Should the mentally ill be placed in the mainstream population of a prison?
Chances are you've never given much - if any - thought to this question. A paranoid schizophrenic kills someone because the voices in his head tell him that person is an alien trying to steal his brain. Is that schizophrenic safe in a prison? Are the other prisoners safe with him (or her) there?
A person suffering with severe bipolar disorder shoplifts an armload of clothing during an attack of acute mania. He or she is sent to prison, to co-exist with gangbangers, rapists, and murderers. Or, perhaps worse, to live in a solitary cell with no human interaction, for 23 out of 24 hours each day. The acute mania shifts to severe depression. What are the chances he or she will survive the prison term?
According to the U.S. Justice Department's Bureau of Justice Statistics, in 1998 approximately 300,000 inmates had some form of mental illness. A decade later, that number rose to 1.25 million.
The National Alliance for the Mentally Ill (NAMI) states that 16 percent of the prison population can be classified as severely mentally ill. This means that they fit the psychiatric classification for illnesses such as schizophrenia, bipolar disorder, and major depression. However, the percentage skyrockets to as high as 50 percent when altered to include other mental illnesses, such as anti-social personality disorder, and borderline personality disorder.
Two major causes attribute to the rise of mentally ill inmates:
In the 1950s, the U.S. had 600,000 state run hospital beds for those suffering from any form of mental illness. Because of deinstitutionalization and the subsequent cutting of state and federal funding, the U.S. now has just 40,000 beds for the mentally ill. The inability to get proper treatment left this segment of our population vulnerable and, consequently, many of them now land in prisons.
Deinstitutionalization hasn't worked. All this has managed to do is to shift the mentally ill from hospitals to prisons - one institution to another. We have made it a crime to be mentally ill.
The largest psychiatric facility in the U.S. isn't a hospital; it's a prison. At any given time, Rikers Island in New York City houses an estimated 3,000 mentally ill prisoners. The average inmate population at Rikers Island is 14,000. One out of every 4 to 5 inmates at this prison suffer from mental illness.
Florida judge Steven Leifman, who chairs the Mental Health Committee for the Eleventh Judicial Circuit, states that, "The sad irony is we did not deinstitutionalize, we have reinstitutionalized-from horrible state mental hospitals to horrible state jails. We don't even provide treatment for the mentally ill in jail. We're just warehousing them."
What happens to the mentally ill in an overcrowded, violent prison system with little to no psychological counseling available?
In state prisons, the mentally ill serve an average of 15 months longer than the average inmate. The very nature of most mental illnesses makes it difficult to follow prison rules. These inmates are more likely to be involved in prison fights and they tend to accumulate more conduct violations.
Prison staff often punishes mentally ill inmates for being disruptive, refusing to comply with orders, and even for attempting suicide. In other words, these inmates are punished for exhibiting the symptoms of their illness.
Gaining parole is also more difficult for the mentally ill. Their disciplinary records are often spotty, they may have no family willing or able to help, and community services are usually inadequate.
In October 2003, Human Rights Watch released a report entitled Ill Equipped: U.S. Prisons and Offenders with Mental Illness. Following two years of in-depth research, this organization found that few prisons have adequate mental health care services. Furthermore, it found that the prison environment is dangerous and debilitating for the mentally ill.
An excerpt from Ill Equipped:
"Security staff typically view mentally ill prisoners as difficult and disruptive, and place them in barren high-security solitary confinement units. The lack of human interaction and the limited mental stimulus of twenty-four-hour-a-day life in small, sometimes windowless segregation cells, coupled with the absence of adequate mental health services, dramatically aggravates the suffering of the mentally ill. Some deteriorate so severely that they must be removed to hospitals for acute psychiatric care. But after being stabilized, they are then returned to the same segregation conditions where the cycle of decompensation begins again. The penal network is thus not only serving as a warehouse for the mentally ill, but, by relying on extremely restrictive housing for mentally ill prisoners, it is acting as an incubator for worse illness and psychiatric breakdowns."
According to Fred Osher, M.D., director of the Center for Behavioral Health, Justice and Public Policy at the University of Maryland, the majority of mentally ill inmates are arrested for misdemeanors and crimes of survival. He states, "That's a whole host of folks who land in the criminal justice system because of their behavioral disorders."
Those on the fringe of society are primarily affected. These people are almost always impoverished and disabled by their illness. They have nowhere to turn, no one to help them, and so we toss them in prison. Even minor offenses keep them locked in prisons, since many cannot afford and/or do not know how to bond themselves out.
The recidivism rate among the mentally ill is higher than that among the general prison population. Prison has become a revolving door system for dealing with mental illness. By default, prisons have become the new mental hospitals. However, they lack the funding and the training to deal with these patient-inmates.
Ratan Bhavnani, executive director of the Ventura County chapter of the National Alliance on Mental Illness, states that, "In general, people with mental illness can recover when given the appropriate treatment rather than to be sent off to jail only to become more psychotic and come back and reoffend."
Michael Jung of Ventura, California suffers from bipolar and hears voices telling him that he is the devil. Over the past 10 years, Jung has been arrested a minimum of 15 times - all for relatively minor offenses. Earlier this year, Jung spent six weeks confined in G Quad, the unit where mentally ill inmates stay in their cells 23 out of the 24 hours in each day.
Cells such as those in G Quad are referred to as the "rubber rooms" because the walls are padded. There is no furniture in these rooms. The "toilet" is a grate in the floor. They are stripped naked and monitored via video camera. Inmates who are paranoid, delusional, or otherwise difficult to manage are often placed in this type of cell, whether for their own protection, the safety of the other inmates, or just plain convenience.
Susan Abril, a former inmate who suffers from bipolar disorder, was placed in this type of cell. During her confinement, Abril began hearing voices for the first time. "I didn't sleep," she said. "I mentally went insane being locked down 23 hours of 24."
We are essentially making the mentally ill inmates sicker, as well as ensuring their return to an already massively overcrowded prison system. Obviously our current system is not working. We cannot expect prison staff to function as psychiatrists. We also cannot expect the mentally ill to be "rehabilitated" in a mainstream prison system.
The Taxpayer Action Board for Governor Pat Quinn of Illinois cited annual savings in the tens of millions of dollars that could be gained by releasing thousands of non-violent offenders, closely monitoring them and providing substance abuse treatment, mental health counseling, education, job training, and employment opportunities.
For the most part, the mentally ill do not belong in prison. It would be cheaper (and smarter) for us as taxpayers to divert funding in order to provide adequate treatment programs to keep them out of prison.Mental Illness in the Prison System