Tuesday, September 11, 2007 The Orange Grove: We need special courts for mentally ill
Imagine you broke your arm, went to the doctor, and for treatment you were simply told to not use it for a while. Not only would this be inadequate but would lead to a more difficult recovery and greater expense down the road when you were finally given proper care. This hypothetical may sound absurd, but something similar, on a larger and more serious scale, is happening throughout California. And the human and monetary costs of the situation are dire. Currently, 15 percent to 20 percent of California's prison inmates and parolees suffer from serious mental illnesses including schizophrenia, bipolar disorder, obsessive compulsive disorder and major depression. Sadly, we do not have a comprehensive system in place to diagnose and treat these offenders; California instead incarcerates them when they get into trouble, and then sends them back onto the streets after they do their time. As a result, they offend again and again. In fact, the U.S. Justice Department reported that nearly a quarter of state prisoners with a mental health problem had served three or more prior jail terms, a recidivism rate about 25 percent higher than for offenders without mental illness. This recidivism alone is costing state taxpayers millions of dollars each year – yet it is largely avoidable. Senate Bill 851, authored by Sen. Darrell Steinberg, D-Sacramento, seeks to remedy the revolving door for mentally ill offenders by providing them with comprehensive diagnosis and treatment. SB851 will implement mental health courts statewide to help divert mentally ill offenders and parolees from prison and into treatment. The bill will also expand screening for serious mental illnesses in prisons and provide more treatment services for parolees. SB851 will help reduce crime, address prison overcrowding and lower our incarceration costs by millions each year. How much does all this cost? Actually, mental health courts would produce a net savings. According to the Legislative Analyst's Office, the expansion of the state's use of mental health courts to divert seriously mentally ill inmates from state prisons could "generate net state savings of a couple of tens of millions of dollars annually when fully implemented." Moreover, the LAO's analysis concluded that there was "no significant net state general fund costs to operate the mental health court program" in that similar mental health courts actually cost less to run than traditional criminal courts. Mental health courts already exist in 31 of the state's 58 counties. The program in Santa Clara County saved $2.2 million in one year in reduced prisoner housing costs. SB851 would standardize mental health courts in California. The bill also gives mental health courts jurisdiction over mentally ill parole violators. California recognizes the seriousness of mental illness and has taken steps to address the problem, including past legislation addressing the chronically homeless mentally ill. This legislation alone has resulted in a 67 percent reduction in the number of days the targeted population spent homeless, a 65 percent increase in the number of days working full-time and an incredible 72 percent reduction in the number of days spent incarcerated. Providing those same services to seriously mentally ill parolees would result, the LAO estimates, in a 58 percent reduction in the number of offenders returning to prison – where they are assigned to beds that can cost up to $110,000 a year for this high-need population. We must give serious consideration to our mentally ill offenders and provide them with proper psychiatric treatment. By ignoring the real source of the problem, they will continue down the same path and return behind bars again and again. SB851 is the right answer at the right time. Not only will this bill provide the resources for proper treatment for mentally ill offenders, but it will also reduce recidivism rates, increase public safety, address prison overcrowding and save California taxpayers money. SB851 deserves to be passed by the Legislature, which could happen as soon as today, and then should be signed into law by the governor.
