Offenders who need psychiatric interventions for theirmental illness should be held in secure facilities if they have committedserious crimes, but those facilities should be designed and operated to meettreatment needs. Society gains little from incarcerating offenders with mentalillness in environments that are, at best, counter-therapeutic and, at worstdangerous to their mental and physical well-being. As another federal judgeeloquently noted:
Mental health treatment can help some people recover fromtheir illness, and for many others it can alleviate its painful symptoms. Itcan enhance independent functioning and encourage the development of moreeffective internal controls. In the context of prisons, mental health servicesplay an even broader role. By helping individual prisoners regain health andimprove coping skills, they promote safety and order within the prisoncommunity as well as offer the prospect of enhancing community safety when theoffenders are ultimately released.
Providing mental health services to incarcerated offendersis frustrated by lack of resources. It is also frustrated by the realities ofprison life. Correctional mental health professionals work in facilities runby security staff according to rules never designed for or intended toaccommodate the mentally ill. For example, mentally ill prisoners areconsigned to segregated units even though the harsh, isolated confinement insuch units can provoke psychiatric breakdown. Moreover, the rules designed bysecurity staff for prisoners in solitary confinement prevent mental healthprofessionals from providing little more than medication to the mentally illconfined in these units; they cannot provide much needed private counseling,group therapy, and structured activities. Correctional staff who have the mostcontact with prisoners and who are often called upon to make decisionsregarding their needs - particularly in the evenings when mental health staffare not present - often lack the training to recognize symptoms of mentalillness and to handle appropriately prisoners who are psychotic or acting inbizarre or even violent ways. It is easy for untrained correctional staff toassume an offender is deliberately breaking the rules or is faking symptoms ofillness for secondary gain, such as to obtain a release from solitaryconfinement into a less harsh hospital setting.
There is growing recognition in the United States that thecountry can ill-afford its burgeoning prison population, and that for manycrimes, public goals of safety and crime reduction would be equally - if notbetter - served by alternatives to incarceration, including drug and mentalhealth treatment programs. Momentum is building, albeit slowly, to divertlow-level nonviolent offenders from prison - an effort that would benefit manyof the mentally ill. But until the country makes radical changes in itsapproach to community mental health - as well as poverty and homelessness -there is every likelihood that men and women with mental illness will continueto be over-represented among prison populations.
Corrections officials recognize the challenge posed totheir work by the large and growing number of prisoners with mental illness. They recognize they are being asked to serve a function for which they are illequipped. Most of what we say in this report will not be new to them. We hopeour report, and the extensive documentation of human suffering that itcontains, will support their efforts to ensure appropriate conditions ofconfinement and mental health services for the mentally ill men and womenconsigned to them. We hope it helps marshal political sentiments and publicopinion to understand the need for enhanced mental health resources - for thosein as well as outside of prison. We also hope it encourages dramatic changesin the use of prisons in the United States - reserving them for dangerousviolent offenders who must be securely confined and not for low-levelnonviolent offenders. The problems we document in this report can be solved -but to do so requires drastically more public commitment, compassion, andcommon sense than have been shown to date.
It is impossible to do justice to the wealth of informationaccumulated during research for this report without creating a publication thatwas thousands of pages in length. Yet, because prisons operate in secret, forthe most part, it is important for the public to have access to as muchmaterial as is possible. We have placed some of the expert reports producedduring litigation on our website, as they are not readily available to thepublic, and reveal, in often harrowing detail, problems with specific prisonsregarding the treatment of mentally ill offenders. They can be found at
Currently pending before the U.S. Senate and House ofRepresentatives is the Mentally Ill Offender Treatment and Crime Reduction Actintroduced by Congressman Ted Strickland and Senator Mike DeWine. If enacted,the bill could catalyze significant reforms across the country in the way thecriminal justice system responds to people with mental illness. The billauthorizes grants to help communities establish diversion programs(pre-booking, jail diversion, mental health courts) for mentally ill offenders,treatment programs for mentally ill offenders who are incarcerated, andtransitional and discharge programs for mentally ill offenders who havecompleted their sentences. The grants program would be administered by theDepartment of Justice in consultation with the Department of Health and HumanServices and could be used to help pay for mental health treatment services inaddition to program planning and administration, education and training, andtemporary housing.
