A Mad Prison System 
Mistreats the Mentally Disabled 

BILL BERKOWITZ / Street Spirit (San Francisco) 1feb04

Art by Cathy Cohen

"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 disabled prisoners are subjected to in U.S. correctional facilities in 2003.

According to "Ill-Equipped: U.S. Prisons and Offenders with Mental Illness," <www.hrw.org/press/2003/10/us102203.htm> written by Sasha Abramsky, a consultant to Human Rights Watch, and Jamie Fellner, director of the U.S. Program at Human Rights Watch, people "with mental illness are disproportionately represented in correctional institutions." One in six U.S. prisoners is mentally disabled and suffering "from serious illnesses such as schizophrenia, bipolar disorder, and major depression.... 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."

Congressman Ted Strickland told the House Subcommittee on Crime's Oversight Hearing on "The Impact of the Mentally Ill on the Criminal Justice System" that, "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." 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 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 disabled 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, housed in nearly 1,400 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 HRW 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 disabled, 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 man-date imprisonment."

In July, the President's New Freedom Commission on Mental Health issued a report entitled, "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 20 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 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." Dr. Kupers wrote, "We are warehousing and mistreating a huge number of mentally ill people — and many people are unaware of its ramifications."

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, 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 needed changes just when prison officials are being forced to institute reforms. "Litigation or the threat of it," the report argues, "is the prerequisite for systematic improvements in mental health services." Improvements in conditions in 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 lawsuits.

While litigation has been successful, with numerous consent decrees in place to mandate improved mental health ser-vices, still HRW finds "some correctional authorities resist putting reforms in place" because of "institutional inertia, bureaucratic obstacles, failure to under-stand the importance of adequate mental health services, or the lack of funding."

The HRW authors found that "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 often imperiled by state budge cuts. 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. Kupers told me in a phone conversation. "Of course it would help 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."

The Human Rights Watch report gives witness to one of the costs of dismantling the social safety net in state after state and community after community. Mentally disabled prisoners are human beings, and "we have a social responsibility to do some-thing about their pain and suffering."

To see the Human Rights Watch report, "Ill-Equipped: U.S. Prisons and Offenders with Mental Illness," go to their website: www.hrw.org/press/2003/10/us102203.htm.

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