Rampant mental illness in jails and prisons combines two forms of suffering for offenders: the illness itself and having to endure it behind bars. The sheer magnitude of the problem is shocking. Jails and prisons hold three times as many mentally ill people as mental health hospitals. This is partly a consequence of the ill-advised deinstitutionalization campaign begun in the 1960’s, an effort that sent many mentally ill men and women into the community with little provision for their care.
These are among the conclusions of a recent report by Human Rights Watch, Ill-Equipped: U.S. Prisons and Offenders With Mental Illness. Because treatment is inadequate or often lacking altogether, and because of crowded conditions and punitive methods for dealing with infractions, mentally ill prisoners may emerge from prison even less able than before to cope with life outside. Often, re-offending and further imprisonment are virtually built into their release dates—dates that, because of accumulated violations of prison rules, can extend well beyond the term set in the original sentence.
Mental disorders afflict between 200,000 and 300,00 men and women in U.S. prisons. The report maintains that most receive little or no meaningful treatment, are neglected and in many instances are dealt with primarily as disciplinary problems. When they do not comply with prison rules, or when they act out—driven by their mental illness—the result is frequently harsh punishment that can even take the form of beatings by correctional officers. A class-action suit brought in 2001 on behalf of mentally ill prisoners at the Phillips State Prison in Georgia, for example, alleged a level of brutality by guards that was virtually systemic, a level that—according to an attorney involved in the case—was “above and beyond beating people up.” Mistreatment can also take the form of abuse by other prisoners. Infractions in many facilities, moreover, may lead to 23-hour-a-day lockdown in special areas, called segregated or security housing units. This form of total isolation, psychiatrists warn, can lead to further mental deterioration.
The situation for women is even worse than it is for men. As the report puts it, “while serious mental illness is epidemic among both male and female prisoner populations, the statistics for women are particularly stark.” In Pennsylvania, for instance, 37.7 percent of incarcerated women are on its mental health caseload. One difference between male and female prisoners that contributes to this starkness lies in the high level of concern women feel for their children, for whom many had been the primary caregivers. Being separated from them exacts a tremendous toll in stress and depression, especially if the children live far from the facility in which the mothers are held.
Litigation has helped to create less punitive and more therapeutic conditions. The landmark case of Madrid v. Gomez in California (1995) led to the creation of a new psychiatric unit at the Pelican Bay facility, along with more rigorous rules governing the use of S.H.U.’s for mentally ill inmates. In its ruling, the court declared that putting mentally ill prisoners in isolation “is the equivalent of putting an asthmatic in a place with little air to breathe.” The creation of the new unit made it possible for those held there to receive group therapy and have regular access to psychiatrists. Court monitors have reported favorably on the unit’s work, but severe staffing shortages have been a hindrance—an implicit recognition of the fact that creating an adequate therapeutic environment is costly. And now, as states struggle with fiscal crises on every side, the challenges are greater. Not only are facilities in some of the poorer states understaffed; the correctional officers themselves are undertrained for dealing with the mentally ill.
Pending legislation in Congress could help improve the situation. Introduced by Representative Ted Strickland (Democrat of Ohio) and Senator Mike DeWine (Republican of Ohio), the Mentally Ill Offender Treatment and Crime Reduction Act could lead to reforms in the treatment of incarcerated prisoners who suffer from mental illness by providing grants for treatment programs behind bars and discharge programs for those completing their sentences. The act would also authorize grants to help establish diversion programs to keep mentally ill offenders from being incarcerated in the first place. One such program already exists in Brooklyn, N.Y. A mental health court there has the power to divert nonviolent offenders into treatment programs. Begun as a pilot program, it has now been integrated into Brooklyn’s overall court system.
Diversion into treatment whenever possible is the humane way to approach the problem. When this is not possible because of the gravity of the crime, therapy and appropriate medications are called for. Congress should enact into law the Mentally Ill Offender Treatment and Crime Reduction Act without delay.