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As featured in Psychiatric Times:

Guilty of Mental Illness

by William Kanapaux

January 2004, Vol. XXI, Issue 1

On any given day, it is estimated that about 70,000 inmates in U.S. prisons are psychotic. Anywhere from 200,000 to 300,000 male and female prison inmates suffer from mental disorders such as schizophrenia, bipolar disorder and major depression. Prisons hold three times more people with mental illness than do psychiatric hospitals, and U.S. prisoners have rates of mental illness that are up to four times greater than rates for the general population.

These are the findings of a report by Human Rights Watch, released Oct. 22, 2003. Many of the statistics cited by the organization have been released by various organizations and agencies, but the 215-page report provides a more complete picture of the U.S. prison system as the nation's primary mental health care facilities. The complete report is available on their Web site at <www.hrw.org/reports/2003/USA1003/USA1003.pdf>.

"Ill Equipped: U.S. Prisons and Offenders with Mental Illness" resulted from two years of research and hundreds of interviews with mental health care experts, prisoners, correction officials and attorneys. It reported that few prisons offer adequate mental health care services and that the prison environment is dangerous and debilitating for prisoners who have mental illness. These prisoners are victimized by other inmates, punished by prison staff for behaviors associated with their illnesses and often placed in highly restrictive cells that exacerbate their symptoms.

The U.S. prison system is "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 the report.

The high prevalence of mental illness in the criminal justice system is related to several factors that psychiatrists should care about, Fred Osher, M.D., director of the Center for Behavioral Health, Justice and Public Policy at the University of Maryland, told Psychiatric Times.

The factors that contribute to a person being in jail in the first place relate to inadequate access to quality behavioral health services, Osher told PT. Without these services, people with mental illnesses often engage in behaviors that capture the attention of law enforcement and lead to arrests.

The majority of people with mental illness in the criminal justice system are there for misdemeanors and crimes of survival, according to Osher. He said, "There's a whole host of folks who land in the criminal justice system because of their behavioral disorders." The problem primarily affects people on the margins of society. They are often minorities, almost always impoverished and disabled by their illness.

The federal government's war on drugs has swept up people with mental illness at higher rates than those for the general population because more people with mental illness use and abuse drugs, Osher said. He added, "I think we want to watch the policy around punishment versus treatment, and we want to be advocates for treatment first."

There is also a high prevalence of people coming into the mental health care system with a history of involvement with criminal justice. Mental health care professionals need to be aware of this and think about the necessary communications with law enforcement and correctional supervision officials. "I think the issue is that many folks in mental health care don't want to work with people who have a criminal justice history, but they do anyway," Osher said. "They're just not looking for it."

The general consensus within the criminal justice system is that people with serious mental illness should not be there. It is a bad situation for both the prisoners and the facilities.

"We hear that everywhere," Chris Koyanagi, policy director at the Washington, D.C.-based Bazelon Center for Mental Health Law, told PT. "From jails all over the country, from prison administrators, from senior correctional administrators."

Inmates with mental illness are often punished for their symptoms. Being disruptive, refusing to obey orders, and engaging in acts of self-mutilation and attempted suicide can all result in punitive action. As a result, the report noted, prisoners with mental illness often have extensive disciplinary histories.

Frequently, the prisoners end up in isolation units. "In the most extreme cases, conditions are truly horrific," the report stated, adding:

Mentally ill prisoners locked in segregation with no treatment at all; confined in filthy and beastly hot cells; left for days covered in feces they have smeared over their bodies; taunted, abused, or ignored by prison staff; given so little water during summer heat waves that they drink from their toilet bowls. ... Suicidal prisoners are left naked and unattended for days on end in barren, cold observation cells. Poorly trained correctional officers have accidentally asphyxiated mentally ill prisoners whom they were trying to restrain.

Root Causes

The report found that the high incarceration rate for people with mental illness is a direct result of underfunded and fragmented services. "Chronically underfunded, the existing mental health system today does not reach and provide mental health treatment to anywhere near the number of people who need it," it explained.

Public mental health care systems are stretched for money, according to Koyanagi. And they have people within their priority population who demand services and are responsive to less expensive treatments. "Those folks tend to get their needs met," she said.

People with serious mental illness who are left out of services are more difficult to reach and more difficult to treat because of the nature of their illnesses, she said. They may be dually diagnosed or already homeless.

Koyanagi noted that, from a cynical perspective, it can be said that criminalization is to the advantage of public mental health care systems. "The system can pretend they're not there."

When these individuals do leave the criminal justice system, they often can't get into local community mental health care programs, just as they can't get into public housing. "They're deemed unsuitable for that particular program because of their record," she said.

Over the last several decades, states have emptied their psychiatric hospitals without moving sufficient resources into community-based programs. Meanwhile, overall prison populations have soared.