Sunday, March 4, 2007
Mental illness is the forgotten stepchild of the criminal justice system. Nearly 20 percent of California's 173,000-plus state prison inmates are presently being treated for mental illness. Last month, government officials proposed building mental health-care units within seven prisons to treat mentally disordered inmates. The plan begs two basic questions: First, does it make sense for the Department of Corrections and Rehabilitation to be one of the state's largest providers of mental health services? Second, how fairly and effectively do our laws treat the mentally ill? Criminal law breaks down along two lines: crimes of specific intent and of general intent. General-intent offenses do not require any particular mental state. Battery, for example, is the unlawful application of force or violence on another. Unjustifiably push, hit, kick or slap someone, and you break the law. It doesn't matter whether you acted with any mean-spiritedness or intended to hurt the person. In contrast, some other crimes, like burglary, require, by definition, specific intent. Burglary requires entry into a structure with the intent to commit theft or any felony. Sneak into a home to find what you can steal, that's burglary. A problem arises with the mentally ill. Commit a crime requiring only general intent, and the law makes no provision for mental illness. A mentally ill offender is subject to the same punishment or prison sentence as anyone else. The historical safety valves for the mentally ill are incompetence and the insanity defense. Both options have proved inadequate. If a bipolar individual has a breakdown, acts out, commits a crime and continues in a disassociative state, the law's response is to suspend proceedings. Depending on the severity of the breakdown, the person might be placed in a local treatment facility or state hospital. So far, so good, but the case is only suspended until the person is again competent. Once professionals are able to restore the patient's functioning, the prosecution then resumes without regard to the previously existing problems. Insanity? Dan White and the "Twinkie defense" doomed the fortunes of countless mentally ill defendants who followed. Public outcry following Mr. White's acquittal on murder charges almost 30 years ago resulted in the elimination of the diminished-capacity defense. Insanity is a functionally antiquated defense that is rarely considered, and even then often for lack of alternative options. To many, it may not matter. After all, a victim is a victim irrespective of the mental state of the culprit. However, the philosophical justifications for punishment is either to discourage others from committing offenses (utilitarianism), or to morally penalize the offender (retributionism). Neither end is promoted by punishing the mentally ill. Someone who suffers from a mental disability did not commit their crime because of some moral deficiency. There is no moral lesson to be imparted, or, perhaps more appropriately, even if there is, it won't be received. Punishment is not a recognized treatment or therapy for mental illness. Likewise the utilitarian theory of punishment amounts to nonsense when applied to the mentally ill: Take heed, you mentally ill. If you commit a crime, we will punish you. How effective is that? Of course, society understandably desires and deserves to be protected from harm, irrespective of whether the culprit is mentally ill. However, the mentally ill also deserve to be protected from those who are mentally fit and dispositionally inclined to prey on others. Under the present system, mental illness is of little, if any, consequence. Break the law, and the underlying reasons don't matter, except to parents and families. The impassioned plea of "My son, my daughter, my brother, etc., is sick and needs help" is painfully common to any defense attorney. The refrain, "I understand, but the law doesn't care," is equally unsatisfying. The law should care. Family members affected by emotionally and mentally disturbed relatives reasonably expect that disabled persons will not be subjected to similar scorn and derision as so-called criminals. But, the reality is that under the present law, there is no appreciable difference. Violate a general-intent law and it matters not whether you're morally bereft or ill. One size fits all. Moreover, the Department of Corrections is particularly ill-suited for treatment of the mentally disordered. Its stock and trade is punishment, and – ideally – rehabilitation. That a federal court concluded it was necessary to appoint an outsider to oversee the prison's health care system underscores the need to restructure the prison system to meet its core competency. An obvious option to address the dilemma is to install a procedure whereby the mentally ill are not channeled into prisons, but rather into hospitals. Create a post-plea or post-conviction protocol where the court or other fact finder could assess an individual's mental health. If the offender's conduct was traceable to a mental disability, he or she would be directed not into the prison system but some equally secure institution operated by mental health experts. The resulting relief for the prison system would, in turn, allow increased and improved attention to rehabilitation and vocational programs.
Prison Fosters Mental Illness Cites Report
1:44 PM PDT, September 6, 2006 SACRAMENTO — More than half of the nation's jail and prison inmates suffer from a mental health problem, according to a federal report released today that comes as California faces court orders to dramatically improve mental health care for the incarcerated. The study, by the research arm of the U.S. Department of Justice, confirmed what wardens, convicts and correctional officers know: that large numbers of inmates, especially repeat felons, display symptoms of depression, mania or psychotic disorders. The survey of more than 25,000 prisoners nationwide showed that mental health problems were strongly associated with violence and previous convictions. A quarter of those state prisoners with mental disorders had been incarcerated three or more times in the past, and 58% of them had been charged with violating prison rules. Mentally ill inmates were more likely to get in a prison fight, and more likely to have been homeless in the year before their arrest. Three out of four were dependent on drugs and alcohol, with 37% saying they had used drugs at the time of their offense. Female inmates were found to have higher rates of mental illness than males — with 73% of females in state prisons reporting symptoms, compared to 55% of all males. Despite the prevalence of mental illness, only one in three state prisoners had received any treatment since admission to prison, the study found. The report comes as California copes with recent federal court orders to immediately hire 550 psychiatrists and other prison mental health staff, and to spend $600 million on new facilities. The orders are part of a long-running lawsuit over care for the mentally ill behind bars. The class-action case was won by inmates in 1995, but despite a sweeping settlement ordering the Department of Corrections and Rehabilitation to provide a constitutional level of care, serious problems remain. Among them: California's prison suicide rate is dramatically higher than the national average, which is falling. The California rate is 27 deaths per 100,000 inmates, compared to 14
per 100,000 nationally, according to the Federal Bureau of Justice Statistics.
