Prisons: Are They the New
State Hospitals?
By Chuck Campbell
Should people be incarcerated
for having disabilities? That is the fate of many people with mental
illness according to the American Bar Association’s Human
Rights Magazine article, Behind Bars in America:
“Mentally ill people are over- represented among inmates … leading
some experts to view the nation’s prisons and jails as its
default mental health care system. According to government figures,
there are almost five times more mentally ill people behind bars
in the United States than in state mental hospitals. Nearly 16% of
inmates are mentally ill, a much higher rate of mental illness than
is found outside the incarceration context.”
A National Institute
of Corrections article, Mentally Ill Persons in Corrections Settings,
says in part, “In 1959, nearly 559,000
mentally ill patients were housed in state mental hospitals. A shift
to ‘de-institutionalize’ mentally ill persons had, by
the late 1990s, dropped the number of persons housed in public psychiatric
hospitals to approximately 70,000.”
“De-institutionalization” saw a corresponding increase
in incarceration of the mentally ill. According to an American Journal
of Psychiatry (AJP) article titled, Mania and the Law in California:
Understanding the Criminalization of the Mentally Ill, “The
mentally ill began to appear in jails and prisons in increasing numbers
in the early 1970s shortly after the massive shutdown of state hospitals
across the nation.”
The U.S. Department
of Justice, Bureau of Justice Statistics estimated that 283,800
people with mental illness were inmates of this country’s
jails and prisons in 1999. The Campaign for Mental Health Reform
puts the number much higher, estimating that 700,000 people with
serious mental illness enter America’s prisons and jails each
year.
Joanne Mariner, deputy
director of the Americas division of Human Rights Watch, addresses
penal institutions’ failure to effectively
treat mental illness in her article, Prisons as Mental Institutions:
The Mass Incarceration of the Mentally Ill. Mariner quotes a California
prison psychiatrist, “We are literally drowning in patients … while
hundreds of men continue to deteriorate psychiatrically before our
eyes.” According to Mariner: “Prisoners with mental illness
frequently endure violence, exploitation and extortion at the hands
of other inmates, and neglect and mistreatment by prison staff. Not
only is the experience of imprisonment counter-therapeutic for such
prisoners, many mental health professionals believe it dramatically
increases their chances of psychiatric breakdown.”
Mentally Ill Offenders
in the Criminal Justice System: An Analysis and Prescription, published
by The Sentencing Project, echoes Mariner’s
analysis:
“Once the mentally
ill are within the criminal justice system, their condition may
deteriorate as a result of inadequate treatment and because the
circumstances of life behind bars are likely to exacerbate their
condition. For example, the overcrowding that is endemic in prisons
today leads to greater levels of violence, a lack of privacy, excessive
noise, and other stressful conditions that are hard on everyone
but particularly so on those subject to emotional and psychiatric
problems.”
“Deteriorated condition,” or even “psychiatric
breakdown,” notwithstanding, people with mental illness must
attempt to re-integrate with society upon release. According to the
Sentencing Project:
“The ‘revolving door’ between jail and the street
is propelled largely by untreated mental illness and co-occurring
substance abuse disorders among individuals who have committed relatively
minor crimes. This population includes homeless and mentally ill
people whose untreated mental illnesses lead to ‘nuisance crimes’ and
jail.”
“Lack of coordination
between systems results in people who have been incarcerated leaving
prison or jail without any connection to support services such
as community agencies or federal entitlement programs to provide
health coverage or money to live on.”
Recent New York City litigation exemplifies this lack of support.
The Sentencing Project reports:
“The lawsuit contends that of the 30,000 inmates who have
received treatment for mental illness who are discharged from the
city’s jail system only 7% have received any discharge planning.
The remaining 93% are either released from court or dropped off at
a subway station between 2 a.m. and 6 a.m. with two subway tokens
and $1.50 in cash. Individuals who were on psychotropic medication
while in jail are not given a supply of medication, nor are mentally
ill inmates given referrals to Medicaid, SSI, housing or other supportive
services.”
Many people with mental illness finance their medications through
Medicaid, and according to The Sentencing Project:
“Many states and
localities terminate inmate eligibility for Medicaid, Supplemental
Security Income and other entitlements such as Social Security
Disability Insurance (SSDI) when mentally ill individuals are released
from jail. As a result, many former inmates must re-apply for benefits
upon release to the community, a process that can take weeks or
months.”
Termination of benefits
leaves many released inmates with mental illness homeless and indigent,
leading them to commit so called “survival
crimes” which may land them back in jail. It would seem sensible
for correctional facilities to help ensure that inmates with mental
illness receive benefits to which they are entitled.
The Sentencing Project recommends diversion of people with mental
illness from the criminal justice system into mental health facilities.
This would require police and judges trained to recognize mental
illness, and quicker turnover of mentally ill arrestees to mental
health care. Currently, an officer can be back on the street within
half an hour from dropping an arrestee off at a county jail, but
may wait hours for the same person to be admitted to a hospital.
“… mental disability is not a scandal – it is
an illness,.” said President Bush in an executive summary from
his New Freedom Commission on Mental Health. This summary states, “Mental
illnesses rank first among illnesses that cause disability in the
United States, Canada, and Western Europe.”
The Commission refers
to “transforming mental health care” endlessly.
Rebuilding mental health care might be a more realistic goal. Some
estimates have only about half of Americans with mental illness receiving
any treatment – this speaks to lack of mental health care capacity.
Rebuilding capacity
will take time and money, but incarceration is more costly. It
costs a minimum of $20,000 a year to house an inmate in a correctional
institution – not including medical
expenses. Providing food, housing, and treatment for non-violent
mentally ill offenders could be accomplished largely through reallocation
of existing resources.
Mental illness is a disability, not a crime. Despite widespread
recognition that criminalizing the mentally ill is failed policy,
more sensible, humane, alternatives have yet to be implemented.
Further information may be obtained from the following Web sites:
U.S. Department of Justice, Bureau of Justice Statistics at www.ojp.usdoj.gov/bjs
Human Rights Watch at www.hrw.org/backgrounder/usa/incarceration
American Bar Association, Human Rights Magazine at www.abanet.org/irr/hr/spring02/mariner
National Institute of Corrections
at www.nicic.org
American Journal of Psychiatry
at www.psychiatryonline.org
Campaign for Mental Health
Reform at www.mhreform.org
The Sentencing Project at www.sentencingproject.org
The President’s
New Freedom Commission on Mental Health at www.mentalhealthcommission.gov