It is tempting for people to conclude that a causal relationship exists between the decreased number of people in state psychiatric hospitals and the increased number of inmates with mental illness, Osher said, but the data do not support that belief.

Over the last 20 years, the U.S. prison population has experienced an enormous increase, with about 3% of the adult population now under some form of jail or correctional supervision, he said. Consequently, the problem has more to do with the way that people get arrested. People who are visibly homeless or have drug and alcohol problems are landing in jails and prisons with greater frequency.

The jails themselves represent a public health opportunity, according to Osher. Given estimates that about 15% to 17% of people coming into jails have a serious mental illness and that there are 11 million arrests a year, "that's a huge number of folks who are mostly not connected with systems of care." Screening programs could help identify those people so that they can get connected with appropriate treatment programs.

People who are privately insured are not immune from run-ins with the criminal justice system. A privately insured person with bipolar disorder can run into serious problems during a manic episode. In such cases, encounters with the legal system are usually less harmful, Koyanagi said. Often these individuals can be stabilized and returned to services within the community.

The people who tend to get stuck in the criminal justice system usually have long records, she told PT. "It doesn't just happen once, it happens again and again because nothing is done to deal with the underlying problems. And you end up in prison because you have a long rap sheet."

Koyanagi agreed that drug crimes are a major contributor to the growing number of mentally ill in jails and prisons. Whether a user or a seller, people with co-occurring mental illness and substance abuse get swept up by punitive drug penalties, she said.
Efforts to Respond

Koyanagi and Osher both served on the steering committee for the Criminal Justice/Mental Health Consensus Project Report, which was issued in 2002. The project represented an unprecedented national effort to bring together federal policy-makers with criminal justice and mental health care professionals to create a more responsive system for addressing the needs of people with mental illness who are at risk of involvement or are already involved with the criminal justice system.

Jail and prison overcrowding issues are high on the priority lists of wardens and sheriffs in this country, and correction officials are clamoring for improved mental health treatment in communities to deal with this, Osher said. Because of the high rates of people with serious mental illness in the criminal justice system and the problems they create in terms of service utilization and jail management, the mental health care field has partners in law enforcement and the courts and among corrections personnel.

"When you go before a state legislature and advocate for better mental health services as a psychiatrist, it seems self-serving," Osher said. "But when you go before them as a warden or a sheriff or a police officer, folks listen."...

The full article can be found at; http://www.psychiatrictimes.com/p040101a.html
 

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Treatment for prisoners with mental illness

As reported by WABC-DT (NY):

Treatment for prisoners with mental illness

(New York - WABC, April 9, 2007) - The figures are staggering. In the past 15 years, the number of inmates with mental illnesses in New York state prisons has grown by 71 percent.
An equally staggering number of them end up in disciplinary lockdown, often 23 hours a day. Now there is a growing call to address the crisis amid one family's heartbreaking story.

The Investigators' Sarah Wallace has more.

It's easy to dismiss prison inmates as someone else's problem, but in New York alone, it's estimated more than 3,000 inmates with mental illness are released every year into our communities. Many of them have spent months, even years in total isolation, with virtually no therapy.

"I'm afraid of them killing my son, that's what I'm afraid of," Barbara Smalls said. "Because he doesn't know when to back down."

Barbara Smalls has good reason to worry. For the past year and a half, her mentally ill son, Wayne, has been hit with a series of disciplinary charges after being involved in escalating confrontations with prison correction officers upstate. He's now in isolation at Southport Correctional facility, in what's called the SHU, special housing unit.

"He's confined 23 hours a day in a cell, and he's let out one hour for recreation," Barbara Smalls said. "They had him shackled from his wrist down to his feet, to his ankles, in the cell."

The family has documented a history of mental and emotional problems that date back to Wayne's childhood.

"He was diagnosed by several doctors, bi-polarism, ADHD, manic depressive, anxiety, panic, schizophrenia," Barbara said.

"You'll look a him and say, 'This guy's a nice guy, when he's on his medication.' When he's off of it? Freddie Kruger," father James Smalls said.

Wayne Smalls was first sent to prison in 2002 on a weapons charge, and was supposed to come home this June. But then he was accused of trying to assault staff and given four months in isolation. Smalls asked for help in a prison class and was accused of interfering and violating orders.

He's back in isolation at Southport. Jack Beck, an attorney for a prison watchdog group says Smalls' experience is typical.

"Often people with mentally illness start their SHU sentence not because they've done some terrible act, but they've done some smaller act," Beck said. "But then, once their in this environment, that is so difficult for them to cope with, they start yelling and screaming and just being non-cooperative."

Last month, Mrs. Smalls received a letter from a fellow SHU inmate who claimed he'd seen Wayne beaten by officers who "broke him up real badly."

