cqr prisoners and mental illness 03-13-2015.pdf · 2015. 3. 17. · cq press is a registered...

Prisoners and mental IllnessAre too many with psychiatric problems behind bars?

Thousands of people with schizophrenia, severe

depression, delusional disorders or other mental

problems are locked up, often in solitary confine-

ment. while some committed violent crimes and

remain a threat to themselves or other inmates and prison staff,

many are incarcerated for minor offenses, simply because there is

no place to send them for treatment. The number of mentally ill

inmates has mushroomed in recent years as states have closed

their psychiatric hospitals in favor of outpatient community mental

health centers that typically are underfunded and overcrowded.

In an attempt to reduce the influx of mentally ill inmates, some

300 specialized mental health courts have diverted them into

court-monitored treatment instead of jail. Yet, many participants

re-offend, and some experts say psychiatric treatment alone won’t

prevent criminal behavior. meanwhile, courts in more than a half-

dozen states have declared solitary confinement unconstitutional

for those with mental illness. However, some corrections officials

say solitary is necessary to separate dangerous prisoners.

At age 16, Kalief Browder was falsely accused ofstealing a backpack and sent to New York City’snotorious Rikers Island jail after he was unable to

post bail. He spent three years at the facility — two insolitary confinement — before being released, neverhaving gone to trial. Like many inmates who haveendured solitary, the once sociable teenager now describes himself as having become

paranoid, quiet and “distant.”

CQ Researcher • March 13, 2015 • www.cqresearcher.comVolume 25, Number 11 • Pages 241-264

RECIPIENT Of SOCIETY Of PROfESSIONAL JOURNALISTS AwARD fOR

EXCELLENCE u AmERICAN BAR ASSOCIATION SILvER GAvEL AwARD

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THE ISSUES ....................243

BACKGROUND ................250

CHRONOLOGY ................251

CURRENT SITUATION ........256

AT ISSUE........................257

OUTLOOK ......................259

BIBLIOGRAPHY ................262

THE NEXT STEP ..............263

THISREPORT

Published by CQ Press, an Imprint of SAGE Publications, Inc. www.cqresearcher.com

242 CQ Researcher

THE ISSUES

243 • Is the proportion of men-tally ill people in jails andprisons rising?• Do programs offeringtreatment instead of jail prevent further crime?• Does solitary confinementinduce mental illness?

BACKGROUND

250 From Jails to BedlamsReformers urged hospitals instead of prisons for thementally ill.

252 Mandatory SentencingAs state mental hospitalsemptied, prison populationsgrew.

255 Mental Health Courtsmodern programs divert thementally ill to treatment.

CURRENT SITUATION

256 State ActionSome states are banning solitary confinement for thementally ill.

256 Local ActionNew York City has a com-prehensive plan for handlingmentally ill inmates.

258 Congressional ActionPresident Obama wants morefunds for mental healthcourts and police training.

OUTLOOK

259 Training Judgesmost reforms are comingfrom the judicial branch.

SIDEBARS AND GRAPHICS

244 Jail Inmates Have HighRate of Mental IllnessTheir rates of serious mentalillness exceed those in thegeneral population.

245 Fewer States to RaiseMental Health SpendingOnly 28 states plan increasesin 2015.

246 Many Prisoners ReportPrior Mental IllnessNearly 37 percent of prisoninmates said they were diag-nosed with a mental illness.

251 ChronologyKey events since 1833.

252 Innovative Program DivertsMentally Ill from Jail“we’re the biggest crime pre-vention program in town.”

254 States Revamping ‘Solitary’for the Mentally Ill“It was a culture change inthe beginning.”

257 At Issue:Should prolonged solitaryconfinement be banned?

FOR FURTHER RESEARCH

261 For More InformationOrganizations to contact.

262 BibliographySelected sources used.

263 The Next StepAdditional articles.

263 Citing CQ ResearcherSample bibliography formats.

PRISONERS AND mENTAL ILLNESS

Cover: Courtesy Paul V. Prestia

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March 13, 2015Volume 25, Number 11

March 13, 2015 243www.cqresearcher.com

Prisoners and mental Illness

THE ISSUESThe photo is shocking.

A young man wearinga helmet lies chained

to a bed. The wall behindhim shows a smear of bloodwhere he had been banginghis head. 1

The helmet and chains were“the treatment that was provid-ed” at the michigan adult prisonwhere 19-year-old Kevin Demotthad been held in solitary con-finement for four months, sayshis mother, Lois Demott.

Kevin had long been trou-bled: a bipolar-disorder diag-nosis at 11, juvenile detentionfor trying to rob a pizza storewith a toy gun at 13 and adultprison at 15. In prison he wascited dozens of times forbreaking rules and sentencedto more time behind bars forassaulting a guard.

Kevin’s mother says the prison im-posed solitary confinement to punishbehavior rooted in his mental illness— throwing objects off a balcony in arage, breaking light bulbs to cut himselfand ripping a so-called “suicide gown”to make a noose to hang himself.

when photographed in solitary, inJanuary 2011, Kevin was receiving nomedication for his condition and “wasvery depressed,” Lois Demott says.

The plight of mentally ill inmates— and how to treat their conditionwhile holding them accountable forcrimes and keeping prisons safe — isreceiving new attention from criminaljustice and psychiatric experts. mentalhealth advocates say budget cuts incommunity mental health services haveled police and courts to lock up manytroubled individuals in jails and prisonsthat are ill-equipped to treat them. Atthe same time, they say, many inmatesare inappropriately placed in solitary

confinement, causing or exacerbatingmental problems.

Even so, some experts say that onlya minority of the crimes committed bymentally ill people are due to their ill-ness, citing other factors such as usingdrugs or associating with criminals.Thus treatment alone will not preventmany mentally ill offenders from re-turning to jail, they contend. meanwhile,unions representing prison guards de-fend the use of solitary confinementas necessary to keep inmates fromharming themselves or others.

more than one in five michigan pris-oners in 2009 had severe mental dis-abilities, according to a University ofmichigan study, but 65 percent of thosehad received no treatment in the pre-vious 12 months. 2

Echoing a nationwide trend thatbegan in the 1960s, michigan closedthree-quarters of its 16 state psychiatrichospitals between 1987 and 2003. The

patients could be better served,it was thought, in communitymental health centers. But bud-get cuts reduced those com-munity services, and michi-gan’s prisons and jails havebecome, in effect, its largestmental hospitals. 3

more people with seriousmental illness are now in aprison or jail in 44 states thanare housed in those states’largest psychiatric hospitals,according to a survey pub-lished last year by the Treat-ment Advocacy Center, agroup in Arlington, va., thatadvocates more timely andeffective treatment for peoplewith mental illness. 4

However, states have lostsome $4 billion in treatmentfunds in the last few years,forcing them to close orshrink mental health clinicsand hospitals. As that’s hap-pened, more mentally ill in-

mates have wound up in jails and pris-ons, and corrections officials say theyaren’t able to deal with the trend.

In the madison, wis., area, DaneCounty Sheriff Dave mahoney says hemust put suicidal or dangerous mentallyill inmates in solitary confinement be-cause he has no mental health facilities.It’s “inhumane” and a “human rightsviolation,” mahoney says, but he’s beenunable to persuade the county to pro-vide the more than $100 million neededto update his jail.

About 15 percent of men and 31 per-cent of women in local jails suffer fromserious mental illnesses, such as schizo-phrenia, bipolar disorder or major de-pression — rates four to six times thatof the general population. 5 (See graphic,p. 244.) most are in jail for misdemeanors— often petty crimes, such as trespassing,disorderly conduct or drug use, resultingfrom a combination of homelessnessand mental illness. 6

BY SARAH GLAZER

Michiga

n Dep

artm

ent of Corrections

/Fa

mily Partic

ipation Program

Kevin DeMott, 19, is shackled in his cell at a Michiganadult prison in January 2011, a helmet protecting againsthis head-banging. Kevin’s mother says the prison kepthim in solitary confinement for four months to punish himfor behaviors stemming from his bipolar disorder and didnot treat his illness. As states have lost some $4 billion

in mental illness treatment funds in recent years,hospitals and mental health clinics have closed, andmany mentally ill people ended up in jails and prisons.

244 CQ Researcher

Sheriff Thomas J. Dart last year pro-claimed Chicago’s Cook County Jail thestate’s largest psychiatric hospital. 7 Onany given day, about a third of its10,000 inmates are mentally ill, accord-ing to the sheriff. 8

Jails are the wrong place to treatmentally ill people, Dart wrote, callingit a “nightmare” that rising numbers ofmentally ill people have been caughtin the web of the criminal justice systemever since the shuttering of mental hos-pitals and clinics. Those who land inhis jail are mainly charged with “crimesof survival,” such as prostitution andtrespassing, he said. “They are, for themost part, good people who suffer froman illness beyond their control andsimply need their government to haveits priorities straight.”

for a fraction of the cost of incar-cerating a mentally ill inmate, he con-tinued, “we can empower new com-munity health centers and establishcomprehensive discharge planning. It’shumane and fiscally prudent.” 9

The situation has become especiallyacute in the nation’s local and countyjails. 10 On one weekend last year,48 percent of some 1,000 inmates atthe Dane County Jail were taking atleast one psychotropic medication fora mental illness, according to a snapshotcensus by the jail. mahoney says thenumber of mentally ill inmates hasrisen since last April, when, to savemoney, madison’s state hospital closedits unit for people with mental healthemergencies brought in by police.

