Magazine article Corrections Forum

ILL-Equipped: U.S. PRISONS AND OFFENDERS WITH MENTAL ILLNESS

Magazine article Corrections Forum

ILL-Equipped: U.S. PRISONS AND OFFENDERS WITH MENTAL ILLNESS

Article excerpt

"It is deplorable and outrageous that this state's prisons appear to have become a repository for a great number of its mentally ill citizens. Persons who, with psychiatric care, could fit well into society, are instead locked away, to become wards of the state's penal system. Then, in a tragically ironic twist, they may be confined in conditions that nurture, rather than abate, their psychoses."

Judge William Wayne Justice, Ruiz v. Johnson, 37 F. Supp.2d 855 (S.D. Texas, 1999).

A staggering number of persons with mental illnesses are confined in U.S. jails and prisons - somewhere between two and four hundred thousand or more, according to expert estimates. The causes of this massive incarceration of the mentally ill are many, but corrections and mental health professionals point primarily to inadequate community mental health services and the country's punitive criminal justice policies. While mental health hospitals across the country were shut down over the last couple of decades as part of the process of "deinstitutionalization," the community-based health services that were supposed to replace them were never adequately developed. As a consequence, many of the mentally ill, particularly those who are poor and homeless, are unable to obtain the treatment they need. Ignored, neglected, and often unable to take care of their basic needs, large numbers commit crimes and find themselves swept up into the criminal justice system. Jails and prisons have become, in effect, the country's front-line mental health providers.

Indeed two of the largest mental health providers in the country today are Cook County and Los Angeles County jails, both of them urban entry points into the burgeoning prisons systems of Illinois and California respectively.

Extent of the Problem

In 1999, the federal Bureau of Justice Statistics, drawing on a survey in 1997 of adult prisoners, estimated that 16 percent of state and federal adult prisoners and a similar percentage of adults in jails were mentally ill.15 This prevalence rate translates into an estimated 230,505 adults with mental illness confined in U.S. prisons, and another 106,476 in its jails.

The Bureau of Justice Statistics has also reported that nearly one in ten prisoners are taking psychotropic medications, with that number increasing to nearly one in five in Hawaii, Maine, Montana, Nebraska, and Oregon.

As these numbers suggest, prisons have become warehouses for a large proportion of the country's men and women with mental illness. In September 2000, Congressman Ted Strickland informed his colleagues on the House Subcommittee on Crime that between 25 and 40 percent of all mentally ill Americans would, at some point in their lives, become entangled in the criminal justice system. According to the American Psychiatric Association, over 700 thousand mentally ill Americans are processed through either jail or prison each year.

Reform through Litigation

While it should not take the threat of a lawsuit to get correctional systems to improve their mental health services, in practice, litigation or the threat of it, has been the cause of systematic improvements in mental health services. The earlier lawsuits challenged the utter lack of mental health services in prisons. More recently, litigation has sought improvements in existing systems.

In Ohio, for example, Dr. Reginald Wilkinson, the director of the Ohio Department of Rehabilitation and Correction, was confronted with a devastating expert assessment of Ohio's mental health services developed after prisoners brought suit in 1993 claiming the services were so poor as to be unconstitutional. After receiving this assessment, Wilkinson engaged in a remarkable collaboration with correctional mental health experts, plaintiffs' attorneys, and other stakeholders to develop the blueprint for a major overhaul of the state's prison mental health services. The suit ended in a settlement without extensive adversarial proceedings, and the department has remained committed to providing quality mental health services. …

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