That inmate's parents, who live in Brooklyn, say they've heard repeated horror stories from their son about the SHU.

"And I keep asking what's going on, and he says, 'Ma, it's like being in hell,'" the inmate's mother, Grace Banton said.

"What concerned him about Wayne is that he would have died and nobody would have known nothing," father Gilmore Banton said.

The Superintendent at Southport told the Smalls family an investigation showed use of force was necessary when Wayne refused to comply, that he wasn't seriously injured by staff.

"They're taking his frustrations as a sign of him being violent and not him having a mental illness," Smalls' brother, William, said. "They're taking his sickness as an act of violence."

"Instead of having mental health beds, we have prisons and jails for the mentally ill," Beck said. "And that is the story."

Advocates are now pushing for a state law that would prohibit mentally ill inmates from being placed in the SHU. But Wayne Smalls has been ordered to stay for at least six more months.

"They don't know Wayne like I know him, and I just can't let this matter, go," Mrs. Smalls said. "I can't."

Incredibly, there is no limit on time in the SHU, so inmates are racking up years and years in isolation.

Tuesday at 6 p.m., we'll meet one of them. He is a former inmate who spent 10 years on and off in 23-hour lockdown. He'll talk about his attempts at suicide and his downward spiral locked in a box.

It is a disturbing portrait that certainly raises an issue of cruel and unusual punishment.

(Copyright 2007 WABC-TV)

The story can be found at; http://abclocal.go.com/wabc/story?section=local&id=5192019

- Janq
 

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Discussion Starter · #3 · (Edited)
Criminal Justice System Involvement of People with Serious Mental Illnesses

As featured at the Judge David L. Bazelon Center for Mental Health:

Fact Sheet #1
Criminal Justice System Involvement of People with Serious Mental Illnesses

Overview

Large numbers of individuals with mental illnesses are in jail or prison today. While mental health advocates have for many years been distressed about the percentage of people with mental illnesses who are arrested or held in jail or prison, their growing numbers and the severity of their problems have recently raised concern to new levels in criminal justice circles.

Police are frustrated by repeat encounters with people who are causing problems in their communities and are clearly in need of mental health treatment. Officers are annoyed about the time necessary to transport these individuals to mental health facilities, taking them away from other duties—particularly when, as often happens, they see the same person causing the same disruptions only a few days later.

Those who run jails and prisons have also grown increasingly frustrated about strange and sometimes dangerous behaviors in their facilities. They are concerned about the safety both of the individual with a mental illness and about staff and other inmates, and feel a strong sense of outrage that the inmates need help rather than punishment. The financial burden of increased personnel—both for corrections and mental health staff—for suicide watches, and additional overtime is also an issue.

Finally, everyone—law enforcement, corrections officials, families, the community and the individuals themselves—is frustrated about the never-ending cycle as, with needs unmet, people with serious mental illnesses get caught up in a pattern of recidivism.

There is a better way. Many communities across the country are beginning to address this issue through collaborative approaches involving both the criminal justice system and the public mental health system. Unfortunately, most of these initiatives are small, with minimal effects on overall numbers. And in most communities a comprehensive approach has not been taken across the different stages of criminal justice system involvement, such as pre-booking, post-booking, at arraignment or upon release.

Before initiating solutions, communities need to know the answers to several key questions:

* Who are these individuals with serious mental illnesses and what do they need in order to break out of a cycle of criminal justice involvement?
* How significant is the problem—what are the numbers?
* What alternative approaches can be taken, and how well have those alternatives worked in communities where they have been tried?
* What will all this cost? Are there offsetting costs that help to reduce overall community costs?
* What is the appropriate role of the mental health system? Do specific services need to be in place to create a different outcome for these people?
* Will the community be safe if we take a different approach?

This set of fact sheets attempts to answer those questions.

Studies of people with mental illnesses in the criminal justice system reveal some important background facts:

* The increase in criminal justice involvement by individuals with serious mental illnesses between 1975 and 1985 (commonly attributed, without data, to deinstitutionalization) mirrors the overall increase in crime and incarceration during this period of time.
* The success of jail diversion programs depends significantly on the severity of the charge, with those arrested for the most serious crimes most likely to have reductions in average length of incarceration. (Possibly because the more serious the disorder, the greater the impact of furnishing treatment.)

Alternative and comprehensive approaches to this problem are needed. These should include:

* improved mental health services for those with the most severe disorders, especially those with co-occurring addiction disorders, to prevent criminal justice contacts;
collaboration between local mental health authorities and local law enforcement and corrections;
* development of mental health programs specifically targeted to people who can be diverted from the criminal justice system and those re-entering society following a period of incarceration;
* law enforcement diversion for minor offenders;
* pre- andpost-booking diversion options for those who are arrested;
* court-based diversion arrangements;
* re-entry programs addressing the need for services, access to benefits, housing, social networks, identification and a job.