Congress should tackle serious deficiencies in federalprograms that fund mental health services, including problems of limitedcoverage and access that keep many mentally ill persons from being able toobtain the treatment they need. For offenders released from prisons, currentlaw leads to long delays in the restoration of eligibility for benefits. Relatively simply changes in the rules governing Medicaid, SupplementalSecurity Income (SSI) and Social Security Disability Insurance (SSDI) wouldenable ex-offenders with mental illness to avoid those delays and to obtainquickly the ability to pay for needed medication and mental health services inthe community and to ensure continuity of care. Rapid restoration of benefitsto released offenders with mental illness not only helps them manage theirillness; it also supports public safety by reducing the risk of new involvementwith the criminal justice system.
Steps should be taken at the federal, state, and locallevels to reduce the unnecessary and counterproductive incarceration oflow-level nonviolent offenders with mental illness. Mandatory minimumsentencing laws should be revised to ensure prison is reserved for the mostserious offenders (whether or not mentally ill) and prison sentences are notdisproportionately harsh. Mental health courts, prosecutorial pretrialdiversion, and other efforts should be supported which will divert mentally illoffenders from jails and into community based mental health treatmentprograms. Reducing the numbers of mentally ill offenders sent to prison willalso free up prison resources to ensure appropriate mental health treatment forthose men and women with mental illness who must, in fact, be incarcerated forreasons of public safety.
We recognize that evencorrections departments are not immune from the budget slashing occasioned bycurrent fiscal crises. But even in the best of times, it is difficult to secureadequate funding for services and programs for prisoners. Improvements inmental health services in prison are, unfortunately, heavily dependent onfinancial resources. Qualified, competent staff cannot be hired and retainedin sufficient numbers absent funding. Governors must support adequate fundinglevels for mental health services and permit corrections officials and mentalhealth staff to argue forcefully, extensively, and publicly on behalf of suchfunding. They must present candid analyses to the public of existing problemswith correctional mental health treatment, the consequences of those problemsand the need for resources to address them. They should encourage legislatorsto reduce prison populations, by lowering unnecessarily harsh mandatorysentencing laws and by supporting alternatives to incarceration for low-levelnonviolent offenders, rather than by cutting indispensable services for thoseprisoners who must be incarcerated.
It is counterproductive and dangerous for correctional staff whohave little or no training in mental illness to work in housing units, on theyards, and elsewhere in prison with prisoners who have serious mentalillnesses. Effective training should be provided to all new officers in suchareas as: signs of mental illness; different treatments for mental illnesses;side-effects of medications used for the treatment of mental illnesses;effective interaction with mentally ill prisoners; defusing potentiallyescalating situations; recognition of the signs of possible suicide attempts;and training on the safe use of physical and mechanical restraints for mentallyill offenders. Additional information pertinent to working with mentally illprisoners should be provided during in-service training.
Individual prison systems report high percentages ofmentally ill offenders. For example, the California Department of Correctionsestimated that as of July 2002, 23,439 prisoners were on the prison mentalhealth roster, representing over 14 percent of the California prisonpopulation. The Pennsylvania Department of Corrections estimates that 16.5 percent of itsprisoner population, or approximately 6,500 people, are on the mental healthcaseload, of whom 1,537 are so ill that their ability to function on aday-to-day basis has been dramatically limited. Eleven percent of New York's sixty-six thousand prisoners receive mental healthservices. In Kentucky, 14.6 percent of the state prison population is on themental health caseload, and in Texas the figure is 11.6 percent. 041b061a72