Mental Illness in Prisons
by Karen Welch
In
the last few months, several studies have been published which confirm what
many in the advocacy community have known for years; jails and prisons are full
of people with mental illness who are receiving no treatment. Additionally, these individuals are often
isolated and kept in inhumane conditions which lead to greater illness. While it is helpful to have this information
compiled in reports, we, as a civilized society must do more. We need to look for solutions to the problem
of the criminalization of those with mental illness and implement these
changes. We cannot sit by idly while so
many people with mental illness suffer and face the horror of no recovery.
One
of these recent studies was conducted by Human Rights Watch, an international
organization dedicated to studying human rights abuses. This study found that as many as one in five
of the 2.1 million Americans in jail and prison have mental illnesses.[1]
According to the report, not only is the number of prisoners with mental
illnesses growing, but more persons are being incarcerated whose illnesses fall
at the most severe end of the mental illness spectrum.[2]
The report quotes several correctional authorities as stating that many
prisoners with mental illnesses are so ill that they have no idea why they are
in prison.[3]
Human
Rights Watch found that prison compounds the problems of inmates with
mental illness. For example, those prisoners with mental
illness may have trouble following the everyday discipline of prison life, like
standing in line for a meal or following basic orders.[4] These infractions then lead to
discipline. The discipline that is
given almost always involves isolation and segregation which exacerbate the
already compromised psychological states of these individuals, thereby creating
greater illness for these individuals.
Where statistics are available, they show that inmates with mental
illness have a higher than average rate of discipline.[5]
The
report concludes that jails and prisons have become the nation’s default mental
health system. This combined with the
fact that medical care for inmates with mental illnesses is almost nonexistent
means that few, if any, of these thousands of individuals are getting better in
prison.
A
second study done by the Correctional Association of New York found that one in
every four New York State prisoners who are kept in punitive segregation --
confined to a small cell at least 23 hours a day- have mental illnesses. [6]
The report states that despite evidence that the most acutely ill prisoners in
punitive segregation grow only more troubled or violent, the state does little
to help them. Instead, when inmates in
lockdown try to hurt or kill themselves, the department policy is to punish
them with additional time in lockdown. The report recommends that prison rules
be changed so that inmates with mental illnesses who have behavioral problems
be treated instead of sent to insolation.[7]
The
attention generated by these two studies along with pending litigation filed on
behalf of inmates with mental illnesses who are kept in the Special Housing
Unit (SHU) led to the introduction of legislation in the New York State
Assembly which would improve care of the people with mental illnesses in prison
and avoid their placement in the SHU’s. [8] However, most experts agree that the prison
system is ill-equipped to deal with the treatment of those with serious mental
illness. The Human Rights Watch study
found that across the country, medical care is almost nonexistent for inmates
with mental illness. For example, in
Wyoming, the state penitentiary has a psychiatrist on duty only two days per
month. In Iowa, there are three
psychiatrists for more than 8,000 inmates.[9] New York fares no better. In order to effectively provide for the
treatment of those with mental illness in our prisons, an entire infrastructure
would have to be created. This would be
very expensive. Given the current
budget woes in New York, it is unlikely that government will expend money for
those in prison.
The
problems detailed in the two reports are not limited to the adult criminal
justice system. Frighteningly, the
numbers are much worse for juvenile offenders.
It is estimated that 50-75 percent of incarcerated youth have a
diagnosable mental health problem. Some
put the number of youth in the juvenile
justice system who meet the DSM-IV criteria at 80 percent.[10] Experts note that the actual numbers are
less important than their implication -- the juvenile justice system needs to
be prepared and equipped to handle the immense need for mental health
treatment.[11] However, this is not the only way to address
the problems of youth in the criminal justice system. It is important to note that widespread availability of community
based mental health services for children and teens may prevent the
introduction of youths into the juvenile justice system.