Article Launched: 8/28/2006 12:00 AM Unsafe conditions
Mason Stockstill, Staff Writer
CHINO - Psychologist Stacy McLain was not surprised that the air conditioning
didn't work in her office during last month's record-breaking heat wave.
Finally, after weeks of frustration, McLain filed a complaint with the state's Division of Occupational Safety and Health about the conditions at the California Institution for Men in Chino. "I'm sure the quality of treatment goes down when you're sweating, sitting across the room from a felon who's sweating," she said. McLain's complaint about the work environment at CIM fits an established pattern at the prison, where inspectors have detected asbestos, lead paint and contaminated drinking water. Cal-OSHA cited the prison in the past two years for safety violations several times. Broken windows and leaky plumbing fixtures are common. However, McLain's concerns are part of a larger problem with CIM and the rest of California's prisons - where decades of budget issues, hiring shortages and institutional barriers have made the treatment of mentally ill inmates a virtual disaster. The mental health care system in the state's prisons operates under the oversight of U.S. District Court Judge Lawrence Karlton. His 1995 ruling in a lawsuit filed by an inmate found treatment was so poor that it violated prisoners' constitutional rights to adequate care. "The court has been directing us for quite some time in how we are to comply with the lawsuit," said department spokeswoman Terry Thornton. Last month, Karlton ordered Gov. Arnold Schwarzenegger's administration to present to the Legislature a proposal for hiring more than 500 new employees to treat the state's mentally ill inmates - believed to be about 20 percent of California's 171,000 prisoners. Michael Genest, the state's finance director, complied with the order - but not without blasting the Department of Corrections and Rehabilitation for failing to earlier resolve the problems. The state has added more than 2,400 new positions for prison mental-health care since fiscal year 1994-95, Genest wrote in his proposal, but the department has still been unable to figure out what its needs are. "CDCR has not adequately tracked these positions and cannot account for how they are actually being used in the institutions to provide mental-health treatment to inmates," Genest wrote. "This lack of management oversight and control is clearly unacceptable." Like each institution, CIM has its own unique problems. McLain, who is the union representative for prison psychologists, lists a litany of concerns, ranging from unsafe working conditions to scheduling conflicts that often mean inmates who need treatment go without. The difficulty in finding an office where inmates can meet with psychologists to deal with their illnesses is one example, McLain said. One facility regularly used for that purpose was closed earlier this year after it flooded several times during winter rains. McLain credits new Warden Mike Poulos with being more open to her suggestions than previous administrators at the prison, but said it's still a struggle to get any action on complaints. For example, workers only recently installed security screening in the day rooms at CIM's Reception Center-East. The screening separates the psychologists' office from the inmates, who live in an open dorm setting. "It required several heated discussions (to get the work done), but it was progress that we even had those discussions," she said. There is still much work to be done, both at CIM and throughout California. At the state level, the special master appointed by Karlton to oversee changes plans to meet regularly with the federal receiver who, in a separate court ruling, has taken over all other health-care operations in the state's prisons. At CIM, McLain says many psychologists are disillusioned with the prison system's lower-than-average pay and staff vacancies. McLain took her job as a prison psychologist in exchange for having some student loans forgiven. The agreement was for several years in the job, but she's not sure if she'll stay in the prison system once that time is up. The strain of working under adverse conditions, and fighting for an appropriate work environment, has taken its toll. "The actual work with the inmates is the easy part," McLain said.