To avoid the five-hour roundtrip to thenearest state mental hospital, in Oshkosh,police instead are charging mentally illpeople with crimes and taking them tojail because “they know I have full-timemental health care,” mahoney says. 11

Often, a mentally ill person landsin jail for disorderly conduct when “the‘crime’ is the fact that he’s off his med-ications,” mahoney says.

The Dane County Jail is unusual inproviding 24-hour mental health caredelivered by a psychiatrist or staff psy-

chiatric social worker. Elsewhere, 83 per-cent of inmates with mental illness re-ceived no treatment for their conditionafter admission, according to a 2015report by the vera Institute of Justice, aresearch group in New York. 12

Even prisoners who receive treat-ment can have periods when theirsymptoms return. They may throw fecesat guards or become belligerent. Ac-cording to a forthcoming Human Rightswatch report, corrections guards re-spond to such behavior by subjectingmentally ill prisoners — more oftenthan other inmates — to “unnecessaryand even gratuitous use of force,” rang-ing from the use of pepper spray and

stun guns to outright brutality. 13

Prison officers “rarely receive trainingto help them understand mental illnessand how it can affect conduct,” thereport says.

mentally ill inmates also are more likelythan other prisoners to end up in solitaryconfinement for breaking rules. They canremain isolated for up to 23 hours a day,a form of sensory deprivation that isstressful even for those without mentalhealth issues, say psychiatrists and advo-cates for the mentally ill.

“Even if they don’t get worse, theydon’t get better because in generalthey’re not given treatment,” says ReneeBinder, president-elect of the AmericanPsychiatric Association, which says pro-longed solitary should be avoided forthe seriously mentally ill.

“You begin to turn on yourself,”says James Burns, 27, who spent almosttwo years of a five-year prison sentencefor armed robbery in solitary in anadult prison in Colorado, starting atage 15. “I would punch the walls untilmy knuckles bled. Hurting myself feltbetter than feeling nothing at all.”

Recent lawsuits on behalf of inmatesproduced a series of court decisions de-claring it a violation of the Constitution’sprohibition against “cruel and unusualpunishment” to place seriously mentallyill prisoners in solitary. As a result, someprisons have been developing specializedhousing and treatment programs for thementally ill. (See sidebar, p. 254.)

This year, massachusetts became thethird state to prohibit solitary for thosewith serious mental illness. Others, in-cluding montana, New Jersey and Newmexico, are considering similar lawsfor psychologically vulnerable popu-lations such as mentally ill or juvenileinmates. 14 As a result of litigation, NewYork recently became the largest stateto limit solitary confinement for youngpeople, declaring it off-limits for thoseunder 18. New York City officials wenteven further recently, banning solitaryfor inmates 21 and younger at its RikersIsland jail, effective next year. 15



However, corrections officers’ unionshave opposed such restrictions, sayingthey threaten the safety of inmates andstaff. (See “At Issue,” p. 257.) In NewJersey, unions oppose a bill to banprolonged solitary for those 21 andunder. “You’ll have a gang memberwho’s going to assault, seriously injureor kill another inmate and then he’sgoing to pass that weapon over to a21-year-old because the 21-year-oldcan’t get locked up in isolation,” saysEdward S. Sullivan, president of theNew Jersey Superior Officers Law En-forcement Association.

most experts say the solution liesin keeping the mentally ill from beingincarcerated in the first place by treatingtheir illness. That’s the idea behindspecialized mental health courts, whichoffer mandated treatment in lieu of aconventional sentence behind bars. (Seesidebar, p. 252.)

most such courts once offered al-ternative sentences only to peoplecharged with misdemeanors, but morenow make the same offer to peoplecharged with felonies — sometimesviolent felonies. But Jeffrey L. metzner,clinical professor of psychiatry at theUniversity of Colorado School of med-icine, says that trend raises two con-cerns: “One is the issue of dangerous-ness, and there’s also an issue thepublic has, which is not unreasonable:If you do something really bad, youought to be punished.”

Even when mental health courtswork well, they handle only a fractionof the thousands of people with mentalillness who end up in a big-city jail,says michael Jacobson, a former NewYork City corrections commissioner andnow director of the Institute for Stateand Local Governance at the City Uni-versity of New York.

“In any system, you probably wantsome of those specialized [mental healthand drug] courts; but there has to besome systematic way, aside from bou-tique courts that handle 20 people aday,” of reducing the numbers of men-

tally ill behind bars, says Jacobson,who is advising the city on how todo that.

As courts, judges, prosecutors, policy-makers and mental health advocatesconsider the problems of the mentallyill in prisons, here are some questionsthey are asking:

Is the proportion of mentally illpeople in jails and prisons rising?

The number of mentally ill inmates inChicago’s Cook County Jail has doubledin the last eight years, even as the county’soverall jail population has been falling. 16

Nneka Jones, the psychologist incharge of mental health services at thejail, cited recent closures of mentalhealth facilities, which include mayorRahm Emanuel’s decision in 2012 toclose six of Chicago’s 12 mental healthclinics. “I do believe that there is a

correlation,” she said. “we have not onlyseen an increase in the number of men-tally ill inmates coming into our custody,we have also seen them coming in ina sicker state.” 17

Jails around the country are reportingsimilar problems. In some cases, thenumber of mentally ill inmates has re-mained relatively constant, but theirshare of the jail population has risenas crime rates have plummeted. In NewYork City, the share of mentally ill in-mates has doubled over the last eightyears, to 38 percent, mainly because theoverall jail population has fallen by abouthalf since the 1990s. 18

However, it’s difficult to know whethersuch a proportion applies nationally orhas changed over time. Although thefederal Bureau of Justice Statistics hasconducted several national surveys,bureau statistician Lauren Glaze says its

IncreasedDecreasedNo change from FY2014

Alaska

Hawaii

Fewer States to Raise Mental Health SpendingTwenty-eight states and the District of Columbia plan to increase spending on mental health services in fiscal 2015 — seven fewer than in 2014. Eleven states plan no change in their mental health budgets, while 10 say they will cut spending.

N.Y.

Ohio

Texas

Va.

Minn.

Iowa

Mo.

Calif.

Nev.

Ore.

Colo.

Wash.

Idaho

Mont.

Utah

Ariz. N.M.

Wyo.

N.D.

S.D.

Okla. Ark.

La.

Ill.

Miss.

Tenn.

Ga.

Conn.

Mass.

R.I.

MaineVt.

W.Va. N.J.

Del.

Md.

Ala.

Fla.

Wis.

Mich.

Ind.

N.C.

S.C.

N.H.

Kan.Ky.

D.C.

Neb.Pa.

Source: “State Mental Health Legislation 2014: Trends, Themes & Effective Practices,” National Alliance on Mental Illness, December 2014, p. 25, http://tinyurl.com/osoj5c6

Changes in State Mental Health Budgets,Fiscal 2014 to Fiscal 2015

246 CQ Researcher

method for measuring mental illnesshas differed from survey to survey, sotrends cannot be determined. (Seegraphic, above.)

Indeed, according to psychologyprofessor Craig Haney of the Universityof California, Santa Cruz, who servedon a National Academy of Sciencescommittee on the growth of incarcer-ation, “we don’t have reliable enoughdata to say with confidence if the actualpercentage of prisoners who are men-tally ill is increasing or not. most suspectit has, primarily because of the ex-panded reach of the prison and jailsystem over the last 35 years, and cor-responding reductions in the size ofthe public mental health system.”

for a prison to calculate its mentallyill population, it must have enoughpsychiatric staff to identify them, some-thing many prisons lack, Haney says.However, as a result of litigation, “anumber of systems are under pressureto at least accurately count for the firsttime,” he says.

The question goes beyond statistics,he continues. “If we’re not countingthem reliably we’re not treating themeffectively, and they’re certainly not get-ting better on their own,” Haney says.

many experts blame the deinstitu-tionalization movement that began dur-ing the John f. Kennedy administrationin the early 1960s, when states beganclosing many of their mental healthhospitals. 19

“The absolute numbers of mentallyill in prisons have risen exponentially”since then, says Doris A. fuller, exec-utive director of the Treatment AdvocacyCenter. “In the mid-1950s, when therewas widespread availability of psychi-atric beds, 4 percent of the prison pop-ulation was estimated to have mentalillness. Over the long arc of time, ithas risen, and it has never abated.”

