Mental Illness In Prisons

The dangers of doing nothing about the mentally ill.
Unchecked mentally ill patients that fall through the cracks have demonstrated to be a great risk to the safety of all in this great nation (Perez R., 2007). We have seen in these recent times that mental illness gripping the mind of a human being can cause some of the greatest loss of innocent human life than we have ever seen. Instead of addressing the real root causes of these major catastrophic events, we see droves of people in powerful leadership positions wanting to place the blame on the weapon used to cause carnage. The weapon used to kill mass amounts of people is not the problem, however, the problem is mental illness, and the lack of solutions to this age old problem that has

swept under the carpet for so long. Something needs to be done or this situation will prove to be as dangerous to all in society as a foreign terror group.

Prison is not meant to be a mental institution.
Now that we have also looked at some of the obstacles and hurdles to this age old problem let’s look at how the prisons have been the default solution to this age-old problem of what to do with the mentally ill. Prisons were not built to be the catch-all for society’s mental misfits, they were built as a place to house the transgressors of the social contract of laws we all choose to abide by (Salvato, A. 1994). This nation is made up of laws and rules that govern the way we live and we as a society choose to abide by the laws made by the people for the people. When people choose to break these laws there has to be a place to put these people so they can live in a different society, and this society is a prison. Prisons have been the catch-all for the mentally ill which in turn has added to cost, security, and increase in population problems of running a prison (Stanek, R., 2012).

Reducing the number of State Owned Facilities: What happened?
With the closures of most Federal, State and Local Government run institutions due to budgets and reformations, the mentally ill have overcrowded our prisons (Warmsley, R., 2005). Are our prisons in the United States recognizing mental health as a serious issue, and what is being done to help? After found guilty and sentenced to a prison the mentally ill are screened by some prisons for mental illness. Once diagnosed with mental health issues a person has a constitutional right to needed care while they are in the care of the government, in contrast, a mentally ill person on the street has no constitutional rights to any medical or psychological care. A Bureau of Justice Statistics Special Report cites a 2000 Census of State and Federal Adult Correctional Facilities, an enumeration of all 84 federal facilities, 1,320 state facilities, and 264 private facilities in operation on June 30, 2000, and found a large percentage of state prisons do in fact conduct screenings and provide some sort of treatment (Beck, 2001):
• 70% - Screen inmates at intake
• 65% - Conduct psychiatric assessments
• 51% - Provide 24-hour mental health care
• 71% - Provide therapy/counseling by trained mental health professionals
• 73% - Distribute psychotropic medications to their inmates
• 66% - Help released inmates obtain community mental health services
With these numbers we can see prisons, therefore, rather than solely a place to house offenders has become a health services facility. Most prisons are not on board or readily equipped care for those who are gripped by a severe mental illness (Strickland, T., 2002). The burden and cost of mental illness is substantial and continually growing causing the need for health care official, programs, and facilities to protect, preserve, and treat mental illnesses. Mental health in prison is a whole prison concern (Warmsley, R., 2005). A majority of prisoners have complex problems that are multi-layered and do not stop with labels such as mental illness and addiction. The severe mentally ill often struggle with homelessness, relationships, poverty, basic life skills, and survival making it very difficult for successful reintegration into society upon release from prison (Salvato, A., 1994). With the lack of places to turn for help and proper care, prison too often has become the defaulted location for those who are afflicted with severe mental illnesses.

Illness and Treatment in the prison system
A further challenge is for prison not only to explain its function to wider society but also to set out its limitations. Prison is not a place where the mentally ill need to be hidden away because society has no other answers of what to do (Knowles, 2015). Prison does not need to be turned into a catch-all alternative to mental health institutions. The failures of deinstitutionalization efforts in removing the mentally ill out of state hospitals by reconnecting the afflicted with communities as an effort to help caused our prisons equipped or not to be the new hospital for the mentally ill (Dlugacz, H. A., 2014).
A large number of men/women with severe acute and chronic mental illnesses such as schizophrenia, manic-depressant illnesses go undetected (Beck, 2001).

