The Human Rights Watch (HRW) released a report, "Ill-Equipped: U.S. Prisons and Offenders with Mental Illness" on October 22, 2003. This 215-page report documents the shameful conditions that the mentally ill face behind bars: woefully inadequate mental health services; violence, abuse and harassment at the hands of other prisoners and even correctional officers; punishment and solitary confinement in response to symptoms of their illness, including self-mutilation and attempted suicide; and scant help upon release.
Richard C. Birkel, Ph.D., Executive Director, NAMI, is quoted on the cover of the report stating that:
"Human Rights Watch has written a profoundly disturbing, hard-hitting report that puts the tragedy of the criminalization of people with serious mental illnesses into clear perspective. Prisons are the worst possible environment for individuals experiencing serous psychiatric symptoms. It is flat out wrong to subject people who require medical treatment to the kind of human rights abuses documented in this reports. But there are solutions to this tragedy, solutions described in great detail in this report"
"Prisons have become the nation’s primary mental health facilities," said Jamie Fellner, director of Human Rights Watch’s U.S. Program and a co-author of the report. "But for those with serious illnesses, prison can be the worst place to be." NAMI acted in partnership HRW to review drafts of the report, and to support its release to the Associated Press and other major news outlets. NAMI and HRW advocate federal and state legislative action in response to the release of this devastating report to redress documented human rights violations in U.S. prisons.
The report documents the woefully deficient state of mental health services available in many prisons that leave prisoners under-treated – or not treated at all. Across the country, prisoners cannot get appropriate care because of a shortage of qualified staff, lack of facilities, and prison rules that interfere with treatment.
According to the report, the high rate of incarceration of the mentally ill is a consequence of under-funded, disorganized, and fragmented community mental health services. State and local governments have shut down mental health hospitals across the United States, but failed to provide adequate alternatives. Many people with mental illness – particularly those who are poor, homeless, or struggling with substance abuse problems – cannot get mental health treatment. If they commit a crime, even low-level nonviolent offenses, punitive sentencing laws mandate imprisonment.
"Unless you are wealthy, it can be next to impossible to receive mental health services in the community," said Fellner. "Many prisoners might never have ended up behind bars if publicly funded treatment had been available."
The Human Rights Watch report is based on more than two years of research and hundreds of interviews with prisoners, corrections officials, mental health experts and attorneys.
It describes prisoners who, because of their illness, rant and rave, babble incoherently, or huddle silently in their cells. They talk to invisible companions, living in worlds constructed of hallucinations. They lash out without provocation, beat their heads against cell walls, cover themselves with feces, mutilate themselves until their bodies are riddled with scars, and attempt suicide.
The HRW report documents how prisoners with mental illness are likely to be picked on, physically or sexually abused, and manipulated by other inmates, who call them "bugs." For example, a prisoner in Georgia, who is both mentally ill and mildly retarded, has been raped repeatedly and exchanges sex for commissary items such as cigarettes and coffee.
Mentally ill prisoners can find it difficult if not impossible to comply with prison rules, and end up with higher than average rates of disciplinary infractions. Security staff – who usually lack training in mental illness – do not distinguish between the prisoner who is disruptive or fails to obey an order because of illness and a prisoner who causes problems for other reasons.
Mentally ill prisoners have been punished for self-mutilating ("destroying state property"); attempting suicide with a torn sheet ("destroying state property"); for yelling and kicking cell doors because of hearing voices ("creating a disturbance"); for throwing papers at a guard while delusional ("battery"); and for smearing feces on the cell door ("being untidy"). Untrained staff escalate confrontations with mentally ill prisoners, sometimes using excessive force. Several mentally ill prisoners have died from asphyxiation after struggling with guards who used improper methods to control them.
Over the past two decades, prison mental health services in the United States have improved – usually because of prisoner litigation. But the surging number of mentally ill men and women entering prison has outrun the availability of services.
Public officials have been unwilling to provide the funds necessary to ensure adequate treatment for all the mentally ill offenders who need it.
"Prison officials are being asked to do something they aren’t equipped to do," said Fellner. "Prisons are designed for punishment, not as places to provide comprehensive mental health treatment. If people with mental illness must be incarcerated, they should be housed in facilities designed and funded to meet their mental health needs."
NAMI in partnership with the HRW has urged the 2003 U.S. Congress to enact legislation proposed by Senator Mike DeWine (R-Ohio) and Congressman Ted Strickland (D-Ohio) that would provide federal grants to divert mentally ill offenders into treatment programs rather than jail or prison, and to improve the quality of mental health services provided to jail and prison inmates.
NAMI supports HRW in recommending the use of independent mental health experts to assess mental health services in each prison system; in urging elected officials and the heads of correctional agencies to ensure that mentally ill prisoners receive mental health services consistent with community standards of care; and in calling for rules to prevent housing prisoners with mental illness in isolated confinement or super maximum security prisons.
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Read more about Human Rights Watch (HRW); and the report, "Ill-Equipped: U.S. Prisons and Offenders with Mental Illness."