Experts cite a variety of causes forthe rising numbers of mentally ill inmates.Two prominent ones are harsher manda-tory sentencing and the nation’s so-called war on drugs, which sent jailand prison populations soaring fromthe 1980s to 2009, when they began toabate. Starting in the 1980s, drug arrestsmore than tripled, peaking in 2006. 20

Those trends ensnared many mentallyill people. Nearly three-quarters of jailinmates with mental illness also sufferfrom drug or alcohol addiction. 21

In addition, the so-called “brokenwindows” strategy — in which police

in New York and other large citiesarrest people for “quality of life” crimesas a strategy for preventing more seriouscrimes — tend to sweep up morementally ill people. The homeless areespecially vulnerable because “they’repeeing in the street, panhandling, sleep-ing in the subway,” says Jacobson atCity University of New York.

The mentally ill also swell the localjail population by coming back moreoften than other offenders. A groupof 400 “frequent fliers” returned to NewYork City’s jails more than 18 timesover the past five years; 67 percent hada mental health need and 99 percenthad a substance abuse disorder. 22

In addition, while most mentally illjail inmates are picked up for minornonviolent crimes, they tend to staylonger than the average inmate. 23 Ac-cording to Homer venters, assistantcommissioner for the Bureau of Cor-rectional Health Services in New YorkCity’s Department of Health and mentalHygiene, mentally ill inmates at theRikers Island jail stay twice as long asthe average inmate, perhaps becausethey are less skilled at obtaining bailand at working the system and aremore likely to commit infractions.

“we have a system that has becomebrittle and inaccessible for people withmental illness,” venters says.

Some say the perceived rise maysimply be the result of jail and prisondirectors doing a better job of screeningand diagnosing those with mental illnessupon entry. “we used to put them inthe hole [solitary confinement]; nowwe get a psychiatrist for them,” thewarden of a California jail told HenryJ. Steadman, lead author of a frequentlycited survey that found about 17 percentof the 12 million people admitted tojails each year exhibit signs of seriousmental illness. 24

As for historical trends, “the pro-portion of people with mental illnessin U.S. jails may not be much differentthan it was 20 to 40 years ago,” saysSteadman, president of Policy Research


Many Prisoners Report Prior Mental IllnessNearly 37 percent of state and federal prisoners surveyed in 2011 and 2012 said they had been diagnosed with a mental illness; 36 percent said they had received mental health therapy.

Source: Allen J. Beck, Marcus Berzofsky, Rachel Caspar and Christopher Krebs, “Sexual Victimization in Prisons and Jails Reported by Inmates, 2011-12,” U.S. Department of Justice, May 2013, p. 24, http://tinyurl.com/nhqcfv4

(Percentage) Mental Health History of Prisoners in U.S.,February 2011-May 2012

05

101520253035

40%

g ) Mental Health History of Prisoners in U.S.,February 2011-May 2012

Receivedprofessional mental

health therapy

Used prescriptionmedication at time

of offense

Had overnight stayin mental hospital

before prison

Diagnosed withmental illness

36.6%

8.9%15.4%

35.8%


Associates, a consulting firm outsideof Albany, N.Y. “was it 17 percent 30years ago? No one ever collected thedata. Even today, in most jails theycan’t tell you how many have seriousmental illness.”

Do programs that offer treatmentinstead of jail prevent furthercrime?

It’s a heart-warming scene repeatedoften around the country. The courtroombreaks into applause as smiling defen-dants march up to the judge’s podiumto receive a certificate and a hug fromthe judge. It’s graduation day in mentalhealth court, a ceremony to congratulatedefendants for completing treatmentunder the court’s supervision.

The first such court opened in 1997in ft. Lauderdale, fla., when suicidesof mentally ill people in BrowardCounty jails prompted officials to pur-sue reforms. As originally conceived,the courts focus on mentally ill peopleaccused of misdemeanors, aiming toget them into treatment and preventthem from committing further, possiblymore serious, crimes. 25

Since then, mental health courts havegrown rapidly to between 300 and 400nationwide, and most operate similarly:In place of a trial and conventionalsentence, a defendant may opt for at-tending court-mandated treatment thatcan last 12 to 24 months. 26 The de-fendant then must appear regularly atstatus hearings in the courtroom, wherea clinical team working with the judgechecks on progress and adherence totreatment. The court can send the in-dividuals to jail if they don’t complywith a treatment regimen.

Advocates of such courts say evalu-ations show graduates are less likely tocommit new crimes. In a frequently citedevaluation of four mental health courtsin California, minneapolis and Indianapo-lis, 49 percent of participants were re-arrested after 18 months, compared with58 percent of mentally ill defendants inthe conventional court system. 27

At first blush, seeing almost half ofa program’s participants re-arrested maynot sound like a resounding success.But evaluation co-author Allison Redlich,an associate professor of criminal justiceat the State University of New York, Al-bany, says, “This population has earnedthe name ‘frequent fliers,’ ” for the fre-quency of their arrests, “so any kind ofreduction can be a success.” Nevertheless,she adds, “mental health courts don’twork for everybody. Trying to figure outhow and for whom they work is wherewe should be focusing our efforts.”

A new research finding — that lessthan 20 percent of crimes committedby mentally ill defendants can be di-rectly traced to their illness — mightexplain the high re-arrest rates. 28

Jennifer Skeem, co-author of thisresearch and a professor in the Schoolof Social welfare at the University ofCalifornia, Berkeley, says mentally illpeople often commit crimes for thesame reasons as others — hanging outwith the wrong crowd, using drugs or

not thinking or caring about the con-sequences of their actions beyond im-mediate gratification.

The premise of most jail diversionprograms — that treating mental illnesswill stop people from committing crime— is too “simplistic,” she says.

“we shouldn’t stop investing in spe-cialty programs for that population,”says Skeem. But, she cautions, “theemphasis of those programs needs tobe broadened” beyond psychiatric treat-ment, “and we need to pay attentionto other risk factors that could relateeven more strongly to their involvementin the criminal justice system.”

for example, she says a form ofcognitive behavioral group therapythat aims to change criminal thinkingpatterns — such as justifying irrespon-sible behavior to oneself — in allkinds of offenders, not just the mentallyill, has been shown to reduce sub-sequent violent acts.

when it comes to reducing crimenationally, mental health courts get

Timothy Heckler says goodbye to program administrator Shari Lewinski after beingreleased from the Court to Community program for people with mental illness inDenver, Colo., on July 17, 2014. “I’ve learned a lot. I’m still off the drugs; I’m reallygrateful for that,” Heckler told Judge Johnny Barajas. One way the criminal justice

system is dealing with mentally ill people is to divert them to specialized mental health courts that allow them to enter mandatory court-monitored

treatment programs instead of going to jail.

Getty Im

ages

/The Denver Post/Craig F. W

alke

r

248 CQ Researcher

“mixed reviews,” depending on thecourtroom, says Nicole waters, prin-cipal court consultant at the NationalCenter for State Courts, an independentcourt improvement organization basedin williamsburg, va. “A court mightbe very effective in one state and notanother, and we don’t know why,”she says.

Research shows it is important tohave a probation officer or judge witha “firm but caring relationship” withthe person being supervised, Skeemsays. That could explain why successvaries so widely from court to court.“You might have a judge who realizesthat unless this defendant stops hangingout with their drug-using cousin, allthe medication compliance in the worldwon’t make the difference in preventingre-arrests,” she says.

Some civil liberties groups and de-fense lawyers complain that court-su-pervised treatment often lasts muchlonger than the conventional sentencea defendant would have received fora misdemeanor — such as probation,a fine or a few weeks in jail.

Steadman, who advises local gov-ernments on such programs, agreesthat mandated treatment tends to lastmuch longer than the 60 to 90 daystypical for a misdemeanor sentence.But, he says, “These are not quickfixes. The people getting into thesespecialty courts have got longer-termbehavioral health problems that takelong-term treatment. You don’t givethem an injection and they’re better.”

“most mental health courts are tar-geted on misdemeanants, many ofwhom would never be involved withthe criminal justice system but for men-tal health courts,” asserts Ira Burnim,legal director of the Bazelon Centerfor mental Health Law, a legal advocacygroup for the rights of the mentallyill based in washington.

He describes a florida mental healthcourt where “they dragged in one guyfor drinking coffee on the street andloitering. This was just a homeless guy

they were trying to bring in for someservices.”

waters agrees that such so-called“net-widening” is a risk for courts thatonly take misdemeanors. But increas-ingly mental health courts are acceptingfelony cases as well, where the de-fendant is more likely to face a sub-stantial prison sentence, she notes.

Upon hearing the word felony, “thepublic has the perception these aremass murders, but those are not thetypes of cases” these courts take, sayswaters.

In miami-Dade County, for example,the majority of felony cases handledby the mental health diversion courtare drug possession charges and as-saults connected with resisting arrest,which can include even slight physicalcontact with the officer. In addition,waters says, the prosecutor has a lotof discretion over which cases to bring:“He can say ‘no’ to murders, sex of-fenses, gang affiliations.”

