It is well known that mentally ill people do not function well in prison. However, by midyear 2005, more than half the people incarcerated in jails and prisons suffered from mental illnesses. Among these mental health problems were schizophrenia, bipolar disorder, and post-traumatic stress disorder (Schmalleger, & Smykla, 2009, p. 476). The mentally ill are a special needs population of offenders that cannot be ignored.
There are nearly eight times as many mentally ill people in prisons and jails than there are in mental hospitals. The three largest facilities in the United States that offer psychiatric treatment are the Cook County Jail in Chicago, Rikers Island in New York City, and the Los Angeles County Jail in California. In 1998, approximately 31 percent of females and 28 percent of males that were booked in the Los Angeles County Jail had some sort of mental disorder. It is estimated that Los Angeles County Jail spends $10,000,000 a year just on psychiatric medication for its inmates (Schmalleger & Smykla, 2009, p. 477).
There are many reasons that mentally ill people do not fair well in jail and prison. One of the primary factors is that the symptoms of their illnesses are considered to be discipline issues. Neglecting personal hygiene, ignoring orders, screaming, and banging walls can all be symptoms of various mental illnesses. However, these behaviors can often lead to an inmate being put into solitary confinement. For mentally ill inmates, this type of punishment may cause their condition to worsen (Smalleger & Smykla, 2009, p. 477).
To make matters worse, correctional staff usually receive very little training on the subject of mentally ill offenders. Once out of prison or jail, people who are considered to be serious psychotic offenders pose a greater risk to society. Because mentally ill people have difficulties understanding and remembering directions that the court gives, probation and parole staff find them more difficult to supervise. Additionally, behavioral requirements set by the court are often difficult to follow for someone that does not have the mental capacity to control his or her own behavior. Furthermore, community mental health resources that aid in maintaining stability of mentally ill offenders are frequently overburdened or not accessible. The result is not enough support for the mentally ill offender which leads to more behavior problems (McCarthy, McCarthy, & Leone, 2001, p. 317).
So, why are there so many mentally ill individuals entering the criminal justice system? In the past when someone’s mental condition had worsened to to point of being a danger, mental health professionals were the ones to respond (Schmalleger & Smykla, 2009, p. 478). Mentally ill individuals that exhibited bizarre behavior would have found themselves in a mental hospital. However, now the same behaviors can get them arrested and sent to jail (Schmalleger & Smykla, 2009, p. 477). Essentially, correctional facilities are becoming today’s mental hospitals. They are now forced to find ways to effectively deal with mentally ill residents (Scmalleger & Smykla, 2009, p. 478).
Dean Aufderheide, the director of mental health services for the Florida Department of Corrections has suggested that society as a whole begin to view mental illness as a chronic illness. In this way new strategies can be developed that can assist in dealing with mental illness inside prison and after release. An important factor to lowering recidivism for people with mental illness is to start therapy when they first enter the institution. This makes the transition from institution to community go much smoother (Schmalleger & Smykla, 2009, pg 479).
A prison in Indiana called Wabash Valley Correctional Facility has taken innovative steps to better ha ndle mentally ill offenders. In December of 2005, MSNBC aired its “Inside Wabash” episode. During this episode, the producers showed the program that Wabash Valley Correctional Facility now uses to house mentally ill offenders. If offenders become violent within Wabash, they are sent to the Secure Housing Unit (SHU), a form of solitary confinement, where they receive regular visits from a psychiatrist. If they are diagnosed with a mental illness, they are transferred to the Residential Treatment Unit (RTU). In RTU the inmates are given proper medication and gradually introduced to functioning around other people. When they are ready, new members of the program begin eating meals with other people in the RTU in the day room. Then, gradually they begin making small trips out into the other areas of the prison. The ultimate goal is to put them successfully into general population. Usually, when they are put in general population, they are assigned a cellmate that they already knew from the RTU. If they leave prison from the RTU, an after care program will be set up on the outside to provide treatment (MSNBC, 2005).
