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.

The post Are American Prisons Becoming Psychiatric Hospitals? appeared first on Law Street.