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Author Topic: Mental Illness and the Prison System  (Read 1473 times)
Darcia Helle
Darcia
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« on: August 04, 2010, 02:44:32 PM »

I read a lot of sociology, including books on our justice and prison systems. Regardless of which way you swing politcally, most of us agree that our system is not perfect. Here is one of the ways I believe it fails.

Mental Illness and the Prison System

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:
 
1. “Deinstitutionalization” – the process of closing down mental hospitals throughout the country. This began in the 1950s but gained strong momentum in the 1980s.

 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.

2. The second issue is the tougher sentencing laws implemented in the 1980s and 1990s. This is particularly true with the advent and pursuit of our “War on Drugs”. People with mental illness use and abuse drugs at a higher rate than the general population. They are also more likely to get caught, arrested, and imprisoned.

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.


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calum
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« Reply #1 on: August 17, 2010, 05:41:33 AM »

I have found this article really interesting and would agree with most of the issues you have highlighted. The person who is mentally ill and has also committed a serious crime is a very difficult individual for the State to deal with. I would argue that both prisons and secure healthcare environments (although these have better daily regimes for the mentally ill) are still not fully conducive to an individual's mental health (loss of freedom, set routines, control on personal items, rules and regulations etc), yet some measure of control in relation to these individuals who may have committed gross and serious crimes against other human beings, is required from the State  in order to protect other members of our society from serious harm. As a society I still think we have a very long way to go in learning how to manage both correctly and humanely, individuals who have a diagnosable mental illness and also may have committed a particular serious crime.
I would be interested to see what other members think on these particularly and possibly sensitive  issues!
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Darcia Helle
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« Reply #2 on: August 17, 2010, 08:51:29 AM »

I agree, Calum. In some ways, I don't think society has advanced all that far in our care for the mentally ill. When I saw photos of those "rubber rooms" that are used here in the U.S. prisons, generally for those who are mentally ill, I felt sick. These people are not mentally able to behave according to the rules, yet we expect them to and punish them when they don't (or can't). We have to find a better way to restrict them, while still allowing some measure of humanity.
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calum
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« Reply #3 on: August 20, 2010, 06:33:47 AM »

Darcia,
In this highly financial and outcome driven world we now live in, it is very hard to measure  in quantitative terms, the relative successes if any, in respect to the actual amount of money that is spent in detaining these particular individual's, never mind then spending money in trying to treat them!
It is sad reflection on today's society that the quality of an individual's life these days all boils down to money, even though that individual may have a mental illness which produces behaviours which may be far  beyond their personal conscious control.
In your studies of the mentally ill held in the American Prison System is there much mention to the suicide rate within the penal establishments in respect to this particularly vulnerable group of people?
C
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Darcia Helle
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« Reply #4 on: August 20, 2010, 07:25:51 AM »

You're right about money being the driving issue in care. Sad when quality of life is based on dollar signs. Money was the big reason given for closing all the mental institutions decades ago and scattering all those people out on the street and into prisons.

My biggest argument with housing the mentally ill within prisons is that the prison staff is not trained in mental health. It's a bit like asking the average person on the street to take a full-grown, wild tiger home and care for it properly.

I do remember reading that the suicide rate for mentally ill inmates was much higher than that of the "average" inmate. However, I don't remember specific numbers. These statistics are tough to come by. I find it interesting that taxpayers support the prisons, juries put people behind bars, yet once prisoners are there, we taxpayers are not supposed to ask questions about what goes on inside. And, for the most part, we don't.

