Of the nearly 2 million inmates being held in prisons and jails across the country, experts believe nearly 500,000 are mentally ill. According to the National Alliance for the Mentally Ill (NAMI), 16 percent of the prison population can be classified as severely mentally ill, meaning that they fit the psychiatric classification for illnesses such as schizophrenia, major depression, and bipolar disorder. According to staff at city and community jails, 25 percent of the jail population is severely mentally ill. However, when other mental illnesses, such as anti-social personality disorder, borderline personality disorder and depression, are included, the numbers are much higher, and NAMI puts the number of inmates suffering from both mental illness and substance abuse the percentage at well over 50 percent.
Most experts agree that the increasing number of imprisoned mentally ill people is due to two major policy shifts over the past decades. One was deinstitutionalization, or the process of closing down mental hospitals throughout the country that began in the 1950s. The idea was that the mentally ill would do better living back in the community with a community-based mental health care system in place to handle their needs. But adequate funding, coordination and commitment didn't follow this change and the lack of resources and commitment to a community-based system of care continues to be a problem in the vast majority of American communities.
In its most recent national study (1999), the Justice Department's Bureau of Justice Statistics reports that mental illness affected 24 percent of the female state inmate population, as compared to 16 percent of the male state inmate population; 13 percent of female federal prison population (vs. 7 percent of males); and 23 percent of female jail inmates (vs. 16 percent of males).
However Human Rights Watch, in its report Ill-Equipped: U.S. Prisons and Offenders with Mental Illness, suggests that the numbers may be higher. Furthermore, it warns, "Most prison systems still have not developed adequate facilities for women at different security levels and do not offer women prisoners the range of programming and services that are available to men. Prison medical care for women is particularly deficient, including mental health care."
The Bureau of Justice statistics published the following chart, indicating the racial breakdown of the mentally ill in prison:
According to the U.S. Justice Department's Bureau of Justice Statistics, mentally ill inmates in state prisons serve on average 15 months longer than other inmates. Mentally ill inmates in local jails serve on average two months fewer than other inmates.
Often the reason mentally ill prisoners end up spending more time in prison -- sometimes longer than their original sentences -- is that because of their illnesses they have difficulty following the strict rules of prison life. They are more likely than other inmates to be involved in prison fights, and they tend to rack up conduct violations, known as "tickets," for violating the rules. Depending on the number of tickets they're received, prisoners' privileges may be revoked or they may be moved to a higher security classification. "It's an evolving process every day, trying to figure out the role that the mental illness plays against the rule infraction and how you're going to deal with that." explains Nixon-Hughes.
The mentally ill also have a more difficult time being paroled than the general population, usually because of their disciplinary records in prison. Also, the parole board may be reluctant to release the mentally ill back into the community because of inadequate community services to help them obtain treatment.
According to the most recent survey by the Bureau of Justice Statistics, 81 percent of mentally ill inmates currently in state prison, 76 percent of mentally ill inmates in federal prison, and 79 percent of mentally ill inmates in local jails have prior convictions. (Seventy-nine percent of other inmates in state prison, 61 percent of other inmates in federal prison and 71 percent of other inmates in local jails have prior convictions.)
The BJS also published the following chart showing the prior criminal history by mental health status:
Number of prior probation/incarceration sentences
Mentally ill inmates
Mentally ill inmates
Mentally ill inmates
3 to 5
6 to 10
11 or more
"We really shouldn't be surprised when the mentally ill show up again at intake, because it was bound to happen," says Alphonse Gerhardstein, an Ohio civil rights attorney and president of the Prison Reform Center. "We knew that was their course of conduct before, because they were in prison earlier. We didn't do anything when they were released to divert them to a better course of conduct, and now they commit a crime, and the same thing is happening."