Nevertheless, waters says, prosecu-tors often fear that a mental healthcourt could release people into thecommunity without adequate supervi-sion, and that they may commit anothercrime. However, a new study suggeststhat accepting felony defendants actu-ally improves public safety by reducingthe risk of future violence. In a one-year follow-up, felony defendants whowent through the San francisco mentalHealth Court were found to be far lesslikely to have committed violent actsthan those from other courts. 29

The study is consistent with otherresearch that presents a seemingly para-doxical finding: Programs targetinghigh-risk offenders produce a betterpayoff in reduced recidivism than thoseaimed at low-level offenders, who aremore likely to get re-arrested for pettyoffenses. 30 At New York City’s NathanielProject, which treats court-referredfelony defendants, only 3 to 4 percentof graduates are re-arrested for a violentcrime two years later, according to pro-ject co-founder Ann-marie Louison.

violent felonies now comprise morethan 40 percent of the caseload at theBrooklyn mental Health Court, althoughthe court won’t take defendants chargedwith murder or rape. Judge matthewJ. D’Emic, who presides over the court,says the decision to accept violentfelonies was based on some early casesin which the crime seemed directlylinked to the person’s mental illness.

As for releasing dangerous defen-dants into the community, D’Emic ad-mits, “I’m worried about it every day.”But because he receives daily reportson defendants, he says he is alertedright away if someone has violated hisor her agreement by dropping out ofa treatment program. He can then orderthat person’s arrest.

Does solitary confinement inducemental illness?

Kalief Browder was a sociable 16-year-old living in New York when hewas falsely accused of stealing a back-pack and sent to Rikers Island, thecity’s huge jail. Browder would spendthree years at Rikers awaiting a trial— two in solitary confinement, typicallyfor repeated scuffles with other inmates.After Browder refused numerous offersto plead guilty to a lesser charge, sayinghe wanted to prove his innocence attrial, prosecutors finally dismissed thecase, saying the man who had accusedBrowder of stealing the backpack hadgone back to mexico and disappeared.Six months after Browder returnedhome he made two suicide attempts— first by attempting to slit his wrists,second by trying to hang himself.

Browder had frequent flashbacks tothe “Bing,” as solitary is called at Rikers.Like many inmates who have enduredsolitary, he no longer felt comfortablearound other people, describing him-self as having become paranoid, quietand “distant.” He told The New Yorker,“I feel like I was robbed of my happi-ness.” 31

In recent years, stories like Browder’sand reports by advocacy groups have



called attention to the psychologicallydamaging effects of solitary confine-ment, especially on young people.

People in solitary are more likelyto commit suicide or deliberately harmthemselves than the general prisonpopulation. 32 And mentally ill inmatesare more likely to land in solitary thanother prisoners, according to severalstudies. 33

Researchers and psychiatrists agreethat solitary confinement can be par-ticularly damaging for the mentally ill.The American Psychiatric Associationsays prolonged solitary “should beavoided” for those with serious mentalillness. 34

However, psychiatrists and psychol-ogists have long debated whether solitaryinduces mental illness in people withouta mental disorder. In research first pub-lished in the 1980s, Harvard medicalSchool psychiatrist Stuart Grassian ex-amined prisoners being held in solitaryconfinement and concluded that isola-tion units tend to induce psychosis.Even inmates who did not become ob-viously psychotic reported psychosis-like symptoms, including hallucinationsand violent outbursts. 35

Three years after California openedits high-security prison at Pelican Bay,the University of California’s Haney in-terviewed a representative sample of100 inmates in solitary as an expertconsultant to a prisoner lawsuit chal-lenging the unit’s constitutionality.Haney found some form of seriouspsychological or emotional disturbancesin nearly every prisoner he interviewed.more than 90 percent reported prob-lems with anxiety; 70 percent felt theywere on the verge of an “impendingbreakdown;” more than 40 percent hadhallucinations; and 27 percent had sui-cidal thoughts. more than three-quartersexhibited social withdrawal, and an al-most equal number suffered chronicwithdrawal, Haney said in an e-mailto CQ Researcher. 36

Terry Kupers, a psychiatrist at thewright Institute in Berkeley, Calif., an

educational institution for psycholo-gists, has visited many prisoners insolitary confinement as an expert wit-ness. “It is very clear from the research. . . that for just about all prisoners,being held in isolated confinementfor longer than three months causeslasting emotional damage, if not full-blown psychosis and functional dis-ability,” he writes. 37

Typically, upon release from solitary,he says, “the first thing most do is shutthemselves in a room . . . as if repro-ducing the conditions of solitary con-finement they’ve become habituatedto; they won’t go places, can’t hold ajob and won’t talk to others.”

However, Jeffrey L. metzner, a clinicalprofessor of psychiatry at the Universityof Colorado, disagrees. “with a fewexceptions, long-term segregation,” assolitary is often called, “does not causesomeone to develop a mental illness.It certainly causes people to feel dis-tressed . . . anxious and depressedand irritable.” But, says metzner, “itdoesn’t make you psychotic.”

metzner adds, “In the movies you’replaced in a cell with no communicationwith anyone. That doesn’t exist. what

exists is people locked down in cellswho communicate with other peoplebecause there may be anywhere from15 to 20 cells adjacent.”

Some inmates say they feel safer insolitary confinement because they havemade enemies in the prison yard, notesJoel Dvoskin, a mental health consultantto states, who served on a controversialColorado prison study of solitary thatfound no adverse effects. “we don’tthink it helped mental functioning, butthere was no evidence of systematicdeterioration,” he says. 38

But the relatively positive results,Dvoskin says, may have occurred be-cause conditions in Colorado may have

been better than in other prisons. manyinmates had Tvs in their cells, and thecorrections officers treated prisonersrespectfully. “If the officers are rude,it makes a difference,” says Dvoskin.

Critics argued that the results inColorado could not be generalized toother states. “I agree: All it tells us isthat in that study that’s what they found,”says Dvoskin, adding that the studyshould be replicated in other states.

Some critics of research by Grassianand Haney say their studies were not

Matt Dougherty, a police officer in Lower Merion, Pa., center, undergoes trainingdesigned to help police recognize and respond to people suffering from

serious mental illness. The trainers, intervention specialist Michelle Monzo andofficer Joe Smith, whisper to Dougherty to help him empathize with a

mentally ill person who hears voices.AP Pho

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250 CQ Researcher


well designed because it was unclearhow many of the prisoners alreadyhad psychiatric symptoms before en-tering prison. Nor was there a com-parison group of prisoners who hadnot experienced solitary, they said. 39

However, Haney disputes these crit-icisms. “I’ve seen a number of casesin which people with no pre-existingmental illness and no record of familyhistory developed serious forms ofpsychosis that persisted, even afterthey were released from prison,” hesays. “I have absolutely no doubt itcan occur. I’d not suggest isolationmakes everyone mentally ill, but I’veseen it happen.”

Corrections officials say solitaryconfinement is an essential tool forprotecting inmates and controllingmisbehavior. “where do you putsomeone who is hallucinating? If youleave him in general housing, every-one’s safety is in jeopardy,” saysThomas J. fagan, a former adminis-trator with the federal Bureau of Pris-ons who is now director of the Di-vision of Social and BehavioralSciences at Nova Southeastern Uni-versity in fort Lauderdale, fla.

“If you take that option away, . . .the other options are going to becostly,” fagan says, because it generallymeans creating a new, secure mentalhealth facility with more psychiatricstaff.

CUNY’s Jacobson says surveys in-dicate that inmates knifing fellow pris-oners or committing other types ofviolence represent a very small per-centage of those who end up in solitary.mainly, he says, “It’s prisoners not lis-tening to an order” or possessing apornographic magazine — infractionsfor which inmates can go to solitaryfor weeks, or even months, he says.

much like with a naughty child, theappropriate answer to misbehavior bya prisoner is a brief timeout in solitary,he asserts. “whatever benefits comefrom cooling people off, you can prob-ably get in a week or two.”

BACKGROUNDFrom Jails to Bedlams

with more mentally ill people nowhoused in prisons and jails than

hospitals, many observers have noteda cruel paradox: The United Statesseems to be returning to 19th-centuryconditions decried by social reformersat the time. 40

In the early 1800s, reformers dis-covered that many mentally ill peoplewere being housed and abused in jailsor poorhouses. A massachusetts preach-er, the Rev. Louis Dwight, was deliveringBibles to a Boston jail when he cameupon a psychotic inmate imprisonedfor nine years despite breaking nolaws. The prisoner was dressed in rags,Dwight wrote, and his only bed was“a heap of filthy straw.” 41

Dwight’s revelations spurred an in-vestigation by the massachusetts Legis-lature and the opening of the first StateLunatic Asylum in 1833, in worcester.when the hospital opened, more thanhalf of the patients came from jails,prisons and almshouses. 42

A decade after Dwight’s original find-ings, Dorothea Dix, a massachusettsteacher, was horrified at finding “insane”prisoners in miserable conditions inunheated jail cells in 1841. She begana campaign, traveling from state tostate, urging the humane treatment ofthe mentally ill in asylums instead ofprisons. Her advocacy led to the open-ing of 32 state psychiatric hospitals in18 states. 43

By 1900, every state had a mentalinstitution. 44

By the mid-20th century, however,state mental hospitals had become thetarget of exposés. Conscientious ob-jectors, appalled at the conditions theyfound while working as attendants insuch institutions in 20 states during

world war II, turned to the press andtestified in Congress about the abusivetreatment.

