Handling the Triple Whammy: Serious Mental Illness, Substance Abuse, and Criminal Behavior

Article excerpt

"I'm not SCHIZOID," the young man said. "I'm a person with an illness - schizophrenia. But it doesn't CONTROL me anymore. With my meds I control it. I seldom HEAR VOICES now, and when do, I don't pay any attention to them."

We sat in the sun on two plastic chairs in the small prison yard. He is an inmate in San Carlos Correctional Facility's therapeutic community (TC), a 32-bed wing of the four-story, 250-bed prison for male inmates with serious mental illnesses. It was opened by the Colorado Department of Corrections (DOC) in Pueblo in 1995. (A TC traditionally is a voluntary substance abuse treatment program in which the residents, with the guidance and supervision of trained staff, are the primary therapists for one another.)

In his soft voice, the inmate spoke expertly of his mental disease. He told of a difficult childhood and abuse of alcohol and drugs. Surprisingly, he didn't use any of this as an excuse for his crime. "I'm responsible for the harm I did," he said. "It would be easy to blame my more or dope. And when I found out here that I had schizophrenia, I had an even better excuse."

'What caused you to give up your excuses?" I asked.

"It took a while - quite a while - several months here." He tilted his head toward the other inmates walking or sitting in the yard and said, "They're the ones who made me change."

Prisons Becoming Mental Hospitals

TCs for mentally ill offenders are arriving on the scene none too soon. For many reasons the number of mentally ill inmates in prison has risen dramatically during the last several years:

* Mental hospitals have been downsizing. Community health centers were supposed to provide the therapy and medication that those with seriously mental illnesses needed, but the centers generally have not been effective. Either support is lacking or the mentally ill don't use them.

* Those who are mentally ill are likely to be alienated from family and friends. They have a hard time getting or holding a job. Over time, many of them will stop taking their medication and turn to criminal behavior to meet their needs.

* Other than prison, judges have few, if any, sentencing alternatives in the community for mentally ill offenders.

* Criminal defense lawyers frequently recommend that their mentally ill clients plead guilty rather than not guilty by reason of insanity; the client often will serve less time in prison than in the criminal ward of a mental hospital.

* Judges tend to give the mentally ill longer sentences and, because of the increased risk of reoffending, parole boards are reluctant to parole them.

"We have 1,000 chronically mentally ill offenders in our system," says John Suthers, executive director of the Colorado DOC. "In 1995 they were only 5 percent of our total population; now it's almost doubled. And 95 percent of them will be returning to our communities, where they'll have very little support. They'll probably stop taking their medication, and many of them become violent without it. That forces them back into the criminal justice system."

Suthers notes that mentally ill offenders are a difficult segment of the prison population to manage. "They're either predators or victims. Fortunately, our Legislature saw our need and funded San Carlos. Both sides of the legislative aisle are beginning to understand that we have to have the tools to modify behavior and cut off this endless supply of returning inmates."

Suthers indicates that he is eager to see the research data, and has confidence in the work they are doing in the San Carlos TC. An independent five-year research study is being conducted by the Center for Therapeutic Community Research (CTCR). "When the study is completed," Suthers said, "I'm looking forward to going to the Legislature and saying, 'Here's the proof. The funds you gave us for this program paid off.'"

How Effective Will it Be? …