From the Los Angeles Times Mental Illness Is Not a Crime
July 16, 2006 THE RECENT U.S. Supreme Court ruling that allows states broader leeway in limiting an insanity defense saddened many in the mental health community. Although the court's judgment is undoubtedly sound legally, it once again points to the tragic lack of understanding about mental illness in our nation. The case was about a 17-year-old Arizona man named Eric Michael Clark, who shot a police officer, believing him to be a space alien. The state court had disallowed an insanity defense because, although Clark had proved that he suffered from mental illness, he hadn't proved that he knew the killing was wrong. Among other things, the court noted, the fact that Clark ran away after the shooting proved that he realized the depravity of his actions. The Supreme Court backed the Arizona decision. The problem with that analysis is that it applies sane logic to an insane mind. It assumes that if the man's judgment was truly not compromised, he would have stayed around the scene of the crime, certain that his actions were morally justified. But some individuals with a severe mental illness exist in a state of jumbled thoughts, voices and delusions. Although it's unknown exactly what went on in the mind of the young man after he shot the policeman, it's reasonable to believe the state of terror that drove him to take another man's life could have easily propelled him to flee. To make inferences about his state of mind by using the standard of what a person without a brain disorder would be thinking if they ran away from the scene of the crime is unreasonable. Clearly, if someone with a mental illness demonstrates they are capable of murder, they need to be removed from society for the public good until they are no longer a danger. They need to be in a hospital. But to hold them morally accountable for their actions, as though delusions and hearing voices would not impair their basic judgment, defies fairness and common sense. The problem of criminalizing people with a mental illness goes far beyond the single tragic case in Arizona. The Bureau of Justice Statistics says there are currently 2.2 million people in prison or in jail. Given that it's estimated that 15% of this population suffers from a severe mental illness, that means the United States has roughly 330,000 people incarcerated who suffer from brain disorders. Professor Richard Lamb of USC estimates that roughly half of this population should be behind bars (a drug dealer suffering from major depression would be an example). But that means another 165,000 should be hospitalized or in outpatient care, not incarcerated. Instead, they are thrown in cages — brutalized, isolated and often untreated — not because of faults in their character or because they behaved in a way they knew to be wrong, but because of behavior stemming from biologically based brain disorders. Future generations will look back on us and our treatment of people with mental illness much as we look back on the Spanish Inquisitors who burned Jews at the stake for not recanting their religion, or on the white racists who lynched African Americans for being insubordinate. Future generations will see us through the lens of history and ask how we dared to be so ignorant.
http://pn.psychiatryonline.org/cgi/content/short/41/11/2 Psychiatr News June 2, 2006
Articles by Daly, R.
Legal News
Calif. Ordered to Upgrade, Expand Prison Mental Health Services
Lack of progress by the state to improve mental health care for prison inmates with severe and persistent mental illness is cited in a judge's order for a major boost to the program's funding. California plans the biggest upgrade to the state prison system's mental health program since a court took over the system more than a decade ago. Gov. Arnold Schwarzenegger (R) was expected to propose more than $600 million in new mental health facilities for the state's 31,000 inmates with mental illness after U.S. District Court Judge Lawrence Karlton approved the Schwarzenegger administration's plan to add 695 beds for mentally ill inmates. The judge's action came as part of a class-action lawsuit filed 11 years ago against the state that led a court takeover of the prison system's 33-facility mental health program and appointment of a "special master" to evaluate the California Department of Corrections and Rehabilitation's (CDC) compliance with the court's order in the case, known as Coleman v. Wilson. "This will be the biggest expenditure of funds on [inmates' mental health care] since the case began," said Randall Hagar, director of government affairs for the California Psychiatric Association. At least 20 percent of the state's 169,000 inmates have been diagnosed with a mental illness, according to a spokesperson for the CDC. The governor was expected to propose specific funding levels and the details of the upgrade as part of his regular mid-May budget revision proposal. Karlton approved a plan in April that calls for the construction of new mental health facilities to be operated by the corrections system at several prison sites, including Folsom and Vacaville. Construction costs alone are estimated at more than $600 million. Staffing costs will greatly increase the final cost to a prison system budget that has grown by more than 60 percent since 2003, when Schwarzenegger was elected governor. The judge's order requires the state to provide more bed space to inmates next year, and mental health advocates expect an additional mandate—although it has not yet been handed down—for increased salaries of psychiatrists and mental health professionals as an incentive to help increase staffing levels. "Many of these prisons are in remote locations that don't make them hugely popular places to relocate and raise a family," Hagar said. California now spends more than $8 billion annually on corrections, and the judge warned that the already substantial amount may greatly increase, according to media coverage of the two-day April hearing. Karlton also ordered corrections officials to make several short-term improvements to the prison system's mental health program, which were needed, in part, due to a population explosion in the prison system that has not been contained by the construction of 22 prisons in the last 25 years. The overcrowding has left authorities with no room to house or treat the large number of inmates who need mental health care. The system's chronic overcrowding led another federal judge, Thelton Henderson, to take control of the prison system's other medical programs in 2004 and give a receiver the authority to set health care budgets and policies for those programs, in the case Plata v. Schwarzenegger, et al. Robert Sillen, the receiver appointed by Henderson, told the media that it was possible that the mental health system could also be placed under his control. The two judges have indicated that they will work together to overhaul the prison health system, with Karlton scheduling a hearing to examine ways in which reforms of the medical and mental health programs may overlap, including in the areas of nursing staff, pharmacy operations, doctors, and bed space. In his order, Karlton blamed the current situation on California's decision in the 1960s to close its state mental hospitals, which in effect turned the prisons into mental hospitals.
