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Well, here is a little piece about prison life in America, as promised
“It is deplorable and outrageous that this state’s prisons appear to have become a repository for a great number of its mentally ill citizens. Persons who, with psychiatric care, could fit well into society, are instead locked away, to become wards of the state’s penal system. Then, in a tragically ironic twist, they may be confined in conditions that nurture, rather than abate, their psychoses.”
— Judge William Wayne Justice, Ruiz v. Johnson, 37 F. Supp.2d 855 (S.D. Texas, 1999).
Somewhere between two and three hundred thousand men and women in U.S. prisons suffer from mental disorders, including such serious illnesses as schizophrenia, bipolar disorder, and major depression. An estimated seventy thousand are psychotic on any given day. Yet across the nation, many prison mental health services are woefully deficient, crippled by understaffing, insufficient facilities, and limited programs. All too often seriously ill prisoners receive little or no meaningful treatment. They are neglected, accused of malingering, treated as disciplinary problems.
Without the necessary care, mentally ill prisoners suffer painful symptoms and their conditions can deteriorate. They are afflicted with delusions and hallucinations, debilitating fears, extreme and uncontrollable mood swings. 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.
Prisons were never intended as facilities for the mentally ill, yet that is one of their primary roles today. Many of the men and women who cannot get mental health treatment in the community are swept into the criminal justice system after they commit a crime. In the United States, there are three times more mentally ill people in prisons than in mental health hospitals, and prisoners have rates of mental illness that are two to four times greater than the rates of members of the general public. While there has been extensive documentation of the growing presence of the mentally ill in prison, little has been written about their fate behind bars.
Drawing on interviews with correctional officials, mental health experts, prisoners and lawyers, this report seeks to illuminate that fate. We identify the mentally ill in prison — their numbers, the nature of their illnesses, and the reasons for their incarceration. We set out the international human rights and U.S. constitutional framework against which their treatment should be assessed. We review their access to mental health services and the treatment they receive. We examine the various levels of care available to them; their confinement in long-term segregation facilities; the way prisons respond to their self-mutilation and suicide attempts; and the services they receive upon release from prison.
Our research reveals significant advances in mental health care services in some prison systems. Across the country there are competent and committed mental health professionals who struggle to provide good mental health services to those who need them. They face, however, daunting obstacles - including facilities and rules designed for punishment. The current fiscal crisis in states across the country also threatens the gains that have been made.
Our research also indicates the persistence in many prisons of deep-rooted patterns of neglect, mistreatment, and even cavalier disregard for the well-being of vulnerable and sick human beings. A federal district judge, referring in 1999 to conditions in Texas’ prisons, made an observation that is still too widely applicable:
Whether because of a lack of resources, a misconception of the reality of psychological pain, the inherent callousness of the bureaucracy, or officials’ blind faith in their own policies, the [corrections department] has knowingly turned its back on this most needy segment of its population.1
In the most extreme cases, conditions are truly horrific: mentally ill prisoners 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. A prison expert recentlydescribed one prison unit as “medieval…cramped, unventilated, unsanitary…it will make some men mad and mad men madder.” Suicidal prisoners are left naked and unattended for days on end in barren, cold observation cells. Poorly trained correctional officers have accidentally asphyxiated mentally ill prisoners whom they were trying to restrain.
Offenders who need psychiatric interventions for their mental illness should be held in secure facilities if they have committed serious crimes, but those facilities should be designed and operated to meet treatment needs. Society gains little from incarcerating offenders with mental illness in environments that are, at best, counter-therapeutic and, at worst dangerous to their mental and physical well-being. As another federal judge eloquently noted:
All humans are composed of more than flesh and bone — even those who, because of unlawful and deviant behavior, must be locked away…. Mental health, just as much as physical health, is a mainstay of life. Indeed, it is beyond any serious dispute that mental health is a need as essential to a meaningful human existence as other basic physical demands our bodies may make for shelter, warmth, or sanitation.2
Doing time in prison is hard for everyone. Prisons are tense and overcrowded facilities in which all prisoners struggle to maintain their self-respect and emotional equilibrium despite violence, exploitation, extortion, and lack of privacy; stark limitations on family and community contacts; and a paucity of opportunities for meaningful education, work, or other productive activities. But doing time in prison is particularly difficult for prisoners with mental illness that impairs their thinking, emotional responses, and ability to cope. They have unique needs for special programs, facilities, and extensive and varied health services. Compared to other prisoners, moreover, prisoners with mental illness also are more likely to be exploited and victimized by other inmates.
Mental illness impairs prisoners’ ability to cope with the extraordinary stresses of prison and to follow the rules of a regimented life predicated on obedience and punishment for infractions. These prisoners are less likely to be able to follow correctional rules. Their misconduct is punished — regardless of whether it results from their mental illness. Even their acts of self-mutilation and suicide attempts are too often seen as “malingering” and punished as rule violations. As a result, mentally ill prisoners can accumulate extensive disciplinary histories.