The exposés began a reform move-ment that became the early impetusfor a push toward deinstitutionalization— the movement to shift mentally illpatients from hospitals to outpatienttreatment in community mental healthclinics.

The movement was aided by thedevelopment of anti-psychotic drugs,the first of which — Thorazine —was introduced in 1954. The drug setoff a pharmacological revolution inthe treatment of schizophrenia. Thediscovery of additional psychotropicdrugs created a sense of optimismthat the seriously mentally ill couldlive independently in their own neigh-borhoods.

Deinstitutionalization was also theresult of stronger due process protec-tions against involuntary commitmentto mental hospitals, the growing in-fluence of psychiatrists who thoughtthe mentally ill could be cared foroutside of institutions and the enact-ment of medicaid in 1965, accordingto the vera Institute of Justice. medicaidwould not reimburse state mental hos-pitals for care, leading many state in-stitutions to release droves of patientsto nursing homes, general hospitalsor the street, where they could obtainmedicaid coverage.

In 1963, President Kennedy pro-posed a series of federally fundedcommunity mental health centers thatwould function as an alternative topsychiatric hospitals, signing into lawthe mental Retardation and Communitymental Health Centers ConstructionAct. It authorized Congress to provideup to $3 billion in grants to states toestablish community mental healthcenters. 45

However, the federal governmentnever followed through with adequatefunds, and by 1980 only 754 of the 2,000planned centers had been built. 46

Continued on p. 252


Chronology1830s-1950sWretched prison conditions forthe “insane” lead to creation ofasylums as humane alternatives.

1833massachusetts lunatic asylum opens.

1841Prison reformer Dorothea Dix beginscampaign to place the mentally ill inasylums — hospitals — not jails.

1900Asylums exist in every state.

1940sConscientious war objectors ex-pose abuses they see while work-ing at asylums, helping set thestage for deinstitutionalization.

1954Thorazine, a schizophrenia drug, ismarketed in U.S., spurring pharma-cological revolution and crusadefor community treatment.

•

1960s-1970sDeinstitutionalization move-ment empties state mental hos-pitals, while psychotropic drugsrevolutionize care.

1963Under President John f. Kennedy’sprodding, Congress authorizes upto $3 billion in state grants forcommunity mental health centers.

1971President Richard Nixon declares a“war on drugs.”

1973New York state’s “Rockefeller druglaws” start a national trend for manda-tory sentences for drug possession.

1980s Homelessnessamong the mentally ill rises. . . .States begin building “supermax”prisons.

1980fewer than 800 community mentalhealth centers exist instead of the2,000 expected.

1988After a police officer kills a mentallyill man, memphis, Tenn., pioneerstraining for police to recognizepsychiatric symptoms.

1989California builds Pelican Bay super-max prison to hold some inmatesin solitary 23 hours a day.

•

1990s Courts rule soli-tary confinement for the men-tally ill is “cruel and unusualpunishment.” . . . First mentalhealth courts are founded.

1993In Casey v. Lewis, federal courtfinds it unconstitutional for Arizonato place seriously mentally ill pris-oners in solitary confinement.

1995In Madrid v. Gomez, federal judgedeclares holding those with mentalillnesses in solitary at California’sPelican Bay prison is unconstitutional.

1997Broward County, fla., opens firstmental health court.

•

2000s-PresentMental health courts grow rapid-

ly, accept more serious crimes;bipartisan support grows for fed-eral legislation to offer treatmentand rehabilitation to prisoners.

2004Congress passes the mentally IllOffender Treatment and Crime Re-duction Act to help state and localgovernments improve responses tothe mentally ill in the criminal jus-tice system.

2008President George w. Bush signsthe Second Chance Act, authoriz-ing grants to states to help prison-ers re-enter society.

2011U.N. expert declares putting men-tally ill and young people in soli-tary confinement is “torture.” . . .New York state prohibits long-termsolitary confinement of peoplewith serious mental illness.

2014Colorado becomes second state tobar long-term solitary confinementfor mentally ill. . . . New Yorkstate activists charge that hundredsof mentally ill people remain insolitary. . . . New York City mayoraltask force announces $130 millionplan to divert the mentally ill fromthe justice system and treat them.

2015massachusetts becomes third stateto limit solitary confinement for thementally ill. . . . To improve fund-ing for treatment, President Obamaproposes increasing grants to statesand local governments. . . . mon-tana, New mexico, New Jerseyconsider bills to limit solitary con-finement for inmates who are men-tally ill. . . . At least 300 mentalhealth courts are in existence;study finds they reduce violenceamong felony defendants.

252 CQ Researcher

Mandatory Sentencing

At the same time that the popu-lation of state mental hospitals

was dropping, the number of peopleentering the nation’s prisons and jailswas increasing.

Drastic cuts in the social safety netin the 1980s contributed to rising home-lessness and to increasing numbers of

mentally ill people on the streets. Growthin prison and jail populations closelymirrored the rate at which state psy-chiatric institutions were emptying. 47

One factor during the 1980s wasthe rise in the prosecution of drugcrimes, beginning with PresidentRichard m. Nixon’s declared war ondrugs in 1971. Another was the growingpopularity of mandatory sentences,starting with the so-called Rockefellerdrug laws adopted in New York state

in 1973, which included mandatorysentences for drug possession.

During the 1970s, crime expertsbegan to question the effectiveness ofrehabilitation for convicted criminals,a changing view that would cause pris-ons to turn away from rehabilitationprograms and politicians to supportharsher sentencing.

Beginning in the 1980s and contin-uing into the ’90s, more states passedlaws mandating long sentences and


Continued from p. 250

Justin volpe had stopped taking his medications for psychosisand was addicted to drugs when he heard voices tellinghim to steal from a co-worker. The 23-year-old was arrested for theft in 2007 and landed in a miami jail for a month

and a half awaiting trial.But instead of a trial and a sentence, volpe was offered an

eight-month court-mandated course of drug treatment and psy-chiatric counseling, part of a mental health jail diversion programrun by miami-Dade County and the 11th Judicial Circuit offlorida. 1

Today, volpe, 31, says the program helped him turn his lifearound. were it not for the jail diversion program, “I wouldhave continued the vicious cycle of drugs and incarceration,”says volpe, who sports a neatly trimmed beard and a readysmile. “If I were still alive, my quality of life would be nowherenear what it is today.”

Now the married father of a 4-year-old, volpe is a full-timeemployee for the miami-Dade County courts. As a certified peerspecialist, he helps mentally ill defendants on their road torecovery, taking them out for coffee and offering support tohelp them make it through their mandated treatment.

Although the mental health diversion program operates outof a court, it has some notable differences from a typical mentalhealth court. Defendants who enter the program are not requiredto plead guilty, as in some courts, and if they successfullycomplete the program their charges are dismissed so they don’tacquire a criminal record.

Recidivism rates — arrests for new offenses — have droppedfrom 70 percent before the program began in 2000 to about 20percent for those who finish the program, according to TimCoffey, coordinator of the court’s diversion program. The programalso works closely with local and county police who have beentrained in crisis intervention, or how to de-escalate conflictsinvolving mentally ill people. In 2013, out of 10,626 mental healthcrisis calls answered by police, only nine arrests were made, ac-cording to Coffey.

The program has had strong support from public defendersand prosecutors. “we want to stop people from committingcrimes,” says Jennie Conklin, an assistant state attorney. “Youcan only lock people up for so long. we can keep arrestingthem for misdemeanor after misdemeanor or try to get themtreatment to reduce recidivism. . . . Just putting them in jailand saying, ‘Good luck and we hope you take your meds’won’t work.”

with the cooperation of prosecutors, the program recentlyhas begun accepting people who have committed low-levelfelonies, mostly for drug possession and assault related to aphysical struggle while resisting arrest, according to Coffey. Re-cidivism rates for felony offenders who complete the programare just 6 percent. 2

The program’s secret ingredient, many experts say, is thejudge who founded it in 2000 and has spearheaded many ofits innovations, Judge Steve Leifman, associate administrativejudge in the miami-Dade County Court Criminal Division. Leifmansays he became convinced the program was needed becausehe was appalled at how badly mentally ill people were beingtreated by the criminal justice system.

“There is so much stigma with mental illness that most judgeshave no clue,” he says, that people can recover from it with ap-propriate treatment, just like any physical illness. Leifman alsoworks with a national program to train judges to recognize psy-chiatric symptoms and address mentally ill defendants respectfully.“when I talk to people with mental illnesses, it is striking howabused they are by the mental health system and the criminaljustice system,” he says. “How you address them in court makesall the difference in the outcome: If they’re motivated, and you’reoffering them help, they’re mostly going to do it.”

Citing the diversion program’s record in reducing re-arrests,he declares, “we’re the biggest crime prevention program in town.”

Yet, it’s difficult to find hospital beds or other aid neededby the people in the program, such as housing, employmentand job training.

