By Matthew T. Mangino
Tuesday, January 10, 2012 05:17
They say justice is blind. It must be to ignore the plight of the mentally ill in America’s prisons.
The Milwaukee Journal Sentinel’s recent two-part series on serious mental illness highlights the shortcoming inherent in a failed system. Wisconsin is far from the only state to push the mentally ill off on the criminal justice system.
An internal review of conditions inside a North Carolina prison, recently obtained by the Associated Press, found that inmates held in solitary confinement were often locked in cells for extended periods without being let out for meals, recreation time or even showers.
This past February, a North Carolina inmate being secured in solitary confinement had a doctor’s order requiring one hour of exercise per day in the prison’s day room. A review of prison records found that the inmate had not left his cell for 78 days consecutive days.
This is not an isolated case.
According to research published in the Harvard University Civil Rights-Civil Liberties Law Review, the mentally ill typically account for as much as one-half of the population in solitary confinement. In Wisconsin, a 2010 audit of three state prisons reported that “between 55 percent and 76 percent of inmates in segregation [solitary confinement] are mentally ill,” according to a report published in The Crime Report.
Last year, a Utah prisoner suffering from schizophrenia and bipolar disorder died of starvation and dehydration after spending four months in the Salt Lake County Jail. A significant period of his incarceration was spent in solitary confinement. Twenty-year-old Carlos Umana weighed approximately 180 pounds when he entered the jail; when he died, he weighed just 77 pounds.
Why would a young man suffering from mental illness, to the point that he would starve himself to death, be in prison?
According to National Public Radio, the answer is simple; the three largest inpatient psychiatric facilities in the country are the Los Angeles County Jail, Rikers Island in New York City and Cook County Jail in Illinois.
Jails and prisons are America's de facto psychiatric hospitals.
As a member of the Pennsylvania Board of Probation and Parole, my number-one priority is public safety. There are, at times, inmates with severe mental illness who might not be suited for prison. Nonetheless, many are also too dangerous to be released directly to the street.
During the 1960s, policymakers across the country decided to close mental health institutions in favor of community treatment. In 1955, there was one psychiatric hospital bed for every 300 Americans.
Today, according to the Treatment Advocacy Center, a Virginia-based non-profit dedicated to the treatment of severe mental illness, there is one psychiatric hospital bed for every 3,000 Americans. As the Journal Sentinel reported, there are 20 times as many people with mental illness in jails and prisons as there are in psychiatric hospitals.
As it became obvious that the community treatment experiment was not working, some policymakers found it easier and less expensive to stigmatize mentally ill persons as criminals and send them to prison, rather than to treat them with the attention and compassion that is required for those suffering from a debilitating disease.
Once in prison, mentally ill inmates have a difficult time getting out. Prison rules are often violated by offenders who believe cellmates, guards and even family at home are out to harm them.
The mentally ill are often targeted by fellow inmates who are aggravated by the strange manifestations brought on by their illness. Mentally diseased inmates may have a problem concentrating in programming and therefore fail to complete required treatment programs.
Prisons are not completely to blame.
Prison medical systems were not designed nor equipped to provide quality mental health services to prisoners in need. Seriously mentally ill inmates often face overworked or undermanned staff overwhelmed with the need to evaluate and implement treatment plans for an ever growing population of ill inmates.
Our board and the Pennsylvania Department of Corrections work extremely hard to assist inmates with mental illness transition back into the community. Some of my colleagues have committed considerable time and energy to this process.
Such efforts do not eliminate the fact that an absence of available psychiatric hospital bed space makes it extremely difficult to place those inmates with violent criminal histories and intensive treatment needs.
Until we are willing to acknowledge that our prisons have become de facto mental hospitals— and unless we are willing to make the hard and costly decisions that both protect the public and humanely treat those inflicted with disease— I believe the American mental health gulag will continue to indelibly blur the line between justice and expediency.
Matthew T. Mangino is a member of the Pennsylvania Board of Probation and Parole and the former district attorney of Lawrence County, Pennsylvania. He also has blog on crime and punishment at www.mattmangino.com and welcomes comments from readers.
Posted by personman
Thursday, January 26, 2012 12:30
Snapping is not cool. Neither is exacerbating.