There are other valuable programs that aid in preventing mentally ill people from entering the prison system. One of the more popular of these programs was developed in Memphis in 1988 after one of the Memphis Police Department’s officers killed a person that was having schizophrenic hallucinations. The Memphis Police Department, the National Alliance for the Mentally Ill, and two local universities worked together to create a Crisis Intervention Team (CIT). The team was trained to recognize when people are in a state of psychosis. During such a state, normal police procedures would increase the chance of violence, confusion, and death. The reason is because when people are in a state of psychosis their perceptions and thoughts are not in line with reality. Therefore, CIT officers are taught to be less aggressive and more effective when dealing with a situation that involves someone in a state of psychosis. Furthermore, the officers experience a contraption called Virtual Hallucinations to help them understand what it is like to have a psychotic episode (Stephey, 2007).
In addition to the deescalation techniques to use when someone is having a psychotic episode, CIT officers, dispatchers, and other important personnel are educated about community health resources and options that are available to people with serious mental illnesses. For the Memphis CIT the University of Memphis medical center has a specialized triage unit reserved for individuals that are referred by the police department. The use of this triage unit has led to fewer arrests, better treatment outcomes, and reduced officer injuries (Schmalleger & Smykla, 2009, p. 479).
A more recent strategy used to keep mentally ill individuals out of jail and prison is called a mental health court. Similar to a drug court, a mental health court has a specialized docket for defendants with mental illnesses. It gives the defendants the chance to participate in court supervised treatment. A mental health court team usually consists of a judge, court personnel, and treatment providers. This team decides the rules for participation. They also continuously assess individuals to give them sanctions or rewards. After the individual successfully completes the court ordered treatment plan, the mental health court team decides the resolution for the case (Schmalleger & Smykla, 2009, p. 479). Mental health courts recognize that punishing a mentally ill person as though he or she were a criminal when their illness was the cause for the criminal act, is neither morally appropriate nor effective. To “protect the public” from mentally ill people that are committing criminal acts, mental health courts address the illness that led to the acts instead of treating the symptoms (Schmalleger & Smykla, 2009, p. 480).
There has been legislation that supports mental health courts. In 2000, the Law Enforcement and Mental Health Project Act made federal funds available to local jurisdictions that seek to create or expand mental health courts. In 2004, the Mentally Ill Offender Treatment and Crime Reduction Act allowed federal funds for jail diversion and mental health treatment for individuals with mental illnesses. It also authorized funding for community reentry services and training (Schmalleger & Smykla, 2009, p. 480).
Another seemingly less popular program exists in fifteen jurisdictions around the United States. The Assertive Community Treatment (ACT) programs consist of teams of social service professionals that provide a variety of services to individuals that are diverted from jails or are reentering communities following prison. Individuals in these programs have severe and persistent mental illnesses. The ACT social service professionals provide services that include medication and medication management, housing assistance, case management, substance abuse treatment, vocational supports, and mobile crisis management. The teams that are involved with ACT are focused on preventing mentally ill individuals from being cast aside and forgotten (Schmalleger & Smykla, 2009, p. 481).
In conclusion, it is obvious that the corrections system was not designed for mentally ill individuals. However, for whatever reason mentally ill people are finding themselves there more and more. Fortunately, corrections agencies have taken step to improve their treatment of mentally ill offenders. While it is not the responsibility of corrections agencies, the reality is that mentally ill people are winding up in corrections programs. The necessity now is to continue to expand and create programs for mentally ill people that divert them from jail and reduce recidivism within this population.
References
McCarthy, B. R., McCarthy, B. J., & Leone, M. C. (2001). Community-based corrections (4 th Ed.). California: Wadsworth Publishing.
MSNBC. (December 3, 2005). Lockup: Inside Wabash [Video file.]. Posted to http://www.hulu.com/watch/9033/lockup-inside-wabash
Schmalleger, F. & Smykla, J. (2009). Corrections in the 21st Century (4th Ed.). New York, NY: McGraw Hill.
Stephy, M. J. (August 8, 2007). Decriminalizing mental illness. Time. Retrieved from http://www.time.com/time/health/article/0,8599,1651002,00.html