Innovative Program Diverts mentally Ill from Jail to Treatment“We’re the biggest crime prevention program in town.”


minimums for certain crimes as wellas “three strikes” laws, which imposeda lengthy mandatory sentence for anoffender’s third conviction.

Between 1970 and 2005, the na-tion’s prison population exploded by700 percent and continued rising toa peak of 1.6 million in 2009. Theincrease in incarceration involvingdrug arrests accounted for about two-thirds of the increase in the federalprison population and one-half of the

increase in state prisons between 1985and 2000. 48

The 1980s also saw the beginningof a state trend to build so-called supermaxprisons, designed to confine the worstof the worst prisoners in solitary con-finement. In 1989, California openedthe Pelican Bay prison with a SecurityHousing Unit (SHU) designed to holdprisoners in solitary for 23 hours a day.

In 1995, a federal judge prohibitedconfinement of mentally ill prisoners

at the SHU and concluded that con-ditions were close to intolerable evenfor the mentally healthy. 49

Among the cases of abuse was thatof an inmate who refused to return afood tray in protest against an officerwho called him derogatory names. Hewas beaten unconscious until a pieceof his scalp had been peeled back. 50

In his decision, U.S. District JudgeThelton E. Henderson ruled that prisonofficials “cross the constitutional line

with 9 percent of the county’s population suffering fromserious mental illness — the highest rate of any urban center inthe country — fewer than 13 percent receive care in the publicmental health system, according to the project’s website. 3

many mental health clinics “don’t want to deal with a homelessguy with mental illness,” Leifman says. “They haven’t bathed;they’re difficult. The treatment providers don’t get paid enough”to give this population the level of service they need. But headds, “It’s not just about putting them on the right medications;it’s about giving them a life where they want to get back upand help themselves again.”

Leifman has become so frustrated with the lack of a facilityoffering appropriate treatment to mentally ill offenders thathe decided to create one. He is leading county efforts toconvert an abandoned state mental hospital into a compre-hensive center for mentally ill offenders. Plans call for 168beds available for up to 90 days of residential treatment, pro-viding a seamless transition from the courtroom to services— all under one roof.

On a recent tour of the building, Leifman showed off thelarge institutional kitchen he plans to turn into a culinary job-training program, an area that will be used as a crisis centerwhere police can bring mentally ill people to be evaluated andoffices where case managers can help link people up withbenefits.

with the help of a $1-a-year lease arrangement with thestate and passage of a $22 million bond issue, he hopesthe new facility will open within two years. Leifman alsohas his eye on a neighboring property he would like to seeconverted into low-cost housing for those coming throughthe program.

Historically, the nation has gone from warehousing thementally ill in state mental hospitals with scant treatment totoday’s conventional court system, where “we’re kicking themall to the street, which is equally horrible,” observes Leifman.with the new facility, he says, mentally ill people “will come

here and we’ll gently reintegrate them back into the community.This will be the crowning jewel; we’ll make sure they geteverything they need.”

— Sarah Glazer

1 The official name of the program is the Eleventh Judicial Criminal mentalHealth Project.2 “Eleventh Judicial Criminal mental Health Project — Program Summary,”http://tinyurl.com/qg4efnk.3 The high rate is thought to be the result of a combination of homelesspeople attracted by South florida’s warm climate and the legacy of the1980 mariel boatlift, when Cuban President fidel Castro allowed more than125,000 people to emigrate to the United States, some of whom were fromCuba’s mental wards and prisons. See Pete Earley, Crazy (2006). Also seeEleventh Judicial Circuit of florida, Criminal mental Health Project website,http://tinyurl.com/qdkjb4d.

Justin Volpe was arrested in Miami after he heard voicestelling him to steal. But instead of a jail sentence, he received drug treatment and counseling,

helping him turn his life around.

CQ Researcher/Sarah

Glazer

254 CQ Researcher

when they force certain subgroups ofthe prison population, including thementally ill, to endure the conditionsin the SHU, despite knowing thatthe likely consequence for such in-mates is serious injury to their mentalhealth.” 51 Placing mentally ill personsin such conditions is “the mental equiv-alent of putting an asthmatic in a placewith little air to breathe,” he wrote. 52

In December 1995, Henderson fol-lowed up by ordering the removal of100 severely mentally ill prisoners fromthe SHU by year’s end.

Nevertheless, Henderson refrainedfrom declaring solitary unconstitutionalfor prisoners without mental disorders.

Conditions in solitary “may well hoveron the edge of what is humanly tol-erable for those with normal re-silience,” he said. However, he added,its use for the general populationdoes not violate the Eighth Amend-ment’s ban on “cruel and unusualpunishment.”

The Pelican Bay ruling led to a se-ries of lawsuits by the American CivilLiberties Union (ACLU) and other ad-vocacy groups on behalf of prisonersconfined in solitary in Arizona, Indiana,New mexico, New York, South Carolina,Texas and wisconsin. That litigationhas led to settlements or court ordersprohibiting confinement of mentally

ill prisoners in solitary, albeit only forthose prison systems named in thesuits.

The ACLU also has waged a cam-paign outside the courtroom to “stopsolitary,” likening isolation to “torture”— advocating the adoption of statelaws to limit solitary. 53 That effort isa recognition, says the ACLU’s Amyfettig, senior staff counsel for its Na-tional Prison Project who directs theStop Solitary campaign, of the difficultyof achieving change merely by filingsuits and enforcing settlements. “Noteven the ACLU can sue every stateand every single facility that engagesin this practice,” she says.


After 25 years spent mostly locked alone in his cell, a Penn-sylvania prisoner identified only as “BB” developed schiz-ophrenia and had difficulty speaking in complete sentences

— a condition “principally attributable to his experiences in solitaryconfinement,” according to a 2014 Justice Department report. 1

But, prompted by a lawsuit filed in march 2013 by theDisability Rights Network of Pennsylvania, the Pennsylvania De-partment of Corrections is taking steps to drastically curtailsolitary confinement for inmates with serious mental illness.

Under a settlement announced Jan. 6, those who have demon-strated “problematic” behavior, such as posing a danger to inmatesor staff, must be sent to specialized but still secure treatment units,where they will be allowed at least 20 hours weekly outside oftheir cell and receive individualized mental health treatment. 2

The settlement specifies that after July 1, 2016, no seriouslymentally ill person can be placed in solitary unless “exceptionalcircumstances” exist, such as lack of bed space, and cannot beheld in solitary longer than 30 days. 3

Pennsylvania’s Department of Corrections says it already hasmoved hundreds of mentally ill inmates out of solitary andplaced potentially dangerous inmates in the newly designedsecure treatment units specified in the settlement.

“Even though the cell size and furnishings are similar [toregular solitary prison cells], the experience is very different,”says Robert marsh, director of the psychology department forthe Pennsylvania Department of Corrections. The new unitsinclude areas where inmates can congregate and cubicles wherethey can meet privately with therapists.

“The artwork lets you know this is different,” marsh says, alludingto inmates’ artwork on themes of recovery adorning the hallways.

The Justice Department initiated its investigation severalmonths after the Disability Rights Network filed its suit andconducted it independently of the advocacy group, says KellyDarr, legal director of the Disability Rights Network of Pennsylvania.The government investigation “confirmed the allegations” in theadvocacy group’s lawsuit and “added pressure” on the PennsylvaniaDepartment of Corrections “to address the issue,” she says. 4

The Justice Department report, based on a statewide inves-tigation, concluded last year that hundreds of mentally ill prisonersremained in solitary confinement for months and sometimesyears in “harsh” conditions in Pennsylvania’s prisons.

“They are routinely confined to their cells for 23 hours aday, denied adequate mental health care, and subjected topunitive behavior modification plans . . . unsettling noise andstench, harassment by correctional officers and the excessiveuse of full-body restraints,” the Justice Department charged. 5

John wetzel, secretary of the Pennsylvania Department ofCorrections, said last year that the report relied on informationfrom one or two years earlier and thus did “not reflect thereality” of how the department was operating at the time ofthe report’s release in february 2014. 6

In January, the Pennsylvania Department of Corrections said fewerthan 150 people with serious mental illness remained in traditionalsolitary confinement cells, down from nearly 850 previously. 7 morerecently, Susan mcNaughton, press secretary for the Department ofCorrections, said in a march 5 e-mail, “we have no seriously mentallyill inmates who experience solitary confinement.”

The corrections department has also undertaken mental healthtraining for its entire custody staff, marsh says. As part of thetraining, correctional officers are given ear buds with a tape

States Revamping ‘Solitary’ for the mentally Ill“It was a culture change in the beginning.”


Mental Health Courts

In recent years, the second gener-ation of mental health courts has

changed the way the specialty courtsdo business, partly in response tosome of the criticisms from civil lib-erties groups about how they operate.for example, some advocates for thecivil rights of the mentally ill objectthat courts often require a defendantto enter a guilty plea before enteringthe program, saddling the person witha criminal record that can bar him orher from public housing or make itdifficult to get a job.

