Prisons: Are they the new State hospitals?

Should people be incarcerated for having disabilities? That is the fate of many people with mental illness according to the […]

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