Suicide risk is one of the main excuses for keeping the mentally ill in 'rubber room' cells. Yet, it's a fact that these rooms worsen the mental illness and even cause mental breakdowns in the otherwise "sane" prison population! I've attached a photo of a rubber room in a California prison. Imagine being locked naked in one of these rooms for days or weeks or, at times, months.
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calum
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« Reply #5 on: August 26, 2010, 03:24:16 PM »

The picture of the room you have posted does look grim. I suppose the dilemma that prison staff have is how to keep an individual who is acutely mentally illl safe from harming themselves or others. If the individual was in a normal prison location, a variety of different items could be used by the person to self harm, or there could be a danger of extreme violence and aggression towards others. It could be argued that these types of rooms are a form of environmental control used in an attempt to keep a person safe. If a prisoner killed themselves or others, there would be a hugh out cry against the state for not guarding against the risks that individual either posed to themselves or others. I would assume that there should be tight rules and proceedures in place that these types of room should only be used for the minimum amount of time and that there should be regular formal reviews of the use of these rooms for each individual case. I would that this type of room would only be used as an extreem last resort, and that other methods of trying to manage the individual  in question would be tried before having to resort to the use of a room such as this. This is just a bit of personal reflection on some of the complex  issues involved in trying to provide humane care to people who could pose a danger to themselves or others as a result of a very disturbed mental state! Prisons I suppose are not hospitals and so, there would be a limit on what could actually be provided within such an environment.
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Darcia Helle
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« Reply #6 on: August 26, 2010, 03:48:25 PM »

I do understand the need, though I don't agree with the methods. These prisoners are stripped completely naked and stuck in a room with absolutely nothing to do. They aren't even allowed to have a book! The camera watches them 24/7 (Creepy - and, seriously, what could they possibly do in there naked?) and the drain in the floor is where they relieve themselves. They don't even have the privilege of a toilet.

These rooms were designed for desperate measures, with no more than 24 hours at a time served inside. However, I read horrible accounts of prisoners - mentally ill, depressed, and so-called healthy - being locked in these rubber rooms for months at a time! One otherwise normal woman developed severe mental illness after being left for weeks.

Can you imagine what it would do to even a healthy mind to be stripped of everything, with no entertainment whatsoever. So much for preventing suicidal thoughts. That would make just about anyone want to commit suicide!
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Maria Savva
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« Reply #7 on: August 27, 2010, 04:51:48 AM »

A very interesting topic, Darcia.  In the UK most mental hospitals were also closed down in the '80s, in favour of  'care in the community' . In other words, people with mental disorders were out on the streets more or less having to look after themselves, and of course there are going to be crimes carried out mentally unstable individuals.  I think it's wrong that they don't get the right treatment nowadays.  Anyone, even if you had a mental illness or not, would surely go crazy being locked in a room without human contact for 23 hours a day (incidentally, I couldn't find that picture of the rubber room that you've posted, where is that?)
In this country, when these individuals are released from prison they are given priority housing with Housing Associations, and for the most part expected to look after themselves.  Inevitably they reoffend. I think it's cruel to leave someone with a serious mental illness to care for themselves.  They are not only a risk to themselves, but also to the public.  It is equally as cruel to lock them up in a prison with no help for their problem.
The system at the moment doesn't work at all.  We need to re-introduce mental hospitals, where people can go and be treated and perhaps even cured of their conditions so that there will be less crime, less overcrowding of prisons and safer streets.  Mental illness is an illness just like any other.  We don't think twice about having all the hospitals we need for people with other conditions, but for some reason people with mental health problems get the short-straw.
 
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Darcia Helle
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« Reply #8 on: August 27, 2010, 05:39:02 AM »

Maria, it sounds like the U.K. & the U.S. have gone similar routes with the mentally ill. You are so right about needing treatment centers. We wouldn't lock a cancer patient up for being sick, we'd treat him or her. We should be doing the same with mental illness. It's hard to believe that there's still such a stigma carried with that label.

I had pulled that photo off a California site back when I first wrote that article. I just went to look for it and I couldn't find it, either. Perhaps that site was taken down or changed. I did find a similar photo in a California prison at this site:

http://www.vcstar.com/photos/galleries/2009/oct/10/prison-inside-prison/4646/
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