According to waters of the NationalCenter for State Courts, at least 43 per-cent of the nation’s mental healthcourts now allow the defendant toenter the program without pleadingguilty.

A tragedy in memphis, Tenn., in1988 — a police officer’s shooting ofa mentally ill man — spurred anothertype of alternative to incarceration.memphis pioneered a 40-hour trainingprogram for officers on how to rec-ognize signs of mental illness andde-escalate a combative situation witha mentally ill person and provideda drop-off center where an officercould take a person exhibiting psy-

chiatric symptoms for evaluation andtreatment. 54

The approach, known as Crisis In-tervention Team (CIT) training, hasspread rapidly, with 2,500 programsoffered in cities and counties throughoutthe United States, according to micheleSaunders, vice president of CIT Inter-national, a memphis-based membershiporganization that provides informationto localities on how to start a CIT pro-gram. In addition, some jails and prisonshave started CIT training to help cor-rections officers deal with mentally illinmates more empathetically and toidentify when they have a mental dis-order, Saunders says.

that simulates the schizophrenic experience of “hearing voices.”Officers listening to the tape have to cope with a demandingsituation — such as repeating numbers backwards. “It’s an eye-opener as to how stressful mental illness can be,” marsh says.

Eldon vail, secretary of the washington state Department ofCorrections from 2008 to 2011, pioneered the alternative approachof providing secure treatment units as deputy secretary from 1999to 2006. “Some of those guys are dangerous to themselves orothers so you’ve got to have them in a more restricted environment,”he says, but it should be a specialized unit where “mental healthstaff have significant authority over how it’s operated.”

Retraining prison guards is crucial, according to vail. “Theorientation for corrections officers for the last 30 or 40 yearshas been around this notion ‘Games Prisoners Play’: You’retaught that every interaction is a potential effort by the inmateto manipulate you, so you start to look with great suspicionat the folks you’re responsible for supervising,” he says.

Prisoner BB, who was exhibiting bizarre speech and respondingto hallucinations, improved dramatically after he was admittedtwice to an offsite inpatient unit, according to the Justice De-partment. Instead of recognizing this improvement as confirmationthat solitary confinement was harming the inmate’s mental func-tioning, Pennsylvania corrections officials viewed it as evidencehe had “malingered” or had “faked” his mental illness while insolitary, the Justice Department reported. 8

Asked if there was a trend of corrections staff accusing inmatesof faking mental illness, marsh says, “It’s very difficult to makethat conclusion,” adding that “mental illness can wax and wane.”

— Sarah Glazer

1 Department of Justice, letter from Acting Assistant Attorney General JocelynSamuels to Gov. Tom Corbett, feb. 24, 2014, p. 12, http://tinyurl.com/p4ayyja.See also Elizabeth Daley, “Pennsylvania Agrees to Keep mentally Ill Inmatesout of Solitary,” Reuters, Jan. 6, 2015, http://tinyurl.com/k4oyz9a.2 “Pennsylvania Department of Corrections Settles Lawsuit with the DisabilityRights Network of Pennsylvania,” news release, Pennsylvania Department ofCorrections Jan. 6, 2015, http://tinyurl.com/pgt9ktm.3 Disability Rights Network of Pennsylvania v. John Wetzel, U.S. District Courtfor the middle District of Pennsylvania, case number 1:13-cv-00635, p. 12,http://tinyurl.com/pn56aop.4 The Justice Department initiated its statewide investigation in may 2013.See Department of Justice, op. cit.5 Department of Justice, ibid.6 mark Berman, “The Pennsylvania Prison System will Stop Putting mentallyIll Inmates in Solitary,” The Washington Post, Jan. 8, 2015, http://tinyurl.com/p7zcjlx.7 News release, op. cit.8 Department of Justice, op. cit.

Recovery-themed artwork by mentally ill inmates now adorns the new units Pennsylvania established forstate prisoners moved out of solitary confinement

in response to a lawsuit.

CQ Researcher/Sarah

Glazer

256 CQ Researcher


CURRENTSITUATIONState Action

montana, New Jersey and Newmexico are considering legislation

to protect mentally ill prisoners fromlong-term solitary confinement, joiningNew York, Colorado and massachusetts,which already have such laws, accord-ing to the ACLU’s fettig. 55

However, advocates for the NewYork law, known as the “SHU ExclusionLaw,” which took effect in 2011, say

they are disappointed with the results.while approximately 200 inmates havebeen moved from solitary into specialmental health units, hundreds of othersremain in isolation because of questionsover their diagnosis. The law’s prohi-bition applies only to those with “seriousmental illness,” including schizophrenia,bipolar disorder and major depressivedisorder. 56

About 700 prisoners in solitary“don’t meet this magic line” of seriousmental illness, but have been diagnosedwith some other more minor form ofmental illness, and some may be insolitary because of misdiagnosis, ac-cording to Jack Beck, director of thePrison visiting Project of the CorrectionalAssociation of New York, a nonprofitthat inspects prisons and reports to thestate Legislature.

“They are not receiving any out-of-cell therapy and are still being harmed,”he says. “we think the ‘serious mentalillness’ line is not working as well aswe would like. People with mental illness[of any kind] shouldn’t be in there.”

To address this gap, his organizationand prisoner advocacy groups are sup-porting a bill introduced in the NewYork Legislature to prohibit solitaryconfinement for inmates with any men-tal illness. 57

Legislation in several states, support-ed by a coalition of religious and civilliberties groups, would prohibit pro-longed disciplinary confinement for allprisoners. New mexico, New Jerseyand New York are considering a 15-day limit, while a bill in montana would

place a 14-day limit for the seriouslymentally ill and those under 18. 58

In support of their efforts, reformershave been citing a 2011 report by theU.N. special rapporteur on torture. Itdeclared that solitary confinement canamount to “torture” for juveniles andfor the mentally ill and should be pro-hibited for both groups, as well as barredfor anyone else beyond 15 days. 59

A bill introduced by DemocraticNew Jersey State Sen. Raymond J. Les-niak would prohibit solitary confine-ment for inmates with mental illnessand those 21 and under and wouldlimit it to 15 days for others. However,unions representing corrections officersand the New Jersey Department ofCorrections oppose the bill, with thelatter warning it would be “financiallyprohibitive.” (See “At Issue,” p. 257.)

“The use of restrictive housing is anecessary tool . . . to ensure a safeenvironment for staff as well as inmates,”the department testified. 60

Court decisions in six states havedecreed that holding prisoners withserious mental illness in solitary is un-constitutional under the Eighth Amend-ment. Several other states, includingPennsylvania, are making changes inresponse to lawsuit settlements.

In an interim agreement reachedlast year growing out of litigation filedby the ACLU, New York state agreedto ban solitary confinement for 16-and 17-year olds and restrict it to 30days for people with developmentaldisabilities, such as traumatic brain in-jury or an extremely low IQ.

A final settlement could lead to evenmore sweeping restrictions. The ACLUhas agreed to suspend its litigation untilfebruary 2016 while an expert for eachside monitors the system and recommendsnew guidelines for solitary confinement.

Local Action

After a schizophrenic man died lastyear in an overheated cell at Rikers

Island, New York City announced whatsome experts call the most extensiveprogram of any city aimed at the mentallyill in the criminal justice system. 61

“The best way to deliver services injails is to make sure people don’t getinto jail,” says Trish marsik, executive di-rector of mayor Bill de Blasio’s Taskforce on Behavioral Health and the Crim-inal Justice System, which came up withthe $130 million plan last December.

The sweeping program aims to con-nect mentally ill people with servicesat every point where they might havecontact with the criminal justice system.Starting with drop-off centers, wherepolice can bring mentally ill people fortreatment and evaluation rather than jail,the plan would also make sure inmatesget treatment upon their release. 62

Continued on p. 258

Court decisions in six states have decreed that holding prisoners with serious mental illness in solitary

is unconstitutional under the Eighth Amendment.

no


At Issue:Should prolonged solitary confinement be banned?yes

yesSTATE SEN. RAYMOND J. LESNIAK, D-N.J.

WRITTEN FOR CQ RESEARCHER, MARCH 2015

t he United States leads the world in the percentage of itspopulation in prison. Antiquated and counterproductive

corrections policies, which often make inmates more likely tocommit crimes than when they entered prison, contribute tothat high percentage. That’s hardly the goal of rehabilitation,which should be in the forefront of corrections policy. Extensiveuse and misuse of solitary confinement is a prime example of acounterproductive corrections policy.

The vast majority of people subjected to solitary confinementwill one day re-enter society. when they return, do we want menand women haunted by that experience, or do we want peoplecapable of making the greatest contributions they can? The hu-mane choice, the one that promotes public safety in and out ofour prisons, is to end solitary confinement in its current form.

what makes solitary confinement so traumatic? It entailslocking up people in a small cell for 23 hours per day, de-priving them of any meaningful human interaction. This leadsto self-mutilation, revenge fantasies, rage and irrational anger,heart palpitations, hallucinations and violent nightmares.

Solitary confinement endures despite sound alternatives. Andits drawbacks far outweigh its very few perceived benefits.

