More Mentally Ill in Prison Than in Hospitals

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More Mentally Ill in Prison Than in Hospitals

Wed Oct 22 18:07:39 2003

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United States: Mentally Ill Mistreated in Prison

More Mentally Ill in Prison Than in Hospitals

 

(New York, October 22, 2003) - Mentally ill offenders face mistreatment and

neglect in many U.S. prisons, Human Rights Watch charged in a report

released today.

 

One in six U.S. prisoners is mentally ill. Many of them suffer 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.

 

According to the 215-page report, Ill-Equipped: U.S. Prisons and Offenders

with Mental Illness, prisons are dangerous and damaging places for mentally

ill people. Other prisoners victimize and exploit them. Prison staff often

punish mentally ill offenders for symptoms of their illness - such as being

noisy or refusing orders, or even self-mutilation and attempted suicide.

Mentally ill prisoners are more likely than others to end up housed in

especially harsh conditions, such as isolation, that can push them over the

edge into acute psychosis.

 

" Prisons have become the nation's primary mental health facilities, " said

Jamie Fellner, director of Human Rights Watch's U.S. Program and a co-author

of the report. " But for those with serious illnesses, prison can be the

worst place to be. "

 

Woefully deficient mental health services in many prisons leave prisoners

undertreated - or not treated at all. Across the country, prisoners cannot

get appropriate care because of a shortage of qualified staff, lack of

facilities, and prison rules that interfere with treatment.

 

According to Human Rights Watch, the high rate of incarceration of the

mentally ill is a consequence of underfunded, disorganized, and fragmented

community mental health services. State and local governments have shut down

mental health hospitals across the United States, but failed to provide

adequate alternatives. 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 mandate

imprisonment.

 

" Unless you are wealthy, it can be next to impossible to receive mental

health services in the community, " said Fellner. " Many prisoners might never

have ended up behind bars if publicly funded treatment had been available. "

 

The Human Rights Watch report is based on more than two years of research

and hundreds of interviews with prisoners, corrections officials, mental

health experts and attorneys.

 

It describes prisoners who, because of their illness, rant and rave, babble

incoherently, or huddle silently in their cells. They talk to invisible

companions, living in worlds constructed of hallucinations. They lash out

without provocation, beat their heads against cell walls, cover themselves

with feces, mutilate themselves until their bodies are riddled with scars,

and attempt suicide.

 

The Human Rights Watch report documents how prisoners with mental illness

are likely to be picked on, physically or sexually abused, and manipulated

by other inmates, who call them " bugs. " For example, a prisoner in Georgia,

who is both mentally ill and mildly retarded, has been raped repeatedly and

exchanges sex for commissary items such as cigarettes and coffee.

 

Mentally ill prisoners can find it difficult if not impossible to comply

with prison rules, and end up with higher than average rates of disciplinary

infractions. Security staff - who usually lack training in mental illness -

do not distinguish between the prisoner who is disruptive or fails to obey

an order because of illness and a prisoner who causes problems for other

reasons.

 

Mentally ill prisoners have been punished for self-mutilating ( " destroying

state property " ); attempting suicide with a torn sheet ( " destroying state

property " ); for yelling and kicking cell doors because of hearing voices

( " creating a disturbance " ); for throwing papers at a guard while delusional

( " battery " ); and for smearing feces on the cell door ( " being untidy " ).

Untrained staff escalate confrontations with mentally ill prisoners,

sometimes using excessive force. Several mentally ill prisoners have died

from asphyxiation after struggling with guards who used improper methods to

control them.

 

Over the past two decades, prison mental health services in the United

States have improved - usually because of prisoner litigation. But the

surging number of mentally ill men and women entering prison has outrun the

availability of services. Public officials have been unwilling to provide

the funds necessary to ensure adequate treatment for all the mentally ill

offenders who need it.

 

" Prison officials are being asked to do something they aren't equipped to

do, " said Fellner. " Prisons are designed for punishment, not as places to

provide comprehensive mental health treatment. If people with mental illness

must be incarcerated, they should be housed in facilities designed and

funded to meet their mental health needs. "

 

Human Rights Watch urged the U.S. Congress to enact legislation proposed by

Senator Mike DeWine (R-Ohio) and Congressman Ted Strickland (D-Ohio) that

would provide federal grants to divert mentally ill offenders into treatment

programs rather than jail or prison, and to improve the quality of mental

health services provided to jail and prison inmates.

 

Human Rights Watch also recommended the use of independent mental health

experts to assess mental health services in each prison system, urged

elected officials and the heads of correctional agencies to ensure that

mentally ill prisoners receive mental health services consistent with

community standards of care, and called for rules to prevent housing

prisoners with mental illness in isolated confinement or super maximum

security prisons.

 

The report is available at: http://www.hrw.org/reports/2003/usa1003

 

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