The article can be found at; http://www.bazelon.org/issues/criminalization/factsheets/criminal1.html
Additional parts of this feature can be found at the following...
* Fact Sheet #2 | People with Serious Mental Illnesses in Jail and Prison - http://www.bazelon.org/issues/criminalization/factsheets/criminal2.html
* Fact Sheet #3 | Individuals with Mental Illnesses in Jail and Prison - http://www.bazelon.org/issues/criminalization/factsheets/criminal3.html
* Fact Sheet #4 | Policy to Address Issues Regarding People with Serious Mental Illnesses in the Criminal Justice System - http://www.bazelon.org/issues/criminalization/factsheets/criminal4.html
* Fact Sheet #5 | A Better Way: Programs Offering Alternatives to Incarceration - http://www.bazelon.org/issues/criminalization/factsheets/criminal5.htm
* Fact Sheet #6 | Pre-Booking Diversion - http://www.bazelon.org/issues/criminalization/factsheets/criminal6.htm
* Fact Sheet #7 | Post-Booking Diversion & Jail-Based Diversion Programs - http://www.bazelon.org/issues/criminalization/factsheets/criminal7.htm
* Fact Sheet# 8 | Post-Adjudication Diversion & Court-Based Diversion Initiatives - http://www.bazelon.org/issues/criminalization/factsheets/criminal8.htm
* Fact Sheet #9 | Comprehensive Diversion Approaches - http://www.bazelon.org/issues/criminalization/factsheets/criminal9.htm
* Fact Sheet #10 | Re-Entry Programs, Linkages Between Jails, Prisons and Community Providers - http://www.bazelon.org/issues/criminalization/factsheets/criminal10.htm
* Fact Sheet #11 | Resource Issues - http://www.bazelon.org/issues/criminalization/factsheets/criminal11.htm

- Janq
 

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so it sounds like a completely different system is needed for these folks.
 

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Discussion Starter · #5 · (Edited)
What we need to do is get serious about mental health/mental illness in America.
Untill we do so things will only continue to trend as they have getting worse and worse per year with an even greater number of criminals and criminal acts as a direct result.

Currently as per multiple reports and statistics America is listed as having the highest incidence of mental illness as a percentage of it's population of any other country on the planet.
In English that means, we Americans are and have a metric shit ton of bat shit crazy people who as based on results and known study often commit crimes of impulse and violence.

The latest examples to be featured in the news toward as much...
Man Kills Houston Complex Manager, Self
Man Facing Eviction From Houston Luxury Apartment Complex Kills Manager, Then Himself

By JOE STINEBAKER

HOUSTON Apr 23, 2007 (AP)— A man facing eviction from a luxury apartment complex shot and killed the manager and then himself after writing an e-mail to friends saying he had died, police said. At least two other people were injured.

Police said the gunman first shot a neighbor through his door, then reloaded his revolver and stormed the complex's office, shooting the manager and pistol-whipping a man trying to serve the eviction notice, police said...

The article can be found at; http://abcnews.go.com/US/wireStory?id=3069988
Man and Woman Shot at Luxury Hotel
Police Shoot and Kill Man and Woman With Gun at Orange County, Calif., Luxury Hotel

By GILLIAN FLACCUS

LAGUNA BEACH, Calif. Apr 23, 2007 (AP)— A man and a woman were killed at a luxury oceanfront resort when police fired into their bungalow after they refused to drop a handgun, authorities said.

Police were called Sunday to the Montage Resort and Spa by a security guard who said a man and a woman were engaged in a domestic dispute, said police Sgt. Jason Kravetz.

"It may not have been domestic violence, but that's how we were called to the scene," Kravetz said. "Usually in a domestic violence (case) the woman doesn't go out and try to shoot at other people."

Several 911 callers said a naked woman was running around the hotel waving a gun, authorities said. She was distraught and periodically threatened people with the gun, Kravetz said.

Police arrived at the pair's room minutes later, and a gun was passed between the man and the woman, who both pointed it at police, authorities said.

Two officers fired into the room after the couple refused to drop the gun...

The article can be found at; http://abcnews.go.com/US/wireStory?id=3069609
Extended and additional gun laws or even a total ban on all firearms of any type be they semi-auto or revolver or rifle or whatever firearm form factor and/or the action it might have is simply and obviously as based on real world practical results not the answer.
What we need most is to address the societal and communal issue of mental health. I'd even go so far as to say that is even more important than extending already currently in play civilian self defense laws (e.g. concealed carry).

Ignoring this very real cause has resulted in effects like what occurred at Virginia Tech amongst others.

- Janq
 
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