As many as three-fifths of soldiers that are discharged for misconduct actually have post-traumatic stress disorder or other types of brain injuries, according to a new report from the Government Accountability Office.

The report confirms a suspicion that has been talked about for a long time. “It is everything many of us believed for years,” said Iraq veteran Kristopher Goldsmith, who is an assistant director at Vietnam Veterans of America. “Now I hope Congress will direct the resources to making it right.”

The report showed that 62 percent of all service members who were discharged for misconduct between 2011 and 2015 had been diagnosed with PTSD, a traumatic brain injury (TBI), or other conditions that can cause similar behavior. That totals over 57,000 soldiers. Out of the 57,000, 16 percent had PTSD or TBI.

The majority of the rest had adjustment and alcohol-related disorders. Those include depression, anxiety, personality disorders, different kinds of substance addictions, or bipolar disorder. Twenty-three percent of the soldiers discharged got an “other than honorable” discharge. This means they are, in most cases, not eligible for any military health care, disability pensions, or other benefits.

GAO Reports that 62% of Soldiers Separated for Misconduct Have PTSD or Other Disorders https://t.co/nwaqKoHH1A pic.twitter.com/5jFIvizWw5

— The Alt Standard (@TheAlt_Media) May 17, 2017

The military has long been criticized for not doing enough to help its veterans. Now experts are also criticizing President Donald Trump’s new health care bill; it passed the House earlier this month. The new bill categorizes PTSD as a pre-existing condition, which could make health insurance inaccessible to millions of veterans.

Given that Trump campaigned on the promise to do more for veterans, a lot of people slammed the new bill. Illinois Senator Tammy Duckworth lost her legs while serving in the Iraq war. She called the health care bill “stunning” for making it harder for veterans to get access to health care.

We need to reduce barriers to mental health care for service members & vets – not make PTSD a pre-existing condition #VeteransResist #NoAHCA

— Ruben Gallego (@RepRubenGallego) May 13, 2017

After speculations first broke that soldiers suffering from PTSD or TBI were frequently discharged, the military introduced regulations, screening soldiers to detect any such diseases before punishing them. But the GAO report showed that this rarely happened. And no one monitored the new regulations to check for compliance.

“Before, we were speculating. Now we have hard numbers to prove there are this vast numbers of combat veterans affected,” said Representative Mike Coffman, a Republican from Colorado and an Iraq War veteran. He said he believes that people want to do something about the problem, but that there has been a lack of understanding. Hopefully, this new information will lead to some change.

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

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Many people see shopping as a hobby or something to look forward to, but for people with autism, it is a hard task that often becomes overwhelming because of the crowds and noises. That is why some stores in the U.S. are now organizing days of “silent shopping” specifically for people on the autism spectrum and just in time for the holidays. Patti Erickson from the Greater Philadelphia Autism Society started the initiative and got her local Toys R Us store to catch on. On Saturday, the store hosted an event that attracted more than 30 families.

For silent shopping, the music normally playing in the store is turned off. “They’re processing it differently, and it could maybe even sound like nails scratching on a chalkboard to them,” said Erickson, who has a 26-year-old daughter with autism. Sensory stations with toys and kinetic sand were set up in the store to offer a distraction that the kids could focus all their attention on if they needed a break. “Different sensory things help them get acclimated to the store and grounds their body so they can really stay focused and can almost ignore anything else around them that would bother them,” according to Erickson.

For families of those on the autism spectrum, shopping can be difficult. Some stores are now offering quiet shopping https://t.co/ck8xndClAM pic.twitter.com/V7o2wXg4aj

— CNN (@CNN) December 9, 2016

Autism is defined by difficulties in social interaction and communication, and engaging in repetitive behaviors. Though some people on the autism spectrum excel at specific skills–like music, art, and mathematics–some cannot function on their own. People with autism often have trouble communicating verbally what they want or how they feel–about a third are nonverbal, but communicate through body or sign language instead. This makes it extra hard for parents who are holiday shopping and trying to determine what their kids want while avoiding situations that can be stressful for their children and people nearby.