Criminals are not monkeys, they are worth the effort.
Sometimes psychiatric drugs might help.
The life long process of learning how to control ones self is most important.
Posted by freddi
Tuesday, January 24, 2012 02:02
In my dealings visiting inmates on a volunteer basis in PA DOC facilities, I have found a thread of commonality among a lot of the young offenders – they have suffered with traumatic head injuries, perhaps as early as childhood. And for crying out loud, they aren’t all killers or rapists! Then there are returning military personnel who have suffered concussions, shrapnel in the head and other tragic injuries that might be more subtle, in addition to the fact that they are trained killers. One ongoing case of note is Nicholas Horner. And Private Needham’s story which was featured recently on “48 Hours” on CBS. (Note also there is a big research project at Boston U right now examiniing brains of football players who have certainly gotten their knocks, and some of whom become aggressive, because of CET.) Some staff in the prisons think because these guys are smart in a lot of other ways, that they aren’t mentally ill. Since when does mentally ill mean you are stupid? In any event, because these fellows “act out”, “snap” (particularly because some staffers like to push their buttons) and otherwise get themselves in trouble due to their behavior (caused by the EXTREME frustration of being trapped inside their mentally disturbed minds, I’m sure), putting them in RHU for years on end does nothing to improve their behavior and condition, which CAN BE DONE with proper treatment, not only with medication, but by humane behavior by the mental health professionals themselves towards these hapless individuals. I’ve gotten further with just visiting some of these kids and men, even in the no-contact venue, because my attitude toward them is that they are human beings and God’s children (no, I’m not a preacher, just a believer) like everybody else. And as for the remark in one of the comments below to the effect that we don’t put kids in jail — what the dickens do you think juvenile detention is? Some of these kids have gone from (abusive) foster care as early as the age of 6, to juvenile detention and then directly to adult prison (5 years of RHU and 7 more to go, in one case) so how do you think someone like that is going to behave? Like Little Lord Fauntleroy? Think about this! What might you be able to do to alleviate some of the misery our fellow human beings are experiencing? They ARE worth it and you might find you will meet some of the most interesting people you could ever become acquainted with.
Posted by Mary Dee Goettsche
Wednesday, January 18, 2012 05:01
It is so easy to point fingers at those we don’t understand and to judge them because they don’t live the way we think that they should. Mental illness is a disease, NOT A CHOICE! We cause so much more harm by cutting off funding to help the mentally ill receive the help that they need! Much mental illness cannot be prevented; it is NOT the result of improper upbringing, diet, exercise! Please have compassion for those who are suffering from it and try to facilitate proper treatment for them! You don’t need to accept or condone their behavior, but DO try to be compassionate toward THEM as fellow human beings!
Posted by gotnotimetobleed
Monday, January 16, 2012 04:38
Hill billies don’t understand mental health or that their ma & pa are brother & sister!! It will always be that way…. If you have no worth to this country, you will be last or forgotten!!
Posted by Matthew T. Mangino
Friday, January 13, 2012 03:49
The idea that mental illness is being criminalized, as Brian proposed, certainly gives one pause. I don’t agree that mental illness can be addressed with “good parenting, taking responsibility to change your behavioural diaper as an adult, not being too proud to admit when you are messing up and need help, a striving for education, and eating as well as you can and excercising,” as suggested by personman.
Something has change in the way we deal with the seriously mentally ill and it’s not for the good.
A survey conducted by the Treatment Advocacy Center and the National Sheriffs Association examined the number of seriously mentally ill people in prisons. The survey also found that about 16 percent of inmates in jails and prisons have a serious mental illness. In 1983, the seriously mentally ill accounted for only 6.4 percent of all incarcerated offenders.
The number of people with serious mental illness in prison has nearly tripled in the last 30 years. The problem is clear. I’m interested in knowing what all of you think might be the answer.
Posted by personman
Thursday, January 12, 2012 07:32
I am speaking from what has been garnered from empirical evidence. Mental illness is not criminalized. Everyone has difficulty functioning in society. Call it failed treatment by evolution, genetics, parenting, reality, even a god if you want. As far as societal responsibility can function; what can we be expected to do? Everyone has a chance of developing mental illness that could alter behaviour detrimentally (no pun). Should we screen everybody when they brush thier teeth in the morning? And if they are found to be unstable can we afford to help them? Do we know what exactly to advise for a true amelioration? I ardently wish we did, and could implement such ubiquitous diagnosing.
