"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."
Bill Berkowitz is a longtime observer of the conservative movement. His WorkingForChange column Conservative Watch documents the strategies, players, institutions, victories and defeats of the American Right.
Copyright 2003 WorkingForChange
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