With many of the nation's prisoners suffering from schizophrenia, bipolar disorder and major depression, mental illness has become a common part of prison culture.  Given the prevalence of mental disorders among inmates, corrections agencies across the country are struggling to address the treatment needs of the mentally ill.  According to a report published recently by Human Rights Watch (HRW), they have been largely unsuccessful at accomplishing this task.

That report, Ill Equipped: U.S. Prisons and Offenders with Mental Illness, focuses on issues pertaining to mentally ill offenders in U.S. prisons, such as the need to provide them with adequate health care while they are incarcerated and the importance of a continuing that care once they are released.  The 215-page report also addresses what corrections staff need to do to better serve the mentally ill inmate population, which HRW estimates to be between 200,000-300,000 men and women.

Based on its research, which includes interviews with corrections officials, mental health experts, inmates and lawyers, HRW made recommendations to the federal government and the public about what they can do to aid corrections agencies in accommodating mentally ill offenders.  In addition, the organization offers suggestions to prison officials and staff about how they can improve the mental health services they provide.

"My basic belief, from all of the research we have done, is that prisons have made a huge effort in the past 20 or 30 years [to improve their mental health services]," said Jamie Fellner, Director, U.S. Program of Human Rights Watch and an author of the report.  But, the mentally ill population in the prisons keeps increasing, she said.  "[The prisons] are always way behind [in addressing the needs of the mentally ill]."

Selecting Staff

To effectively accommodate the ever-growing population of mentally ill offenders, the report advocates that prisons employ an adequate number of experienced mental health workers.

"Quality mental health services cannot be provided without sufficient numbers of qualified staff with different areas of expertise," said the report.

To recruit and retain such employees, it recommends that corrections agencies offer employee incentives and competitive wages, but that may be difficult for departments to do during tough financial times.

"The staff issue, however you slice it, costs money," said Fellner, who believes that if states are going to put people in prisons, they need to provide corrections departments with enough money to care for them.

"The state has to pony up the funds," Fellner said.

Training to Treat

While increasing staffing levels and employee quality inevitably costs money, there are other changes prisons can make to improve their mental health services that won't be as financially burdensome, Fellner pointed out.

"Mental health training for corrections staff shouldn't be that much money," said Fellner, who believes that all staff, not just those who provide mental health services, should be educated about how to deal with the mentally ill.

"Every officer should have some training," Fellner said, noting that it is particularly important to train staff in how to de-escalate incidents involving mentally ill inmates and how to identify potentially suicidal offenders.  "I think there should be more training in the academy," she said.  Ongoing, in-service training is important as well, she added.

A Healing Place

Aside from hiring qualified staff and providing them with adequate training, the report says that corrections agencies should also have enough hospital beds and specialized care facilities to accommodate the mentally ill.

"Prisoners with serious mental health needs should not be removed from [specialized] facilities simply to free up space for others," according to the report.  "Nor should prisoners have to wait to be able to get the services they need."

Inmates with physical ailments, like strep throat or tuberculosis, would not be refused treatment because of space or financial constraints, Fellner said.  "Mental illness should be seen as the same," she said.

Limiting Lockdown

While mentally ill inmates should not be forced out of acute treatment areas, they also should not be placed in segregated confinement areas or maximum security facilities, according to the report.

"No psychiatrist would say it's a good idea to put people with certain illnesses in 23 [or] 24 hour-a-day lockdown situations," Fellner said.  "The stresses of that can be difficult for anybody."

Mentally ill inmates are segregated from general population in many states, however.  According to the report, in Oregon, 28 percent of the inmates in the state's most secure facilities are on the mental health caseload and nearly 30 percent of inmates who are in administrative segregation in California's prisons have mental health issues as well.

"[Offenders with mental illness] end up in segregation because [prisons] don't know what to do with them," Fellner said.  "It [happens] all across the country."

Continuing Treatment in the Community

While providing mentally ill inmates proper treatment during incarceration is a recommended goal for corrections agencies, the report also shed lights on the importance of ensuring that offenders have access to treatment once they are released back into the community.

"Prisons and community mental health systems need to develop comprehensive continuity-of-care protocols and programs to break the cycle of release-recidivism-reincarceration," according to the report.

"Some states have really done some aggressive things [to establish continuity of care]," said Fellner.  The report shows that Maine, Virginia and North Carolina have all been progressive in terms of helping prisoners secure medical benefits as soon as they are discharged from a correctional facility.

"You could have a big gap [if ex-offenders don't have immediate access to medical care]," Fellner said.  If they have access to treatment and choose to discontinue it, she said, "at least you've done everything you can."

Changing Mindsets

Connecting mentally ill ex-inmates with the community resources they need to stay healthy can be difficult at times, according to Herb Hoelter, Cofounder and Chief Executive Officer of the National Center on Institutions and Alternatives (NCIA).

"When you have people who have mental illness leave the correctional system, they're left with no system taking responsibility for them," Hoelter said.  "The mental health system generally doesn't want to deal with people who've committed crimes."

Similarly, there is no political motivation in this country to help offenders, Hoelter said.

"There doesn't seem to be any sympathy at all [for offenders]," Hoelter said.  "It's too easy and too politically correct in today's world [to ignore the treatment needs of inmates]."

Corrections, Hoelter believes, needs to make a commitment to address these treatment needs as opposed to focusing on inmate custody.

"There's plenty of money [in state corrections departments]," Hoelter said, pointing out that they typically receive the largest share of most states' budgets.  "Unfortunately, most systems response to that is to use it on more custody, more fences, sharper barbed wire."

A Path to Prison

While treatment for the mentally ill is important in corrections, there is a much broader issue at hand.

"The story begs the question, why are there so many mentally ill people in prison," said Martin Horn, Commissioner of the New York City Department of Correction.  "It's all well and good to point to corrections officials, but it is the much more fundamental, much more important question [that should be tackled]."

When states desinstitutionalized mental health care, many individuals with mental disorders found themselves living on the streets and committing crimes that landed them in prison.  Correctional facilities then faced the challenge of how to care for and treat the mentally ill inmate population.

"It's not as if the mental health community has been banging down the doors of the prison and asking to help," Horn said.  "This problem can't be solved by corrections officials [alone]."

Hoelter and Fellner agree that the overwhelming number of mentally ill people in prison is at the root of the problem of how to treat them.

 "We all have for years pushed the goal of reducing the incarceration of persons with mental illness," said Hoelter.

"You want to overall lower the [prison] populations of the mentally ill," Fellner added.  "If you had fewer people there, then the contrast between need for mental health services and supply wouldn't be as great." 

While reducing the number of mentally ill people who are incarcerated in the nation's prisons would ease the demand for treatment placed upon corrections agencies, the fact remains that a large proportion of inmates in this country suffer from mental disorders and require some type of specialized care.

"I think [the Human Rights Watch report] is a laudable effort," Hoelter said.  "I hope and wish that some of the recommendations they put forth would be implemented," he said.  "[But] I don't think it's paving new ground; It's just something that adds more fuel to the fire."

Resources:

To access HRW's Ill Equipped: U.S. Prisons and Offenders with Mental Illness, go to http://www.hrw.org/reports/2003/usa1003

To learn more about HRW, go to www.hrw.org

To contact Jamie Fellner, call (212) 290-4700

To learn more about NCIA, go to www.ncianet.org

To contact Herb Hoelter, call (703) 684-0373

To contact Martin Horn, call (212) 361-8977