http://www.signonsandiego.com/news/uniontrib/fri/opinion/news_mz1e13fellne.html Prisons no place for the mentally ill
By Jamie Fellner and Sasha Abramsky February 13, 2004 It is rare to find police, sheriffs, prosecutors, defense attorneys, judges, prison officials and human rights activists all on the same page. But across the criminal justice spectrum there is a striking consensus that something has gone painfully awry: the nation's jails and prisons have become mental health facilities – a role for which they are singularly ill-equipped. At least one in six prisoners in the United States is mentally ill – well over 300,000 men and women. There are three times as many mentally ill in U.S. prisons as in the country's mental health hospitals, suffering from schizophrenia, bipolar disorder and major depression, among other illnesses. Three decades ago few prison systems provided any mental health treatment. Most now offer something, but nowhere near enough – in quality and quantity – for the soaring number of prisoners with serious mental illness. Understaffing, insufficient specialized facilities and limited programs leave prisoners without the treatment they need. Untreated or undertreated, mentally ill prisoners suffer painful symptoms. They rant and rave, babble incoherently or huddle silently in their cells. They talk to invisible companions and live in worlds constructed of hallucinations. They lash out without provocation and often refuse to obey orders. They beat their heads against cell walls, cover themselves with feces, and self-mutilate until their bodies are riddled with scars. Many attempt suicide; some succeed. How is it that such desperately ill and vulnerable people are incarcerated? The quick answer is they committed a crime and were sentenced to prison by judges increasingly reluctant to declare defendants incompetent to stand trial and by juries increasingly loath to find them "not guilty by reason of insanity." The longer answer is that the mentally ill are victims of two failed public policies. The first is the failure of public officials to ensure an effective mental health system. Beginning in the 1960s, a process of "deinstitutionalization" freed mentally ill men and women from the bleak mental hospitals in which they had previously been dumped. But the system of community-based mental health services envisioned by the architects of deinstitutionalization never materialized. Today, community mental health services are a shambles. People living with mental illness – especially if they are poor and homeless and have substance abuse problems – find it nearly impossible to obtain help. Untreated, they can find themselves on the margins of society, deteriorate psychiatrically and may ultimately break the law. As criminal offenders, they then confront the second failed public policy: punitive laws, such as mandatory minimum sentences, that send people to prison even for low-level nonviolent crimes. As these laws have sent the U.S. prison population soaring to levels unimaginable in the rest of the world, so they have propelled the incarceration of many mentally ill. Tragically, for some of the mentally ill, jail or prison may be the first time they have received any mental health services. But the more common experience of the mentally ill behind bars is to receive little or no meaningful treatment. Committed mental health professionals working in prisons acknowledge that treatment is often limited simply to medication. Prisons were never designed for and are not now run to accommodate the unique needs of the mentally ill who find it difficult to abide by the formal and informal rules that govern prison life. Prison staff neglect them, accuse them of malingering and treat them as disciplinary problems. Other prisoners exploit and victimize them. Some correctional staff mock them, ignore their suffering or even use excessive force against them – covering them in pepper spray when they will not stop yelling, hitting them and even, in a few cases, suffocating them to death through improper methods of control. Prisoners who break the rules because of their illnesses are punished. Even self-mutilation and attempted suicide are dealt with as disciplinary matters. Mentally ill prisoners who break too many rules, who "act out" or who are otherwise unpleasant or disruptive, are locked up interminably in segregated units or supermax prisons that provide high-security solitary confinement. Indeed, these special segregation or isolation units are disproportionately populated by mentally ill prisoners. There they live 24 hours a day in small, sometimes windowless cells, allowed out for solitary exercise in a barren space a few times a week. They have little or nothing to do all day. Mental health treatment and programs are even worse for isolated prisoners than elsewhere in the prison systems. Prolonged solitary confinement is hard enough for anyone. But it can be overwhelming for people whose coping mechanisms are weakened by mental illness. Many will break down completely into acute psychosis, and then have to be taken to a hospital for intensive psychiatric treatment. Once stabilized, they are returned to solitary confinement, where the cycle of their deterioration repeats. The misery of the mentally ill in