The Consensus Project, a coordinated effort by the Council of State Governments to improve services for mentally ill offenders, recently released a report calling for a complete overhaul of the way mentally ill offenders are treated. Rather than simply turning offenders loose after they have served their sentences, the report recommends planning for post-release services almost from the day they arrive in the justice system. A successful system for reentry would coordinate efforts among specialists in a range of services, integrate treatment for mental illness and substance abuse, combine primary healthcare with mental healthcare, create and improve housing resources for the mentally ill, involve families and the community with the offender's treatment, and ensure that people with mental illness are accessing the full range of government entitlements for which they are eligible, such as Social Security Disability Insurance.
According to the Human Rights Watch report Ill-Equipped:
Our research suggests that few prisons accommodate [mentally ill prisoners'] mental health needs. Security staff typically view mentally ill prisoners as difficult and disruptive, and place them in barren high-security solitary confinement units. The lack of human interaction and the limited mental stimulus of twenty-four-hour-a-day life in small, sometimes windowless segregation cells, coupled with the absence of adequate mental health services, dramatically aggravates the suffering of the mentally ill. Some deteriorate so severely that the must be removed to hospitals for acute psychiatric care. But after being stabilized, they are then returned to the same segregation conditions where the cycle of decompensation begins again. The penal network is thus not only serving as a warehouse for the mentally ill, but, by relying on extremely restrictive housing for mentally ill prisoners, it is acting as an incubator for worse illness and psychiatric breakdowns.
According to Dr. Gary Beven, the regional medical director of the Ohio prison system, "Providing effective psychiatric care in a maximum-security prison is extraordinarily difficult. Many patients decompensate and become extremely depressed, hopeless, suicidal. Many turn to severe self-mutilation or acts of self-injury. And many inmates that also suffer from severe mental illness become delusional and hallucinate."
Another issue in treating mentally ill prisoners is malingerers, or those who exaggerate or fake problems in order to receive treatment. Beven says that one of the risks in treating potential malingerers is that the staff becomes desensitized to the truly sick. "… [T]he worst thing you could do is to assume everyone is a malinger," he says. "That's the worst thing you can do because eventually you're going to ignore somebody who's very, very sick."
But Beven says that there are also success stories. "… [W]e work with patients on such an intensive, long-term basis that over time, perhaps several years, they begin to trust you and they can show you that they have earned some trust that they've never had before," he explains. "And in that setting, you can have some genuine success. There's been some miracle cures for patients that other people have believed in the past -- even their own families, school systems, private psychiatric agencies have thought, 'This person's completely hopeless.' And then when they come here, they turn around entirely and it's almost a miracle."
Segregation is when prisoners are sent to solitary confinement, usually because of discipline problems. According to Human Rights Watch, the mentally ill are disproportionately represented in segregation units and in most prison systems, the mental health services in segregation is lacking.
"If you're mentally ill when you go into segregation, you're going to become worse invariably," says Fred Cohen. "If you're not mentally ill, the risk of becoming mentally ill is very high from isolation. Some people dispute that, but in my experience, the people who are just so unsocialized and so psychologically fragile to begin with are deprived of any kind of social support, any kind of psychological stimulus. And they just fall apart."
Judges in California, Wisconsin, and Texas have ruled that holding the mentally ill in segregation is unconstitutional and violates the Eighth Amendment's prohibition against cruel and unusual punishment.
Lauren E. Glaze, Doris J. James
September 6, 2006 NCJ 213600
Presents estimates of the prevalence of mental health problems among prison and jail inmates using self-reported data on recent history and symptoms of mental disorders. The report compares the characteristics of offenders with a mental health problem to those without, including current offense, criminal record, sentence length, time expected to be served, co-occurring substance dependence or abuse, family background, and facility conduct since current admission. It presents measures of mental health problems by gender, race, Hispanic origin, and age. The report describes mental health problems and mental health treatment among inmates since admission to jail or prison. Findings are based on the Survey of Inmates in State and Federal Correctional Facilities, 2004, and the Survey of Inmates in Local Jails, 2002.
Highlights include the following: