As a 2014-2015 'Soros Justice Fellow', investigative journalist Alisa Roth spent a year studying the plight of mentally ill prisoners in the U.S. Criminal Justice System. Roth visited jails and prisons in New York, Illinois, California, Georgia, and Oklahoma. She also interviewed mentally ill subjects and their families; consulted experts; perused medical and jail records; inspected court reports and other public documents; and read newspaper articles, books, and other source materials.
Alisa Roth
Roth found that almost every correctional facility in the country has a large number of prisoners with mental illness. Mental illness is a term that includes a wide array of disorders that affect a person's mood, thinking, and behavior. Examples are anxiety disorders; addictive behaviors; bipolar disorder; and schizophrenia.
Diagnosing and treating mental illness is difficult because there is no definitive test, and finding reliable drugs is often a matter of trial and error. Medical professionals have found that it's difficult to find the correct dosages; medications sometimes stop working; and there can be serious side effects.
Mental illness is a challenge even in the civilian community - with insufficient treatment centers and the like - but the problem is exacerbated in jails and prisons. Mentally ill people who are incarcerated generally get little or no treatment, and - upon release - are often sicker than when they went in.
One reason for this is the difficulty of diagnosing mental illness in the jail population. Some institutions - especially large ones - often try. In Cook County Jail in Chicago, for instance, a social worker oversees intake exams for new arrivals, looking for clues about mental health. This is frequently difficult, since mentally ill detainees often don't know - or don't want to talk about - their mental health issues. One tactic is to talk about medical problems, like blood pressure or diabetes, and ask, "Where did you get help?" The individual might then accidently mention a psychiatric hospital.
Administrators at Cook County Jail assert that - with recent improvements in the facility - a mentally ill prisoner can now get individual therapy, group therapy, and special housing.....and that many of the institute's corrections officers are trained to work with people with mental illness. This is not typical, however, of most prisons in the country.
Cook County Jail
A therapy session
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The author was permitted to observe the Twin Towers Correctional Facility at the Los Angeles County Jail, which is one of the biggest providers of psychiatric care in the country. The Twin Towers Facility houses the sickest inmates in Los Angeles - people who can't share a cell with another person and who aren't permitted to wear regulation jail attire - baggy pants and a scrub shirt. Instead, the mentally ill prisoners wear shapeless smocks made of quilted cloth that is supposed to be indestructible, so they can't be torn or tied into a noose. Patients are not offered any therapy, and mental health care consists entirely of medication and medication management.
The Twin Towers Correctional Facility
Inside the Twin Towers
When Roth peered into one of the cells in the Twin Towers Facility, she saw a prisoner wrapped in a dark blue blanket-cocoon lying on the lower bunk. The inmate's unit was covered in feces, which was spattered on the edge of the top bunk; rubbed on the floor; smeared in circles on the walls, and used as paste to stick sheets of paper towels to the wall - like a row of artworks. This wasn't an isolated incident, as many mentally ill prisoners 'decorate' their cells with feces. Even worse, one corrections officer described a prisoner who ate his feces, then drank water from the toilet.
A prisoner in his cell
Roth notes that prisoners in the Twin Towers are only allowed out of their cells in handcuffs or handcuffs and leg shackles - and some refuse to come out of their cells at all. These restrictions are necessary because corrections officers are not medically trained specialists schooled to manage the mentally ill; instead, they're law enforcement personnel taught to maintain safety.
A prisoner being handcuffed
A prisoner chained to a table
The Los Angeles County Jail does have a hospital unit, called the Forensic Inpatient Unit (FIP), which is a licenced acute psychiatric ward for the very sickest inmates. Unfortunately, the FIP doesn't have nearly enough beds to accomodate all the prisoners who belong there.
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The most debilitating form of incarceration in any corrections institute is solitary confinement - the practice of keeping a person alone in a small cell for 23 or more hours per day for weeks, months, years, or even decades at a time. Prisoners are generally placed in solitary for bad behavior.....and people with severe mental illness are among the most likely prisoners to end up there. Being alone and cut off from human interaction can cause or aggravate symptoms of psychosis such as hallucinations, paronoia, sleeplessness, and self-harm.....and mental health treatment in 'the hole' is minimal or non-existent.
