America’s “Mental Health Gulag”

The Crime Report
January 10, 2012

They say justice is blind. It must be to ignore the plight of the mentally ill in America’s prisons.

The Milwaukee Journal Sentinel’s recent two-part series on serious mental illness highlights the shortcoming inherent in a failed system. Wisconsin is far from the only state to push the mentally ill off on the criminal justice system.

An internal review of conditions inside a North Carolina prison, recently obtained by the Associated Press, found that inmates held in solitary confinement were often locked in cells for extended periods without being let out for meals, recreation time or even showers.

This past February, a North Carolina inmate being secured in solitary confinement had a doctor’s order requiring one hour of exercise per day in the prison’s day room. A review of prison records found that the inmate had not left his cell for 78 days consecutive days.

This is not an isolated case.

According to research published in the Harvard University Civil Rights-Civil Liberties Law Review, the mentally ill typically account for as much as one-half of the population in solitary confinement. In Wisconsin, a 2010 audit of three state prisons reported that “between 55 percent and 76 percent of inmates in segregation [solitary confinement] are mentally ill,” according to a report published in The Crime Report.

Last year, a Utah prisoner suffering from schizophrenia and bipolar disorder died of starvation and dehydration after spending four months in the Salt Lake County Jail. A significant period of his incarceration was spent in solitary confinement. Twenty-year-old Carlos Umana weighed approximately 180 pounds when he entered the jail; when he died, he weighed just 77 pounds.

Why would a young man suffering from mental illness, to the point that he would starve himself to death, be in prison?

According to National Public Radio, the answer is simple; the three largest inpatient psychiatric facilities in the country are the Los Angeles County Jail, Rikers Island in New York City and Cook County Jail in Illinois.

Jails and prisons are America's de facto psychiatric hospitals.

As a member of the Pennsylvania Board of Probation and Parole, my number-one priority is public safety. There are, at times, inmates with severe mental illness who might not be suited for prison. Nonetheless, many are also too dangerous to be released directly to the street.

During the 1960s, policymakers across the country decided to close mental health institutions in favor of community treatment. In 1955, there was one psychiatric hospital bed for every 300 Americans.

Today, according to the Treatment Advocacy Center, a Virginia-based non-profit dedicated to the treatment of severe mental illness, there is one psychiatric hospital bed for every 3,000 Americans. As the Journal Sentinel reported, there are 20 times as many people with mental illness in jails and prisons as there are in psychiatric hospitals.

As it became obvious that the community treatment experiment was not working, some policymakers found it easier and less expensive to stigmatize mentally ill persons as criminals and send them to prison, rather than to treat them with the attention and compassion that is required for those suffering from a debilitating disease.

Once in prison, mentally ill inmates have a difficult time getting out. Prison rules are often violated by offenders who believe cellmates, guards and even family at home are out to harm them.

The mentally ill are often targeted by fellow inmates who are aggravated by the strange manifestations brought on by their illness. Mentally diseased inmates may have a problem concentrating in programming and therefore fail to complete required treatment programs.

Prisons are not completely to blame.

Prison medical systems were not designed nor equipped to provide quality mental health services to prisoners in need. Seriously mentally ill inmates often face overworked or undermanned staff overwhelmed with the need to evaluate and implement treatment plans for an ever growing population of ill inmates.

Our board and the Pennsylvania Department of Corrections work extremely hard to assist inmates with mental illness transition back into the community. Some of my colleagues have committed considerable time and energy to this process.

Such efforts do not eliminate the fact that an absence of available psychiatric hospital bed space makes it extremely difficult to place those inmates with violent criminal histories and intensive treatment needs.

Until we are willing to acknowledge that our prisons have become de facto mental hospitals— and unless we are willing to make the hard and costly decisions that both protect the public and humanely treat those inflicted with disease— I believe the American mental health gulag will continue to indelibly blur the line between justice and expediency.