prison is not only appalling, it is unnecessary. Recommendations abound for effective steps that would strengthen community-based mental health services. There is also growing recognition of the need to divert nonviolent mentally ill offenders from the criminal justice system into treatment facilities and to ensure that dangerous offenders with mental illness are confined in secure facilities that meet their mental health needs. Some Americans no doubt question why mentally ill offenders should receive publicly funded mental health care when countless people who have not committed a crime cannot. The answer is that everyone in the United States should have access to medical and mental health care for serious illnesses. Unfortunately, the Constitution only recognizes the state's obligation to care for those who are incarcerated. The state must meet the medical and mental health needs of those who are locked up and therefore dependent on the state for all their needs because they quite literally cannot care for themselves. But if the law and compassion are not sufficient motivation to improve mental health services in prison, then self-interest should be. Communities are little served if mentally ill offenders are released from prison, as most eventually will be, in worse shape than when they went in. Fellner is director of the U.S. Program at Human Rights Watch and Abramsky is consultant to Human Rights Watch. They are co-authors of the Human Rights Watch report, "Ill-Equipped: U.S. Prisons and Offenders With Mental Illness."
Mad in the USA Bill Berkowitz - WorkingForChange 11.19.03 - "They are afflicted with delusions and hallucinations, debilitating fears, extreme and uncontrollable mood swings," reads a disturbing paragraph from a recent Human Rights Watch report. "They huddle silently in their cells, mumble incoherently, or yell incessantly. They refuse to obey orders or lash out without apparent provocation. They beat their heads against cell walls, smear themselves with feces, self-mutilate, and commit suicide." This description isn't about conditions faced by prisoners in a gulag in the old Soviet Union, it isn't detailing life in one of Saddam Hussein's hell holes, and it isn't about a concentration camp in some far-off place. This is a description of the situation too many mentally ill prisoners are subjected to in U.S. correctional facilities in 2003. According to "Ill-Equipped: U.S. Prisons and Offenders with Mental Illness", written by Sasha Abramsky, a consultant to Human Rights Watch, and Jamie Fellner, director of the U.S. Program at HRW, people "with mental illness are disproportionately represented in correctional institutions." One in six U.S. prisoners is mentally ill and suffering "from serious illnesses such as schizophrenia, bipolar disorder, and major depression." Each day, some seventy thousand are psychotic. "There are three times as many men and women with mental illness in U.S. prisons as in mental health hospitals. The rate of mental illness in the prison population is three times higher than in the general population." "On any given day, at least 284,000 schizophrenic and manic depressive individuals are incarcerated, and 547,800 are on probation. We have unfortunately come to accept incarceration and homelessness as part of life for the most vulnerable population among us." Congressman Ted Strickland told the House Subcommittee on Crime, Oversight Hearing on "The Impact of the Mentally Ill on the Criminal Justice System," in September 2000. The mentally ill in prison are easy prey, and "are likely to be picked on, physically or sexually abused, and manipulated by other inmates, who call them 'bugs,'" the Human Rights Watch (HRW) report charges. Based on an exhaustive two-year study that included interviews with hundreds of prisoners, corrections officials, mental health experts and attorneys, the 215-page Human Rights Watch (HRW) report maintains that the mentally-ill are warehoused without proper treatment -- in many cases without any treatment at all -- "because of a shortage of qualified staff, lack of facilities, and prison rules that interfere with treatment." The report focuses on the adult prison population, who are housed in nearly fourteen hundred adult state and federal prisons across the country. Although some prisoners are receiving adequate mental health services from "competent and committed mental health professionals" prisons operate under "rules designed for punishment," -- not treatment. In addition, the "fiscal crisis" of most states threatens to torpedo the decent programs currently in place. "In the most extreme cases," however, conditions of mentally ill prisoners "are truly horrific: [they are]... locked in segregation with no treatment at all; confined in filthy and beastly hot cells; left for days covered in feces they have smeared over their bodies; taunted, abused, or ignored by prison staff; given so little water during summer heat waves that they drink from their toilet bowls." The report attributes the criminalization of persons with mental illness to the closure of state mental hospitals and failure of communities to provide adequate treatment and support. In state after state, the dollars that once funded state hospitals did not follow mentally ill individuals