Our research suggests that few prisons accommodate their mental health needs. Security staff typically view mentally ill prisoners as difficult and disruptive, and place them in barren high-security solitary confinement units. The lack of human interaction and the limited mental stimulus of twenty-four-hour-a-day life in small, sometimes windowless segregation cells, coupled with the absence of adequate mental health services, dramatically aggravates the suffering of the mentally ill. Some deteriorate so severely that they must be removed to hospitals for acute psychiatric care. But after being stabilized, they are then returned to the same segregation conditions where the cycle of decompensation begins again.3 The penal network is thus not only serving as a warehouse for the mentally ill, but, by relying on extremely restrictive housing for mentally ill prisoners, it is acting as an incubator for worse illness and psychiatric breakdowns.
International human rights law and standards specifically address conditions of confinement, including the treatment of mentally ill prisoners. If, for example, U.S. officials honored in practice the International Covenant on Civil and Political Rights, to which the United States is a party, and the United Nation’s Standard Minimum Rules for the Treatment of Prisoners, which sets out detailed guidelines on how prisoners should be treated, practices in American prisons would improve dramatically. These human rights documents affirm the right of prisoners not to be subjected to cruel, inhuman, or degrading conditions of confinement and the right to mental health treatment consistent with community standards of care. That is, human rights standards do not permit corrections agencies to ignore or undertreat mental illness just because a person is incarcerated. The Eighth Amendment to the U.S. Constitution, which prohibits cruel and unusual punishment, also provides prisoners a right to humane conditions of confinement, including mental health services for serious illnesses.
Prisoners are not, however, a powerful public constituency, and legislative and executive branch officials typically ignore their rights absent litigation or the threat of litigation. U.S. reservations to international human rights treaties mean that prisoners cannot bring suit based on violations of their rights under those treaties. Lawsuits under the U.S. Constitution can only accomplish so much. Federal courts have interpreted the U.S. Constitution as violated only when officials are “deliberately indifferent” to prisoners’ known and serious mental health needs. Neglect or malpractice are not constitutional violations. In most states, prisoners cannot sue public officials under state law for medical malpractice. Finally, the misguided Prison Litigation Reform Act, enacted in 1996, has seriously hampered the ability of prisoners to achieve effective and timely help from the courts.
Mental health treatment can help some people recover from their illness, and for many others it can alleviate its painful symptoms. It can enhance independent functioning and encourage the development of more effective internal controls. In the context of prisons, mental health services play an even broader role. By helping individual prisoners regain health and improve coping skills, they promote safety and order within the prison community as well as offer the prospect of enhancing community safety when the offenders are ultimately released.
The components of quality, comprehensive mental health care in prison are well known. They include systematic screening and evaluation for mental illness; mechanisms to provide prisoners with prompt access to mental health personnel and services; mental health treatment that includes a range of appropriate therapeutic interventions including, but not limited to, appropriate medication; a spectrum of levels of care including acute inpatient care and hospitalization, long-term intermediate care programs, and outpatient care; a sufficient number of qualified mental health professionals to develop individualized treatment plans and to implement such plans for all prisoners suffering from serious mental disorders; maintenance of adequate and confidential clinical records and the use of such records to ensure continuity of care as prisoners are transferred from jail to prison and between prisons; suicide prevention protocols for identifying and treating suicidal prisoners; and discharge planning that will provide mentally-ill prisoners with access to needed mental health and other support services upon their release from prison. Peer review and quality assurance programs help ensure that proper policies on paper are translated into practice inside the prisons.
Many prison systems have good policies on paper, but implementation can lag far behind. In recent years, some prison systems have begun to implement system-wide reforms - often prompted by litigation - and innovative programs to attend to the mentally ill. Nevertheless, across the country, seriously ill prisoners continue to confront a paucity of qualified staff who can evaluate their illness, develop and implement treatment plans, and monitor their conditions; they confront treatment that consists of little more than medication or no treatment at all; they remain at unnecessarily high risk for suicide and self-mutilation; they live in the chaos of the general prison population4 or under the strictures of solitary confinement - with brief breaks in a hospital - because of the lack of specialized facilities that would provide the long-term supportive, therapeutically-oriented environment they need.
Providing mental health services to incarcerated offenders is frustrated by lack of resources. It is also frustrated by the realities of prison life. Correctional mental health professionals work in facilities run by security staff according to rules never designed for or intended to accommodate the mentally ill. For example, mentally ill prisoners are consigned to segregated units even though the harsh, isolated confinement in such units can provoke psychiatric breakdown. Moreover, the rules designed by security staff for prisoners in solitary confinement prevent mental health professionals from providing little more than medication to the mentally ill confined in these units; they cannot provide much needed private counseling, group therapy, and structured activities. Correctional staff who have the most contact with prisoners and who are often called upon to make decisions regarding their needs — particularly in the evenings when mental health staff are not present — often lack the training to recognize symptoms of mental illness and to handle appropriately prisoners who are psychotic or acting in bizarre or even violent ways. It is easy for untrained correctional staff to assume an offender is deliberately breaking the rules or is faking symptoms of illness for secondary gain, such as to obtain a release from solitary confinement into a less harsh hospital setting.
For more of this article and other links try this url www.hrw.org/reports/2003/usa1003/1.htm
Friends, i feel that it is our duty to see to it that people with mental illness start getting the same kind of treatment as people with other types of illnesses. Pleas write to you state representatives and senators and ask them to free our mentally ill from prison and give them the care that they need and deserve.
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