How
is it that so many individuals with mental illness have wound up in prisons and
jails? In its study, Human Rights Watch
concluded that these problems were caused by the deinstitutionalization
movement. It notes:
While mental health hospitals across the country
were shut down over the last couple of decades as part of the process of
“deinstitutionalization,” the community-based health services that were
supposed to replace them were never adequately developed. As a consequence, many of the mentally ill,
particularly those who are poor and homeless are unable to obtain the treatment
need. Ignored, neglected, often unable
to take care of their basic needs, large numbers commit crimes and find
themselves swept into the burgeoning criminal justice system.[12]
Lack
of mental health services in the community plays a large part in the
criminalization of people with mental illnesses. The existing mental health system today does not reach and
provide mental health treatment to anywhere near the number of people who need
it. As the President’s New Freedom
Commission on Mental Health found
Mental
health delivery system is fragmented and in disarray . . . lead[ing] to
unnecessary and costly disability, homelessness, school failure and
incarceration . . . In many communities, access to quality care is poor,
resulting in wasted resources and lost opportunity for recovery. More individuals could recover from even the
most serious mental illnesses if they had access in their communities to
treatment and supports that are tailored to their needs.[13]
With
these factors in mind, the most important action that can be taken to decrease
the number of persons with mental illness who become involved in the criminal
justice system is to expand the amount
and scope of community mental health services that are available to people in
this country. If people have widespread
access to affordable and quality mental health care, they can become mentally
well and perhaps commit fewer crimes.
Affordable and quality mental health care could be achieved in a number
of ways including the passage of parity legislation, the increase of federal
benefits coverage in this area and increased government funding of
services.
Secondly,
we should insist that alternatives to incarceration for those with mental
illness be created and implemented in our communities. While this is being done on a small scale
throughout the country, it needs to be expanded. The City of Buffalo recently implemented a mental health court
which seeks to divert those with mental illnesses from the criminal justice
system. However, it applies only to
those charged with certain misdemeanor offenses. Courts such as these should be expanded to cover more
crimes.
We
must also address all the individuals with mental illnesses who languish in prisons and jails with no opportunities
for recovery. The Humans Rights Watch
report has several pages devoted to recommendations for change so that we can
assist those in prison with mental illness.
The most critical piece in helping these people seems to be the
improvement and expansion of mental
health services that are available in prison.
Human Rights Watch research shows that what is lacking in prison mental
health services is not knowledge about what is needed but the resources and
commitment to do it. Therefore, we must urge our public officials, both state
and federal to carry out policies that will create more mental health services
in prisons and jails. Human Rights
Watch notes that setting high standards for mental health services in
prisons not only helps prisoners but
also improves the safety within prisons.
We
can not forget any of those with mental illness. If there is life, there is
always the possibility of redemption and recovery.
1".Study Finds
Hundreds of Thousands of Inmates Mentally Ill,” The New York Times, October 22,
2003, Internet edition.
2. Id.
3. Human Rights
Watch, Ill Equipped: U.S. Prisons and Offenders with Mental Illness, [Is this
the name of the article which I think should be in quotations and what is the
source? I changed some of the footnotes to have the quotations around the name
of the articles . Then make same as 9
and 11DN check format for footnotes??] October 11, 2003.
4. “Study Finds
Hundreds of Thousands of Inmates Mentally Ill,” The New York Times, October 22,
2003, internet edition.
5. Id.
6. “Report on State
Prisons Cites Inmates’ Mental Illness,”
The New York Times, October 22, 2003, internet edition.
7. Id.
8. “Prison Isolation Faulted,” The Poughkeepsie
Journal, November 19, 2003.
9. Human Rights Watch, Ill Equipped: U.S.
Prisons and Offenders with Mental Illness, October 11, 2003.
10. Biggins, Stacey
and Oss, Monica E., “Reaching Mentally Ill Young Offenders, “Behavioral
Health Management, September/October 2003.
11. Id.
12. Human Rights Watch, Ill Equipped: U.S.
Prisons and Offenders with Mental Illness, October 11, 2003.
13. Id.