We’ve teamed up with @ToysRUs in #Miami for #autism friendly quiet shopping hours on 12/10/2016. Learn more –> https://t.co/6o0CBX7AAx pic.twitter.com/8hegz72VWz

— American Autism Assn (@MyAutism) November 28, 2016

“When you have those parents who mutter under their breath and stare, you know, it hurts. A smile versus a stare makes such a difference,” Linda Moser, mother of 10-year-old Adam who was at the Pennsylvania store, told CNN. But at the same time, it can be good to practice difficult situations both for parents and children. “If we’re avoiding those situations, we’re not able to teach them how to navigate them,” said Candice Colón-Kwedor from the May Institute School for Autism and Developmental Disabilities. The ultimate goal for family members of children with autism is that they can go into stores or public places and enjoy it.

After the silent shopping success, more stores are following the lead this Saturday, like the Target in Lancaster, Pennsylvania and the Toys R Us in Miami. If more businesses join the cause, it could lead to a meaningful lesson in diversity. When more individuals with autism were seen out and about, the general public’s knowledge and acceptance of autism might increase. “When you have something like this, it makes it easier on everyone, and that can mean so much to a family,” Erickson said.

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

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A Human Rights Watch report released this month titled “Callous and Cruel: Use of Force Against Inmates With Mental Disabilities in U.S. Jails and Prisons,” reported on the treatment of mentally ill inmates in prisons. The report documented major abuses in the prison system and major flaws in the availability of mental health services, and indicates that mentally ill do not do well in the American prison system. But why do they end up in correctional facilities in the first place? Read on to learn about mental health care in the United States and how it intersects with criminal justice.

How many mentally ill people are in correctional facilities?

People with mental illnesses are heavily represented in correctional facilities across the United States. In 2006, mentally ill inmates numbered 705,600 in state prisons, 78,800 in federal prisons, and 479,900 in local jails. In 2009, mentally ill individuals were on parole and probation at rates two to four times the general population. As of 2012, there were 356,368 mentally ill inmates in American jails and prisons. At the same time, psychiatric facilities hosted only 35,000 mentally ill patients, ten times less than the number of mentally ill inmates housed in correction facilities.

By various estimations, 20 percent of jail inmates and 15 percent of state prisoners, including violent and non-violent offenders, have some sort of mental ailment. Some of them were born with mental illnesses, while many acquired mental disabilities as the result of various circumstances. 

Why are so many mentally ill Americans in the prison system?

In order to understand why so many mentally ill Americans end up in correctional facilities instead of psychiatric hospitals, it’s important to look at the history and the changing dynamics of mental health care in the United States.

Using prisons and jails to house mentally ill people is not a new phenomenon. In fact, from 1770 to 1820, individuals with mental disabilities were routinely confined to correctional facilities. This practice was condemned as cruel and inhumane. As a result, the government asserted its obligation to care for and treat mentally ill people in a more suitable environment, creating a wide net of mental health hospitals across the country. Before the 1940s, the majority of mentally ill individuals, especially those with severe mental ailments, were housed in public mental institutions.

This situation changed in the beginning of 1950s. The government was again criticized for the inhumane treatment of mentally ill patients, now housed in psychiatric facilities, resulting in the inception of the deinstitutionalization movement. From this point on, instead of providing treatment and care in public mental hospitals, the government shifted the policies toward community-based treatment centers. The deal was sealed by the Mental Health Centers Act of 1963 that pushed mental health care away from state-run psychiatric hospitals and toward community-based centers. These changes allowed those with mental ailments to live in the community while receiving treatment at nearby mental facilities.

But in practice, this shift in policies created a disconnect between the care and treatment of mentally ill people, especially those with severe and chronic mental ailments. After deinstitutionalization, many were left without needed care as the government’s focus shifted toward outpatient mental services.

