People with Serious Mental Illnesses in Jail and Prison
By Arthur Buchanan
People with mental illnesses often come into contact with the criminal justice system.
"Steven, 28, has bipolar disorder. He can maintain a normal family life and a job as a landscaper. He had never had problems with the law or any history of violent behavior. One night while he was driving, the police pulled him over. He heard voices telling him to keep going. He did, was shot in the hand, bitten by police dogs and arrested. He spent four months in jail, without the medication that had kept him stable. Eventually, he was found not guilty by reason of insanity and was hospitalized; the charges were dismissed. (Health Foundation of Greater Cincinnati, 8/00)
A man with a mental illness who was homeless was arrested in Florida for shoplifting an ice-cream sandwich that cost $ 1.16, then imprisoned because he lacked the $25 bail for release. (Sun-Sentinel, Ft. Lauderdale, 11/98)
Many lack access to adequate services through the public mental health system.
"Roy was so desperate for mental health treatment that he showed up at the courthouse and signed his commitment papers. On the day of his hearing, he packed, ready for a hospital stay, but the hospital couldn't take him for two months. "What am I supposed to do until then," he asked. No other services were offered him. Seven weeks later, Roy walked into the woods, strapped his belt around a low branch and stepped off a plastic bucket. His body was found a week later, on the day his mother got a call that the hospital was ready for him. (Time, 7/00)
"Seeking help for their 20-year-old son who was exhibiting unexplained paranoia, a Latino family called the community mental health crisis line. Nine hours later a mental health professional arrived with police. After a brief exam the mental health worker said the young man may need hospitalization and the officers agreed to take him to a mental health facility. Although they had found him passively sitting on a sofa, the officers used physical force, beating him with nightsticks and ultimately pepper-spraying the apartment. The family watched, stunned. The young man was diagnosed with schizophrenia and more than a year later remains withdrawn and unable to return to his job. His family is discouraged about accessing any public services. (Report from a Washington DC suburb, 4/02)
The criminal justice system is used to fill the void.
"A man with a history of epilepsy was arrested after appearing confused and disrupting service on a city bus. Upon release, he was found outside the jail banging his head on a wall and crying. He was then admitted to hospital, where he threatened people with pencils. Hospital staff called the police and allowed them to enter patient areas with firearms. After the man became agitated from complications associated with epileptic seizures, he was shot dead by a police officer. His family had brought his seizure medication to the hospital the day before, but they spoke only Spanish and no one could communicate with them. The medicine was set aside. (Mental Health Weekly, 6/01)
Once people are in the
criminal justice system, their mental health needs are not met.
"An Oregon man with a mental illness gouged out his eyes as he waited in a Portland jail cell for a psychiatric hospital bed. (The Oregonian 6/12/02)
"Romus was arrested and brought to the Orange County jail in New York, shouting gibberish. As a result of budget cuts, no psychiatrist was on call, so Romus was pepper-sprayed and shackled to a restraint chair, where he sat shouting, twisting and kicking for hours. Eventually, an officer dragged
Romus, in the chair, to the jail's mental health unit and pushed him in. (Middletown Times Herald-Record, NY, 7/01)
"Shawn, 20, diagnosed with schizophrenia, depression and bipolar disorder, has been in and out of state hospitals. He was arrested after punching a security guard who tried to stop him from stealing. While in jail awaiting a court hearing, Shawn has tried to kill himself at least four times. "I use razors, floor tiles, nails, screws, glass, anything," he says, "I want to die." When he tries to hurt himself, the jail locks him in the medical observation cell. "When I get locked up like that, all I do is cry, punch myself in the face, bang my head against the wall." Guards then strap him in a restraint chair. "There is not a day...that I don't think of killing myself," he told a reporter. "I just want help. I want this to end. I've come to the conclusion that death is the only way out." (Portland Press Herald, 11/01)
Criminal justice and mental health systems have not collaborated well.
"Paul, 24, was arrested for breaking and entering. While processing him, police saw that he was highly agitated and his behavior was strange. Concerned, the arresting officers called the area mental health center, a hospital, the state police and the District Attorney's office to find out what to do. While the various organizations argued over who should take him, Paul hanged himself in his cell. (Health Foundation of Greater Cincinnati, 8/00)
"Joseph is deaf, has a serious mental illness and cannot speak. He was arrested on a misdemeanor charge. Although the charges were dropped, he remained in the detention center for two years, lost somewhere between the city's criminal justice and mental health bureaucracies. (The Washington Post, 9/01)
Collaboration between mental health and criminal justice can lead to better outcomes.
"Richard, 43, has schizophrenia. He has been arrested 137 times for petty crimes such as trespassing and panhandling. Unwilling to take medication on his own, he was caught in a dangerous cycle, from jail to hospital to homelessness. Thresholds, a nonprofit rehabilitation agency, convinced a judge to release Richard to their custody. Now he has a single room the group provides for him, food, money and constant support. It took time, but Richard has been able to break his cycle of living on the streets or in prison. Over a year later, he remains arrest-free and says he has never felt happier. Thresholds costs $25 a day, while jail costs $75 a day. (Health Foundation of Greater Cincinnati, 8/00)
Individuals with Mental Illnesses in Jail and Prison
"Nearly two million new jail admissions are of people with mental illnesses"35,000 individuals a week.
"At the end of 2000, nearly one million individuals with mental illnesses were in the criminal justice system.
