样做，