Two articles from NY Times on how jails are being used as mental
health facilities:


New York Times, October 22, 2003

Study Finds Hundreds of Thousands of Inmates Mentally Ill

By FOX BUTTERFIELD

As many as one in five of the 2.1 million Americans in jail and prison
are seriously mentally ill, far outnumbering the number of mentally
ill who are in mental hospitals, according to a comprehensive study
released Tuesday.

The study, by Human Rights Watch, concludes that jails and prisons
have become the nation's default mental health system, as more state
hospitals have closed and as the country's prison system has
quadrupled over the past 30 years. There are now fewer than 80,000
people in mental hospitals, and the number is continuing to fall.

The report also found that the level of illness among the mentally ill
being admitted to jail and prison has been growing more severe in the
past few years. And it suggests that the percentage of female inmates
who are mentally ill is considerably higher than that of male inmates.

"I think elected officials have been all too willing to let the
incarcerated population grow by leaps and bounds without paying much
attention to who in fact is being incarcerated," said Jamie Fellner,
an author of the report and director of United States programs at
Human Rights Watch.

But, Ms. Fellner said, she found "enormous, unusual agreement among
police, prison officials, judges, prosecutors and human rights lawyers
that something has gone painfully awry with the criminal justice
system" as jails and prisons have turned into de facto mental health
hospitals. "This is not something that any of them wanted."

Reginald Wilkinson, director of the Ohio Department of Rehabilitation
and Correction, said the "mere fact that this report exists is
significant."

"Some people won't like it, and the picture it paints isn't pretty,"
Mr. Wilkinson said. "But getting these facts out there is progress."

Many of the statistics in the study have been published before by the
Justice Department, the American Psychiatric Association or states.
But the study brings them together and adds accounts of the
experiences of dozens of people with mental illness who have been
incarcerated.

The study found that prison compounds the problems of the mentally
ill, who may have trouble following the everyday discipline of prison
life, like standing in line for a meal.

"Some exhibit their illness through disruptive behavior, belligerence,
aggression and violence," the report found. "Many will simply -
sometimes without warning - refuse to follow straightforward routine
orders."

Where statistics are available, mentally ill inmates have higher than
average disciplinary rates, the study found. A study in Washington
found that while mentally ill inmates constituted 18.7 of the state's
prison population, they accounted for 41 percent of infractions.

This leads to a further problem - mentally ill inmates who cannot
control their behavior are often, and disproportionately, placed in
solitary confinement, the study found.

Solitary confinement is particularly difficult for mentally ill
inmates because there is even more limited medical care there, and the
isolation and idleness can be psychologically destructive, the report
says.

Medical care for mentally ill inmates is often almost nonexistent, the
study says. In Wyoming, a Justice Department investigation found that
the state penitentiary had a psychiatrist on duty two days a month. In
Iowa, there are three psychiatrists for more than 8,000 inmates.

There is no single accepted national estimate of the number of
mentally ill inmates, in part because different states use different
ways to measure mental illness.

The American Psychiatric Association estimated in 2000 that one in
five prisoners were seriously mentally ill, with up to 5 percent
actively psychotic at any given moment.

In 1999, the statistical arm of the Justice Department estimated that
16 percent of state and federal prisoners and inmates in jails were
suffering from mental illness. These illnesses included schizophrenia,
manic depression (or bipolar disorder) and major depression.

The figures are higher for female inmates, the report says. The
Justice Department study found that 29 percent of white female
inmates, 22 percent of Hispanic female inmates and 20 percent of black
female inmates were identified as mentally ill.

One reason some experts have suggested for the higher numbers among
female prisoners is that psychologists and psychiatrists working in
prisons tend to be more sympathetic to women, finding them mentally
ill, while they tend to evaluate male inmates as antisocial or bad.

But Mr. Wilkinson said, "I think the differences are real; more female
inmates are mentally ill." He suggested that prisons were seeing more
severely mentally ill inmates now "only because the volume is
greater," meaning that the number of people in prison has increased.

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New York Times, October 22, 2003

Report on State Prisons Cites Inmates' Mental Illness

By PAUL von ZIELBAUER

Nearly one of every four New York State prisoners who are kept in
punitive segregation - confined to a small cell at least 23 hours a
day - are mentally ill, according to a new report by a nonprofit group
that has been critical of state prison policies.

One in five of the roughly 5,000 prisoners punished with that
isolation have a serious drug problem, the report said. But despite
graphic evidence that the most acutely ill prisoners in punitive
segregation, or lockdown, often grow only more troubled and violent,
the state Department of Correctional Services, which runs the state's
70 prisons, rarely does anything to help them, said the report,
released yesterday by the group, the Correctional Association of New
York.

To the contrary, when inmates in punitive segregation try to hurt or
kill themselves, the department's policy is to punish them with
additional lockdown time, according to the report. About half of the
258 inmates interviewed by the report's authors said they had
attempted suicide in prison. Many prisoners spend years under
lockdown.

The findings of the association, an inmate-advocacy group, are based
on state records, the authors' visits to 29 state prison lockdown
units and interviews with hundreds of prisoners, correction officers
and prison supervisors. The association, established in 1844, is
authorized by state law to visit prisons and interview inmates and
employees.