Shifting mental health policies toward outpatient services and breaking the link between treatment and care resulted in the decline of inpatient care and depreciation of state mental hospitals. In 1959, public psychiatric hospitals housed 559,000 mentally ill patients, by the late 1990s there were only 70,000 patients in such facilities. Now, there are only 35,000 patients in psychiatric hospitals, the lowest number in decades. Most states don’t even have enough psychiatric beds. From 2009-2012, the government disposed of 4,500 beds in public psychiatric hospitals. For example, Connecticut has only 20 beds per 100,000 people, while the nationally recommended standard is 50 beds per 100,000 people.

Thus, the deinstitutionalization of mental health services shifted public spending toward prescription drugs and outpatient treatment, largely ignoring the needs of those mentally ill people who required inpatient treatment. At the same time, access to outpatient mental health services proved to be worse than access to any other health services. In 2010, there were 156,300 mental health counselors in the United States. It’s estimated that 89.3 million Americans are living in areas that lack mental health professionals.

Mental health care is very expensive. In fact, 45 percent of people who suffer from some sort of mental illness fail to receive appropriate treatment due to the high costs associated with mental health services. A quarter of those who are mentally ill and have sought outpatient mental health services end up largely paying for treatment themselves, with out-of-pocket costs ranging from $100 to $5,000.

From 2009 to 2012, state governments, who pay most of the mental health care costs, also cut $5 billion from their funding overall, negatively influencing the availability and price of outpatient mental health services. 

The failure of the current mental health system to treat and care for people with severe and chronic mental illnesses paired with the lack of access to outpatient services is what has brought so many mentally ill people into the prison system. Those who have severe and/or chronic mental illnesses and cannot get access to outpatient mental health treatment, often end up in the criminal justice system. Before deinstitutionalization mentally ill people with severe and chronic illnesses were hospitalized, reducing their chances to break the law and come in contact with law enforcement. Some experts argue that beginning in the 1970s the United States has turned back toward incarceration practices resembling the 1800s paradigm of confining mentally ill people instead of treating and caring for them.

How do people with mental illnesses end up in the prison system?

Often, mentally ill people are arrested for crimes that could be avoided with proper mental health treatment or inpatient services. Those crimes are more bothersome than dangerous, and can include disorderly conduct, trespassing, disturbing the peace, and public intoxication. 

As 25-50 percent of mentally ill people in American prisons also suffer from substance abuse disorders, and 60 percent reported using drugs, alcohol, or both a month prior to their arrest, substance abuse issues can increase the likelihood of people with mental illnesses ending up in jail or prison. 

After initial contact with law enforcement, mentally ill individuals go through the court system. Due to harsh drug sentencing policies, such as “zero tolerance” and mandatory sentencing for certain drug offenses, mentally ill people are often sentenced to jail or prison terms.

All in all, those with mental disorders have a higher chance of coming into contact with law enforcement, mostly due to their mental condition. If they are regularly using drugs or alcohol, the chances are even higher. But, instead of offering treatment and support services to those with mental illnesses, the American justice system often uses the most punitive approach: incarceration.

What are the issues with incarcerating mentally ill individuals? 

Inadequate Staff Training

Inadequate staff training is one of the most important issues when talking about mentally ill people in the prison system. Many correction officers and jail deputies receive no guidance in how to interact with mentally ill inmates. Prison staff often don’t recognize symptoms of mental illness, nor do they use appropriate techniques, such as verbal de-escalation, when communicating with such inmates. Even when mental health professionals are available in the vicinity of the prison, guards rarely call for their intervention.

Physical Abuse

According to the recent Human Rights Watch Report, mentally ill inmates in American prisons and jails are regularly abused, including physically, by prison staff. The study cites the use of chemical sprays and stun guns as well as strapping mentally ill inmates to chairs and beds for prolonged periods of time. 

Solitary Confinement

Besides the fact that mentally ill inmates often suffer from physical abuse from prison or jail staff, they are also more often held in isolation, sometimes for months. According to a 2010 audit of three state prisons in Wisconsin, 55-75 percent of inmates in solitary confinement were mentally ill. Prolonged isolation of such inmates can exacerbate their conditions and increase symptoms of mental illness, often resulting in more misconduct instead of compliance.