People with these types of illnesses have serious impairments in everyday functioning. Mentally ill people often display simple problem-solving skills and motivation to participate in their communities or family functions (Torrey, 1997). These illnesses can cause lack in relationships, irrational behavior, and violence, mental and physical deterioration leading to suicide (Salvato, A., 1994). Prisons are often poorly equipped to recognize the mental illnesses and too often blanket the problem as behavioral issues. Two to four percent in state prisons and 1.0 to 1.1 percent of jail inmates have schizophrenia or another psychotic disorder, according to the National Commission on Correctional Health Care’s (NCCHC) clinical guidelines for the treatment of schizophrenia in correctional institutions. The guidelines also cite the fact that many of these mentally ill inmates have other risk factors associated with a higher incidence of violent behavior, such as substance abuse, neurological impairment, and poor impulse control (NCCHC). One of every eight state prisoners was receiving mental health therapy or counseling services in mid-2000 (Bureau of Justice Statistics Special Report: Mental Health Treatment in State Prisons, 2000), and nearly 10 percent were receiving psychotropic medications, such as antidepressants, stimulant,

tranquilizers, sedatives and other anti-psychotic drugs. The use of these drugs was the most common in facilities specializing in mental health confinement (Dlugacz, H. A., 2014).

Corrections Officers are seldom prepared.
Too often prisons are lacking in properly trained and fully equipped staff and facilities that can effectively house and treat the mentally ill (Coffey P., 2012). Not only do most prisons struggle in these areas, but the fact that they are located in remote areas where there is a lack of specialized trained health care providers available (Coffey P., 2012). With these inadequately equipped and staffed prisons comes lack of available funding for corrections and mental health services causing added stress on the already mentally inflicted inmate. Inmates with schizophrenia or other psychotic illnesses are under more stress from incarceration, explains Gary Seven, MD, CCHP, regional medical director, MHM Services, which serves the Oakwood Correctional Facility, Columbus, Ohio. When they violate rules, they are transferred to maximum security. Many of them have been segregated, causing their mental illness to deteriorate further (Gater, 2005). For the most part, maximum secure prisons allow inmates out of their cells typically 10 hours a week for daily visits to the psychiatric health care nurse and group counseling sessions. The programs range from learning how to control anger to substance abuse to music and art therapy. The treatment provided to inmates should meet the standard of care in the community, but the problem is that psychotropic medications are all very expensive (Knowles, 2015). Medication costs for mentally ill inmates at a large facility can run into millions of dollars per year (Torrey, 1997). Along with the treatments for mental illness inmates have to often be put on 24-hour suicide watch. Suicide is the 3rd leading cause of death among the incarcerated in the United States (Gater, 2005). An active education campaign is under way to teach staff what to do for someone who is suicidal. Bad news from home or a very long prison sentence can also cause an inmate to attempt suicide. Depression and suicide is a significant component of mental health services and it must be taken seriously in order to preserve the lives of those who are gripped with a mental illness (Knowles, 2015). For the mentally ill to be appropriately treated, there has to be a full spectrum of care, from counseling to inpatient care for those who are very sick or suicidal. A correctional facility must have adequate suicide prevention measures in place (Gater, 2005).

Solitary Confinement of the Mentally Ill, Right or Wrong?
What happens to the mentally ill in the prison system?

The 8th Amendment to the US Constitution that protects against, “Cruel and Unusual Punishment” is often violated by the prisons system. The Americans Disabilities Act (ADA) and the Rehabilitation Act are the two most commonly ignored rights mentally ill inmates inadvertently endure. Of the inmates in solitary confinement, 30% or more suffer from a mental illness. The (ADA) is supposed to protect mentally ill inmates from discrimination on the basis of their disability. Most prisons, due to lack or ill-equipped staff or facilities to handle severe mentally ill inmates, often slip into gross negligence or violations of basic constitutional rights. Examples of these violations are when they isolate mentally ill inmates directly because of their actual mental illness, prolong mentally ill inmates in solitary confinement causing deterioration, or failure to provide access to aids, benefits, or services to the mentally ill inmates (Knowles, 2015). The United States incarcerates more prisoners in solitary confinement than any other country in the world an estimated 80,000 prisoners nationwide (Knowles, 2015). This extreme form of isolation often lasts for years and sometimes decades. By contrast, the United Kingdom confines just 500 prisoners in isolation, and only for limited periods of time (Jacobi J. V., 2005). The United States also imprisons a disproportionate number of mentally ill inmates in solitary confinement, also

known as the "SHU" (security housing unit) or the "hole." In New York State, for example, nearly one-third of the prisoners in solitary confinement have been diagnosed with either schizophrenia or bipolar disorder. Remarkably, the average solitary confinement sentence for New York inmates with mental illness is also six times longer than that of the general inmate population (Knowles, 2015).