"More than 16% of jail inmates have a mental illness, according to the United States Department of Justice.
"Seventy percent of jail inmates with mental illnesses are there for nonviolent offenses.
Offenders with Mental Illness
In Jails : 101,000 individuals with mental illnesses were inmates in local jails at year-end 2000. Of these, 63,000 had a severe mental illness.
5 Jails are locally operated facilities that hold people pending arraignment or awaiting trial, conviction or sentencing. Sentencing is either to probation or incarceration in jail (generally under a year) or prison. There are 3,365 local jails.
"In Prisons : 201,000 individuals with mental illnesses were inmates in state (191,000 or 16.2%) and federal (10,000 or 7.9%) prisons at year-end 2000. Of these, 132,000 had a severe mental illness.
7 There are 1,558 adult correctional facilities housing state prisoners and 110 facilities housing federal prisoners.
"On Probation : 614,000 individuals (16%) with mental illnesses were on probation at year-end 2000. Of these, 315,000 had a severe mental illness.
8 Probation represents a more moderate sanction than incarceration. It is generally given to offenders with few or no prior convictions or to those guilty of less serious offenses.
Description of the Population
New Department of Justice data confirm previous research findings that most individuals with mental illnesses in the criminal justice system have had extensive experience with both the criminal justice and mental health systems and have a severe mental disorder and poor functioning.
As seen in this table on offenders with mental illnesss, on every item, in all settings"jails, state prisons, federal prisons and probation-offenders with mental illnesses are more likely than other offenders to have the reported problem.
1. Based on admission rates reported in Bureau of Justice Statistics Bulletin, Census of Jails, 1999 (August 2001, NCJ 186633, p. 5) multiplied by the percentage of jail inmates with a mental illness (16.3%) reported in Bureau of Justice Statistics Special Report, Mental Health Treatment of Inmates and Probationers (July 1999, NCJ 174463).
2. Calculated using the respective rates of mental illness reported in Bureau of Justice Statistics Special Report, Mental Health Treatment of Inmates and Probationers (NCJ 174463) and year-end jail and prison population numbers reported in Bureau of Justice Statistics Bulletin, Prisoners in 2000 (August 2001, NCJ 188207) and probationers reported in Bureau of Justice Statistics press release of August 26, 20001.
3. Bureau of Justice Statistics Special Report, Mental Health Treatment of Inmates and Probationers (NCJ 174463).
5. Based on self reports by inmates and probationers and, for severity, on overnight admissions to a mental hospital or treatment program.
6. Bureau of Justice Statistics Bulletin, Census of Jails, 1999 (August 2001, NCJ 186633).
7. Bureau of Justice Statistics Bulletin, Prisoners in 2000 (August 2001, NCJ 188207).
8. Bureau of Justice Statistics Special Report, Substance Abuse and Treatment of Adults on Probation, 1995 (March 1998, NCJ 166611).
9. Bureau of Justice Statistics Special Report, Mental Health Treatment of Inmates and Probationers (July 1999, NCJ 174463).
Policy to Address Issues Regarding People with Serious Mental Illnesses in the Criminal Justice System
The increase in the number of individuals with serious mental illnesses who come in contact with law enforcement officers or are booked into jail or sentenced to incarceration means that more and more individuals suffer significant harm. For example:
"They experience great trauma in connection with arrest, booking or detention.
"They are unnecessarily stigmatized by involvement with criminal justice.
"They are penalized in their eligibility for housing, employment and public benefits as a result of"and long after"arrest or detention.
The various parts of the criminal justice system also face major problems, including:
'repeated use of significant police time and judicial resources;
'significant stress among law enforcement personnel (for example, when individuals with depression try to encourage the officer to shoot them);
"occupancy of jail beds needed for more serious offenders;
"management problems in jail, often requiring suicide watch or causing major disruptions for jail staff;
"challenges to probation and parole officers who lack special training or are too few in number to work with people with serious mental illnesses;
"a scarcity of financial resources as a result of these and other issues.
Taking a Different Approach
What is needed is a new approach to policy that will:
"assure that individuals with serious mental illnesses do not end up in the criminal justice system when a mental health approach would be more appropriate or because of prior failures to make mental health services accessible;
"effectively move people with serious mental illnesses out of the criminal justice system more expeditiously; and
"ensure that those who have been arrested or incarcerated do not return.
Goals for Policy
Such policies will result in:
"better outcomes for the individual with mental illness;
"greater safety for all"the community, law enforcement officers, correctional staff, the individual with a mental illness and his or her family;
a more efficient criminal justice system;
"greater cost-effectiveness across the criminal justice and mental health system, as mental health issues are addressed earlier and in a more appropriate forum;
a more pleasant community for all.
Approaches That Have Been Tried
Many communities have adopted programs that will divert people with serious mental illness from the criminal justice system at various stages of the process:
"time of arrest (pre-booking diversion);
"as the individual's case is initially processed in the jail (pre-booking diversion);
"following booking, but without a trial (post-booking diversion);
"at adjudication or the trial stage (court-based diversion); or
"following incarceration (re-entry programs)
Diversion is most likely to succeed, to violate individual rights less and to be less costly to the criminal justice system if it occurs in the early stages of criminal justice processing. However, depending on the seriousness of the crime or the individual's prior history in the criminal justice system, this may not be feasible.
About The Author
Listen to Arthur Buchanan on the Mike Litman Show!