Essentially, the person cannot be allowed to harm innocents. If they cannot curb themselves then we must treat them as an animal of lower taxonomical situation, a monkey if you will; monkeys seem unable to conform to the rules of (human) society.
Of course we don’t jail people with the ailments that Brian mentions. We don’t put kids in jail either.
Real alternatives IMO are as simple and complex as good parenting, taking responsibility to change your behavioural diaper as an adult, not being too proud to admit when you are messing up and need help, a striving for education, and eating as well as you can and excercising.
If psychiatrists do get involved, it is very unlikely they will help, sometimes the best they do is keep patients locked up in a hospital. Often they are very willing to help tho don’t have the wherewithal to conceive of all aspects of the patient. Sometimes they get caught up in fantasies of being a healer and lose track of prudence.
Psychiatric drugs are dangerous alot of the time. Sometimes it seems it makes sense to sedate a person who is dangerous their self. The cost of the drug is likely less than incarceration, tho from what I gather, it is easier to stop taking a drug than breaking out of jail.
Posted by Brian
Thursday, January 12, 2012 03:03
This article elaborates on a serious problem in soicety today, we’ve criminalized mental illness. There are poeple suffering from serious mental illness who will have difficulty functioning in society. A paranoid, schizophrenic who thinks the CIA is trying to kill him is capable of being violent to prevent himself from preceived danger. If he ends up in prison he is likley to spend his entire sentence behind bars—as a result of bad behavior and failed treatment.
Essentially, this person is in prison because they have a disease that inhibits their ability to conform to the rules of society. We don’t jail people with cancer, or diabetes or heart disease.
We need real alternatives to prison for the mentally ill.
Posted by personman
Wednesday, January 11, 2012 01:42
Practically speaking, regardless of a diagnosis that may not be accurate (or make sense) if any inmate is not treated well then they should not be let out as they will probably get worse. How to treat them is interesting. I would guess that most psychiatrists could make suggestions with a decent chance at efficacy, tho they are not omniscient.
Public safety is the priority we would agree, unless we are all mentally ill. We have limited resources to ensure this safety and we are no more omniscient than a psychiatrist. We should stop feeling sorry for people who claim to have mental illness, and are backed up by doctors who want to propegate thier profession (not saying that all of them are biased as such tho look at the reality). We don’t want to anger unstable individuals and groups tho do we? So we could use the death penalty more, we could treat instituionalized criminals better… I don’t know what would be best aside form keeping ourselves and our children healthy. (I’ve found that a diet lacking bullshit really helps this:)
Posted by Frank Hartnett
Tuesday, January 10, 2012 06:07
I wish Mr. Mangino had addressed the court decisions that make it extremely difficult to mandate mental health treatment. The psychiatric hospitals were closed due to limitations on court ordered commitments. It would have also been interesting had he covered the fact that inmates in state prisons can, and often do, refuse treatment. Unless they become an eminent danger to self or others they are free to wonder around the institution and see the parole board totally untreated.
Posted by Ken Kerle
Tuesday, January 10, 2012 12:44
Jails over the past 3 decades have become the largest mental centers in urban America. Reentry is a big challenge as to whether most of these inmates with co-occurring disorders will be rearrested. Part of the answer is CIT (Crisis Intervention Training) where the criminal justice systems connect with mental health and alchohol drug treatment to keep this category of offenders out of the criminal justice system.
Posted by IrvinWaller
Tuesday, January 10, 2012 12:05
This is a great article on the problem. There has long been a correlation between the rise and fall of persons in mental hospitals and numbers of persons behind bars. Mad and/or bad!!!
The missing piece in this article is prevention. In 2012, we have compelling evidence about how to reduce violent crime through prevention. WHO, CDC and even US DOJ (including its crime solutions site) share programs that work. We also know that every dollar invested in targeted social risk factor prevention saves $7 or much more in reactive costs.
The options are not just mental hospital or incarceration. They must include real investments in effective prevention