Management Problems

As life in correctional facilities is heavily regulated and supervised, mentally impaired individuals can experience issues following rules, creating additional problems for prison guards. In many cases, their behavior is symptomatic, meaning that it’s conditioned by mental illness. They can  refuse to follow orders, and sometimes injure themselves, all things that can disrupt the daily routines of correction officers and other inmates. In some cases mentally ill inmates are provocative and can pose a danger to themselves or others.

Lack of Treatment

As prisons are not psychiatric hospitals, they often lack  mental health services as well as mental health professionals. Inmates are often not properly diagnosed, don’t have timely access to mental health services, and are often treated with medications only. Correctional facilities cannot usually aid mentally ill inmates in their recovery or even alleviate symptoms of their mental illnesses. In fact, the most helpful procedures for mentally ill patients are often not used in correctional facilities. Mentally ill inmates rarely receive therapeutic mental health interventions or participate in psychiatric rehabilitation programs.

Longer Stay

Mentally ill inmates usually stay in the prison system longer than those who have no mental issues. There are two primary reasons for this. First, mentally ill inmates can be less obedient due to their mental disorder, leading to additional charges and prolonged sentences. The other reason centers on the long waiting periods for beds in psychiatric hospitals. For example, in Florida’s Orange County Jail the average stay for mentally ill inmates is twice as long than for those without mental illnesses. In New York’s Riker’s Island Jail, the average stay for a mentally ill inmate is even longer—215 days–compared with 42 days for inmates without mental ailments. 

It’s Expensive

The cost of holding mentally ill inmates in prisons and jails is higher than average. This is due to the higher spendings on mental health services, including medications and staffing. It’s estimated that mentally ill inmates cost $130 a day, $50 more than average. The overall cost of incarcerating mentally ill inmates can be two to three times higher than average. 

Suicide & Rape

Mentally ill inmates are more likely to commit suicide than inmates who do not have mental illnesses. Multiple studies confirmed that the harsh prison conditions and the lack of proper treatment can increase the odds of suicide for this population. For example, a 2002 study of a Washington county jail noted that 77 percent of all suicides were committed by inmates with a mental illness. Sexual assault is another danger for mentally ill inmates. Many are are sexually assaulted, and their likelihood of being raped is higher than the general population in American prisons and jails. 

Watch the video below to get a full picture of mental health behind bars:

Conclusion

It’s evident that there are many issues with incarceration of mentally ill people, as there are many shortcomings and flaws in American mental health care, especially in prisons and jails. Such a system creates a cycle of incarceration for mentally ill people, by providing no remedies after the initial release. States should invest in more beds in public mental hospitals and provide better access to outpatient community treatment programs. It’s time to start treating and caring for the mentally ill, not just incarcerating them. 

Resources

Primary

National Institute of Corrections: Mentally Ill Persons in Corrections

Additional

Health Affairs: Mental Health Policy in America: Myths and Realities

The New York Times: Mentally Ill Inmates Are Routinely Physically Abused, Study Says

Human Rights Watch: Callous and Cruel: Use of Force against Inmates with Mental Disabilities in US Jails and Prisons

Washington Post: A Shocking Number of Mentally ill Americans End up in Prison Instead of Treatment

West Hartford News: Lawyers: Mentally Ill Need Services, not Prison

Treatment Advocacy Center: How Many Individuals with Serious Mental Illness are in Jails and Prisons? – Backgrounder

Mother Jones: There Are 10 Times More Mentally Ill People Behind Bars Than in State Hospitals

Stanford Law School: Three Strikes Project: When did Prisons Become Acceptable Mental Healthcare Facilities?

Washington Post: Seven facts about America’s Mental Health-care System

USA Today: Cost of Not Caring: Nowhere to Go

HNGN: Human Rights Watch: Mentally Ill Prisoners Are Abused In U.S. Correctional Facilities

The Sentencing Project: Mentally Ill Offenders in the Criminal Justice System: An Analysis and Prescription

Valeriya Metla

Valeriya Metla is a young professional, passionate about international relations, immigration issues, and social and criminal justice. She holds two Bachelor Degrees in regional studies and international criminal justice. Contact Valeriya at staff@LawStreetMedia.com.

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