to their communities. At least a third of the homeless population is mentally ill -- many with co-occurring substance abuse. "Many people with mental illness -- particularly those who are poor, homeless, or struggling with substance abuse problems -- cannot get mental health treatment. If they commit a crime, even low-level nonviolent offenses, punitive sentencing laws mandate imprisonment." In July, the President's New Freedom Commission on Mental Health issued "Achieving the Promise: Transforming Mental Health Care in America." The Commission found a system in shambles and concluded that there needs to be an "overhaul of the system -- focusing on early diagnosis and treatment -- that will enable people with mental illness to live, work and fully participate in their communities -- and live meaningful lives." The report also found that "there are many unmet needs and barriers to care for people with mental illness. And despite an increased scientific knowledge base that has led to many effective treatments, many Americans are not receiving the benefits. Too often, treatments and services are unaffordable and uneasy to access." Over the past twenty years, the politics of lock-em-up-as-fast-as-possible became the anti-crime mantra of most politicians. Hundreds of thousands of victims of the "war on drugs" were imprisoned. As the rate of incarceration soared so did the prison population of mentally ill inmates. The Human Rights Watch (HRW) report is only the most recent work documenting the inhumane conditions of the mentally ill in prison. In 1999, in his groundbreaking work, "Prison Madness: The Mental Health Crisis Behind Bars and What We Must Do About It" (Jossey-Bass, 1999), Dr. Terry Kupers fired an early warning shot, alerting the public to a "major crisis brewing in our prisons": "We are warehousing and mistreating a huge number of mentally ill people... and many people are unaware of its ramifications," Dr. Kupers wrote. Prison policies add to the problem by "traumatizing formerly 'normal' prisoners and making them angry, violent, and vulnerable to severe emotional problems." Dr. Kupers, a psychiatrist and professor at the Wright Institute of Psychology in Berkeley, California, is a longtime advocate for the humane treatment of prisoners, and has testified as an expert witness on behalf of prisoners in more than a dozen class action lawsuits. "The deinstitutionalization of the public mental health system, combined with changes in the law that make it far less likely that a defendant's mental illness will be considered a mitigating factor when sentences are being decided, has put an unprecedented number of Americans with major psychiatric problems in the criminal justice system," Kupers wrote. According to the HRW report, funding cutbacks threaten reform efforts just when prison officials are being forced to institute change. "Litigation or the threat of it," the report argues "is the prerequisite for systematic improvements in mental health services," Improvements in conditions in such states as Alabama, Arizona, California, Florida, Indiana, Iowa, Louisiana, Michigan, New Mexico, New Jersey, New York, Ohio, Texas, Vermont, Washington, and Wisconsin have come about as a result of class action law suits. Litigation has been successful, with numerous consent decrees in place to mandate improved mental health services. Still HRW finds "some correctional authorities resist putting reforms in place" because of "institutional inertia, bureaucratic obstacles, failure to understand the importance of adequate mental health services, or the lack of funding." The HRW authors were unable to determine "figures for total national expenditures on prison mental health services," and "many individual prison systems... indicated they were unable to calculate the portion of their medical budgets devoted to mental health services." Mental health treatment, medications, and additional correctional staff for inmate supervision do not come cheap. Providing for these services is first on most states' budgetary agendas. For example, Michigan, a state praised by HRW for "dramatic improvements" in correctional mental health services, cut $5 million of its $72 million budget and reduced 50 mental health positions in 2002. "No set of changes limited to jail and prison mental health programs will fix the larger problem," Dr. Terry Kupers, who consulted with the authors of the report, told me in a phone conversation. "Of course it would help a little to double or triple the number of psychiatric hospital beds within the prisons, or to expand diversion programs, but that would not alter the fact that with the widening gap between rich and poor a whole lot of people suffering from mental illness are disappeared into our jails and prisons. "We have to halt the heartless dismantling of the social safety net, including public mental health services. We have to end the racism that's rampant in the criminal justice system. The Human Rights Watch report reminds us that prisoners are human beings, and we have a social responsibility to do something about their pain and suffering." (c) 2003 Working Assets Online. All rights reserved
URL: http://www.workingforchange.com/article.cfm?ItemID=16013
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