A solitary confinement cell
The author mentions Brian Nelson, who spent 23 years in solitary confinement (mostly at the now closed supermax Tamms Correctional Center in Illinois) after being convicted of accessory to murder. Other harsh disciplinary measures used in prisons are hog-tying or cutting off water to cells.....and again the mentally ill are the most likely recipients.
There are many stories about the shoddy mental health care that people get in jails and prisons. In a 2017 class action lawsuit, prisoners at the federal penitentiary in Lewisberg, Pennsylvania claimed that the Bureau of Prisons provides little one-on-one counseling and that the 'supposed' counseling mostly consists of conversations through cell doors, which could easily be overheard by others. Even worse: "care for people with mental illness at Lewisburg consist of staff passing out coloring books and puzzles and calling it 'treatment'."
The author found similiar stories in almost all the instutions she investigated. The reasons prisons can't effectively deal with mentally ill people include:
- Overcrowding. A large population of very sick people are jammed into facilities that weren't designed for so many individuals.
- Lack of staff. There aren't enough medical personnel and corrections officers because the working conditions are difficult; prisons are often in inconvenient or remote locations; and the pay is low.
It's also important to note that race and poverty overlap with mental illness in the criminal justice system, creating a downward trajectory. The result is that once an indigent mentally ill person is arrested, he/she can't make bail, can't cope with being incarcerated, becomes disruptive, gets a longer sentence, becomes sicker....and so on. It's a vicious cycle. This is especially troubling among African-Americans and Hispanics, because they make up a large percentage of the prison population.
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To illustrate her points about mentally ill people in the criminal justice system, the author presents a number of case studies. I'll give some examples.
- In March, 2006 former firefighter and family man Bryan Allen Sanderson was arrested for indecent exposure in a South Carolina motel. At the time of his arrest Sanderson was manic and hearing voices in his head. Being in jail made Sanderson's symptoms worse, and he smeared feces around his cell and threatened officers and other prisoners. Sanderson was put in solitary confinement where he continued to cause trouble by throwing his food instead of eating it. Finally, five months after he was arrested, Sanderson appeared before a judge and accepted a plea for time served. However, the ordeal and its aftermath resulted in Sanderson losing his family, his livelihood, and his middle-class life.
- In 2012 Darren Rainey was serving a sentence for cocaine possession in a Florida prison. Being diagnosed with schizophrenia, Rainey was housed in a unit for mentally ill inmates. When corrections officers found that Rainey had smeared his cell with feces he was taken to a 'special shower' to clean up. At 160 degrees, the water temperature in the shower far exceeded the legal limit of 120 degrees. The officers left Rainey in the scalding water for two hours, by which time he was dead and his reddened skin was peeling 'like fruit roll-ups.' Prisoners and ex-convicts claim that abuse like this is the norm (though it doesn't usually go as far as murder).
Darren Rainey Illustration by Mark Espinosa
- Edgar Coleman, a former football player and teacher, was arrested by the University of Minnesota police over 200 times between 1996 and 2012....and that doesn't include the myriad times he was just shooed along. Coleman would stay in the school's buildings at night and steal food from buffet lines. Sometimes the police would take Coleman to jail, sometimes to a homeless shelter, but he was soon back on the streets. Coleman is dubbed a 'super-utilizer' - a person who cycles in and out of jail, getting re-arrested shortly after being released.
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There may be a light at the end of a (very long) tunnel since some communities are trying to improve conditions for mentally ill prisoners, including Cook Country and Los Angeles (mentioned above) and Riker's Island in New York City - which is increasing the number of special mental health units called the 'Program to Accelerate Clinical Effectiveness (PACE).'
Mental Health Unit at Riker's Island
According to Roth, what may really turn the tide "is the consensus that what we're doing is wrong. Whether we're talking about the people who are locked up and their families, or the corrections officers, or the prosecutors, the defense attorneys, the judges, the doctors — you name it. They're in agreement that what we're doing is not working, that it's counterproductive, that we need to change. We need to figure out how to come to a consensus about what that change looks like, but at least we're all on the same page – that this is not the way it should be and that nobody is benefiting from this situation."
This is a well-researched and well-written treatise on mental illness and the U.S. Justice System. Recommended to people interested in the topic.
Rating: 4.5 stars
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