The Correctional Services commissioner, Glenn S. Goord, declined to
comment yesterday on the report's specific conclusions and
recommendations, which include changing prison rules so that
emotionally disturbed inmates who misbehave would be treated instead
of sent to isolation. Instead, Mr. Goord accused the Correctional
Association of proffering "phony issues," and criticized the report's
principal author, Jennifer Wynn, as unprofessional.

But in interviews, several prison experts, psychiatrists and state
officials who are familiar with the report agreed with its conclusion
that the prison system is unprepared to properly treat mentally and
physically ill inmates.

Yesterday, an independent report by Human Rights Watch found that as
many as 25 percent of prisoners nationwide are mentally ill.

"The 25 percent is very much like it is for other states; there are
probably some that are even worse, and it's a scandal," said Michael
L. Perlin, a professor at New York Law School who has studied prison
mental health issues. "It reflects a mentality that we should have
discarded a century ago."

Professor Perlin, who sits on the Correctional Association's advisory
board, said Commissioner Goord, who has dismissed criticism of
punitive segregation in the past, should heed the association's
findings. "There should be a tremendous obligation on the part of New
York's authorities to deal with this frontally and forthrightly," he
said.

In the association's 51-page report, the authors paint a grim portrait
of the lockdown units in some state prisons. They describe observing
one inmate alone in his cell, smeared with his own feces; another
inmate sprawled on the floor because his wheelchair was confiscated
for security reasons; a prisoner with AIDS, dying and barely able to
lift his head; and dozens of others with symptoms of acute psychoses
or covered in scars from self-inflicted cuts.

"These are serious human-rights abuses," said Robert Gangi, the
Correction Association's executive director. "There are people who die
needlessly in New York State prisons because they are put in there
when they are mentally ill, and they kill themselves."

He added, "The state's political leaders should recognize how
important a matter this is."

Using nearly $200 million in federal grants, New York has built 10
prisons with 3,788 beds since 1997, solely for punitive segregation,
Mr. Gangi said. Beyond those units, there are more than 20 "segregated
housing units" in the state's seven maximum security prisons, as well
as lockdown cells in separate blocks within other prisons.

About 7.6 percent of the 65,000 inmates in the state prison system
were in lockdown in April, according to the report.

The report said department records indicate that the average prisoner
in 23-hour lockdown remains there for five to six months before
returning to the general prison population. (One hour a day is allowed
for what is called recreation in a small, empty outdoor cage.) But in
interviews with inmates, the association reported their average stay
to be three years. Most punitive segregation is solitary confinement;
some units house two inmates.

In an interview in May 2000 in DOCS Today, a departmental newsletter,
Commissioner Goord said segregated housing units "had an immediate and
positive effect on the system" by reducing inmate assaults on
correction officers.

But Dr. Stuart Grassian, a psychiatrist who has studied the effects of
isolation on mentally ill inmates, said that when dealing with
mentally ill and drug-addled inmates, what is good for the prison
system is not good for public safety.

"The paradigm is that if we punish them enough, they will change their
behavior," Dr. Grassian, whose research is cited in the report, said
yesterday. "There's too great a tendency to label their behavior as
willful. You put them in situations that are more and more stressful,
their behavior will become worse."

He added, "Most of these people get out at some point, and then they
become a danger to all of us."

Despite repeated cases of inmates hanging and starving themselves
while in punitive segregation, and despite repeated criticism from the
State Commission of Correction, an oversight agency with little
authority to force the department to change its rules, New York
prisons are not much different from those in many other states.

"This is an issue for every prison system," said Michael P. Jacobson,
a former New York City correction commissioner who is a professor at
the John Jay College of Criminal Justice.

Punitive segregation costs less per prisoner than less restrictive
prison blocks because it requires fewer officers and relatively less
space for programs and activities. In its report, the Correctional
Association accused the department of sending too many inmates into
punitive isolation for infractions like smoking cigarettes or
"horseplay."

Mr. Jacobson said, "You have to be very selective about who goes in"
lockdown cells, "and you have to be very careful about watching them
once they're in."

In its report, the Correctional Association recommended creating an
oversight body with authority to inspect lockdown units, a body
similar, in fact, to the Board of Correction, which sets minimum
standards for inmate populations in New York City jails and monitors
them.

After receiving an advance copy of the Correctional Association's
report, in August, Mr. Goord, the Correctional Services commissioner,
accused Ms. Wynn, the report's principal author, of using the
Correctional Association's privileged status to communicate with a
particular inmate, and he banned her from entering the prisons beyond
the visiting area. Since then, he has imposed new limits on how many
association employees may visit a prison, prohibited association
interviews with prison staff and declared access to all segregated
housing units off limits.

Jeffrion L. Aubry, a Democratic state assemblyman from Queens and
chairman of the Committee on Corrections, said he plans to introduce a
bill in January that would prohibit inmates with serious mental
illnesses from being sent to lockdown and require them to receive
treatment instead.

"I've been in the S.H.U.'s," he said, recalling how he was temporarily
locked in a segregated housing unit during a tour of a state prison.
"I'm not surprised they have a negative impact on inmates."