Prisons as Mental Institutions
The Mass Incarceration of the Mentally Ill

By JOANNE MARINER

Monday, Oct. 27, 2003

U.S. prisons and jails, packed with over two million inmates, hold many people that society would be wise to keep elsewhere. With state budgets bankrupted by the high costs of mass incarceration, the need to reconsider the draconian sentences meted out to nonviolent drug offenders has never been more obvious.

There is, moreover, another sizeable group of prisoners for which wholesale imprisonment is even less appropriate: the mentally ill. Prisoners with mental illness frequently endure violence, exploitation and extortion at the hands of other inmates, and neglect and mistreatment by prison staff. Not only is the experience of imprisonment counter-therapeutic for such prisoners, many mental health experts believe that it dramatically increases their chances of psychiatric breakdown.

Despite good reasons to limit the incarceration of the mentally ill, the number of mentally ill people behind bars continues to grow. Over the past few decades, the country's prisons and jails have become its default mental health system. Somewhere between two and four hundred thousand mentally ill people are incarcerated, several times more than the number of people living in mental institutions.

The results, from a therapeutic, humanitarian, and human rights perspective, are appalling. "We are literally drowning in patients," explains one California prison psychiatrist, "running around trying to put our fingers in the bursting dikes, while hundreds of men continue to deteriorate psychiatrically before our eyes."

"Criminalizing" the Mentally Ill

The American Psychiatric Association, in a study published in 2000, concluded that as many as one in five prisoners was seriously mentally ill, with up to 5 percent being actively psychotic at any given moment. It also estimated that over 700,000 mentally ill people were processed through prison or jail each year. The mental disorders affecting these prisoners include such serious illnesses as schizophrenia, bipolar disorder, and major depression.

There are no national data on historical rates of mental illness among prisoners, but state information suggests that the proportion of mentally ill prisoners has grown significantly. Human Rights Watch, in a report published last week, traces this increase to the inadequacy of the country's mental heath services.

With the "deinstitutionalization" effort that began in the 1960s, hundreds of thousands of mentally ill men and women were released from state institutions. These people escaped grim conditions and sometimes brutal treatment. They largely did not, however, obtain proper care after their release. Rather than receiving continuing mental health treatment, thousands of mentally ill people were released to communities that had made little or no accommodation for their care.

While states cut funding for mental hospitals, they have not made commensurate increases in their budgets for community-based mental health services. Chronically underfunded, the country's mental health system does not reach anywhere near the number of people who need it today.

Left untreated and unstable, mentally ill people enter the criminal justice system when they break the law. And given the punitive criminal justice policies of the past few decades, they often face long stays behind bars.

Neglect and Abuse

In a series of chilling passages in its recent report, Human Rights Watch described the abuses endured by the mentally ill while incarcerated.

To begin with, few prisons or jails have sufficient numbers of trained staff to accommodate prisoners' mental health needs. As a result, many mentally ill prisoners go untreated, or receive treatment that is extremely limited in both quantity and quality.

From other prisoners, who label them "dings" or "bugs," the mentally ill are vulnerable to assault, sexual abuse, exploitation, and extortion. From security staff, who frequently dismiss their symptoms as faking or manipulation, they may face physical abuse and mental harassment. Human Rights Watch cited numerous cases of correctional officers who taunted mentally ill prisoners, deliberately provoked them, physically mistreated them, used force against them maliciously, or turned a blind eye to abuses against them by others.

Viewing mentally ill prisoners as difficult and disruptive, correctional staff also frequently place them in barren high-security solitary confinement units. In these small, sometimes windowless cells, these inmates are deprived of nearly all human interaction and face extremely limited mental stimulus.

In such harsh conditions, some mentally ill prisoners deteriorate so severely that they must be removed to hospitals for acute psychiatric care. But after their condition stabilizes, they are frequently returned to the same segregation units until the next psychiatric episode occurs.

The Need for Reform

The immeasurable human suffering caused by the mass incarceration of the mentally ill is not only inhumane, it is unnecessary. While some dangerous offenders must be confined to protect society, there are many low-level, nonviolent offenders with mental illness who could be safely diverted into community-based mental health treatment programs.

By reducing the overall number of mentally ill prisoners, such programs would also free up prison resources that could be used to remedy the generally low quality of prison mental health care.

Federal legislation is currently pending in Congress to institute such reforms. The bill, called the Mentally Ill Offender Treatment and Crime Reduction Act, would provide federal grants to divert mentally ill offenders into treatment programs rather than prison or jail. It also allocates funding to improve the quality of prison and jail mental health services, and to establish discharge programs for mentally ill prisoners who are released.

It is a national shame that our prisons and jails serve as mental institutions. It reflects a lack of planning, a failure of public commitment, and a single-minded focus on punishment. The pending legislation represents a saner and more compassionate approach.


Joanne Mariner is a lawyer with Human Rights Watch. This article is based on Human Rights Watch's just-released report, "Ill-Equipped: U.S. Prisons and Offenders with Mental Illness," which was written by Sasha Abramsky and Jamie Fellner.

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