U.S. courts and international human rights bodies have cor-rectly recognized prolonged isolation as torture, especiallyamong vulnerable populations such as children and prisonerswith mental illnesses. The legislation I proposed in New Jerseywould eliminate solitary confinement for these groups. Afederal judge described solitary confinement for mentally illindividuals as equivalent to “putting an asthmatic in a placewith little air to breathe.” The developing brains of youngpeople are particularly susceptible to the harms associatedwith solitary confinement.

Beyond the mental and emotional anguish of the people di-rectly subjected to it, solitary confinement poses dangers to thecorrections community, as well as the broader society. The statesthat have dramatically reduced its use have all seen incredibleresults. when maine reduced its reliance on solitary, it saw reduc-tions in inmate violence, use of force and self-mutilation, whichwent from a weekly occurrence to one almost nonexistent. mis-sissippi has had even more dramatic results, ultimately leading tothe closure of its solitary unit, saving the state millions.

Limiting solitary confinement, as proposed in my legislation,will reduce repeat offenses, provide better safety for correctionworkers and save taxpayer dollars. It’s worked in maine andmississippi. It can also work in New Jersey.no

MICHAEL POWERSPRESIDENT, NEW YORK STATE CORREC-TIONAL OFFICERS & POLICE BENEVOLENTASSOCIATION

WRITTEN FOR CQ RESEARCHER, MARCH 2015

t hose who spend every day working in our prison system— protecting the safety and security of inmates and fellowstaff members — understand that solitary confinement can-

not be completely eliminated. Opponents of this widely acceptedpractice tend to be agenda-driven advocacy organizations thatdemonstrate their lack of experience by relying on Hollywoodmyths, not real-life situations, to make their case.

Disciplinary separation for inmates of any age is a provenstrategy for restoring stability and safety to the often danger-ous correctional environment. Implemented thoughtfully, it’s acritical tool in today’s prisons.

The only inmates put in disciplinary confinement in the specialhousing unit — known as “solitary” — are those needing to bethere for the protection of the staff, other inmates or sometimeseven the inmate himself. Solitary is the only mechanism for re-moving a violent inmate from the general population.

And make no mistake — some need to be removed. Inthe real world, inmates continue to perpetrate violence afterthey’ve lost their freedom and are living behind prison walls.

for example, an inmate serving 15 to 45 years formanslaughter, burglary and attempted arson recently beat acorrection sergeant so badly that he was hospitalized with twobroken ribs and a punctured lung. An inmate doing 15-to-lifefor murder and robbery seriously injured two officers whotried to break up a fight he was having with other inmates.

After these incidents, and the subsequent legal hearingprocess, these inmates were removed from the general popu-lation so they could not perpetrate more violence.

In solitary, inmates are closely monitored through constantrounds made by correction officers and other staff. They areallowed reading and legal materials, and they get to exercise.

Keeping those determined to harm others apart from lessviolent inmates is an important strategy in medium-securityfacilities, where inmates live in dorms with dozens of otherinmates. violent disruptions also prevent orderly inmates fromtaking part in the educational and other programs aimed athelping them transition back into society.

Today’s disciplinary confinement policies have evolved overdecades of experience. while we are always open to identify-ing new ways to improve public safety and the protection ofeveryone at our facilities, the smartest and most effective policychanges come from those of us working in the field — notthose whose only exposure to the corrections system is “Orange Is The New Black” or Hollywood prison movies.

258 CQ Researcher

An important goal is to identify thementally ill before they are charged atan arraignment hearing so judges realizethat in many cases, “we don’t need tosend those people to jail,” says marsik.“we’ve just been using jail because wedon’t know what else to do.”

The plan has so far received favor-able reviews from advocates for men-tally ill prisoners. But CUNY’s Jacobsonnotes that “even in a place like NewYork City, which has more community-based [treatment] capacity than most,there’s not remotely enough capacityto deal with these folks.”

In addition, for people who are men-tally ill but pose a threat to other people,“a drop-off center won’t do it for them,”he says. “You may need secure facilitiesbecause you can’t deal with them ina 48-hour drop-off center.”

The mistreatment of mentally ill in-mates at Rikers Island, revealed by pressaccounts and a two-and-a-half-year in-vestigation by a U.S. attorney in man-hattan, prompted these and other re-forms, including a shakeup of the jailleadership by de Blasio and expandedtherapy inside the city’s jails. 63

However, last month The New YorkTimes reported abuse by guards waspersisting at Rikers Island. It document-ed another 62 cases of inmates, someof them mentally ill, who were seriouslyinjured in conflicts with guards in thesix months after the U.S. attorney inmanhattan published a report in Augustdescribing in graphic detail widespreadbrutality against inmates. 64

New York City corrections officerscomplain that they now have fewermethods to control inmates. After thestate eliminated solitary confinement for16- and 17-year-olds in December, therewas a spike in violence among inmates.And in march, more than half of theinmates at Rikers were locked downin their cells for 34 hours to curb risinggang violence. Previously an inmatecould be locked in solitary up to 90 days,but now the limit is 30. 65

“It appears to me that the inmatesare being emboldened to think thatthere is virtual impunity for their ac-tions,” said Sidney Schwartzbaum, pres-ident of the union for assistant deputywardens. 66

Congressional Action

when it comes to funding a mentalhealth court or training police

to recognize mental illness, some stateand local governments have been helpedby grants under the federal Justice andmental Health Collaboration Program.

The program, which aims to improveresponses to mentally ill people involvedwith the criminal justice system, is fund-ed under the 2004 mentally Ill OffenderTreatment and Crime Reduction Act,due to expire this year. Sen. Al franken,D-minn., is expected to introduce abill to reauthorize the program undera new title, the Comprehensive Justiceand mental Health Collaboration Actof 2015.

However, at its current funding levelof $8.5 million, the program funds onlyabout 15 percent of applicants, accord-ing to Ron Honberg, director of policyand legal affairs at the National Allianceon mental Illness. President Obama’sbudget would boost funding for thisprogram by 60 percent — to $14 millionin fiscal 2016. 67

“we’re hoping to increase fundingfor this,” says Honberg. “we have op-portunities for this, because the biggergoal of reducing the number of peoplewho are incarcerated is becoming abipartisan conversation,” as fiscally con-servative lawmakers such as Sen. RandPaul, R-Ky., have joined with liberalsto reduce spending on prisons. 68

In february a bipartisan group, in-cluding such conservatives as Sen.Ted Cruz, R-Texas, backed the SmarterSentencing Act of 2015, which wouldcut some mandatory sentences in halfand give judges greater discretion insentencing. 69 The bill was introduced

in the Senate by mike Lee, R-Utah,and Dick Durbin, D-Ill., and in theHouse by Rep. Paul Labrador, R-Idaho.In a meeting with 16 members ofCongress on feb. 24, President Obamareportedly threw his support behindthe bill, but the legislation is still ex-pected to face opposition from SenateJudiciary Committee Chairman ChuckGrassley, R-Iowa, who condemned asimilar bill last year as “lenient” and“dangerous.” 70

Obama is also seeking more moneyfor two other programs that couldhelp mentally ill people who comein contact with the justice system. Heproposes to almost double fundingto $120 million for the Second ChanceAct, signed into law by President Georgew. Bush in 2008. It provides grants tostates and nonprofits to develop re-entry programs for released prisoners— such as connecting them to jobs,housing and treatment — with the aimof reducing recidivism. This programhas strong bipartisan support.

The Justice Reinvestment Initiative— another program that would get abudgetary boost (from $27.5 millionto $45 million) — aims to help statesreduce their prison populations by in-vesting in recidivism-prevention strate-gies, such as drug treatment for peopleon probation and parole. 71

However, outlays for these programsare tiny when compared with the morethan $4 billion that states have cut inmental health funding in recent years. 72

(See graph, p. 245.)“The pendulum in funding has

swung in the negative territory for awhile; a deep hole needs to be filled”in mental health services, says fredOsher, director of health systems andservices policy at the Council of StateGovernment’s Justice Center, which ad-vises states on strategies for reducingprison populations.

One thing that could help, Oshersays, is Obama’s Affordable Care Act(ACA). Under the ACA, childless singlemen are obtaining insurance for the


Continued from p. 256


first time through an expanded medicaidprogram. “That’s opening up doors inincreased expenditures,” Osher says.

One of the biggest problems mentallyill prisoners face is the loss of medicaidwhile in prison and the difficulty in re-enrolling after their release. Some jails,like Sheriff mahoney’s in Dane County,wis., sign prisoners up for medicaidimmediately upon their release in aneffort to keep them connected to treat-ment and, ideally, out of jail.

OUTLOOKTraining Judges

As New York City’s new top-to-bottom plan for the mentally ill

suggests, some localities are trying anew tack. But it may take more tragicstories from inside prisons and jails —and more money from state legislaturesand local governments — for this ap-proach to become widespread.

most of the reform energy is comingfrom the judicial branch, maintainsSteve Leifman, an associate adminis-trative judge in the miami-Dade CountyCriminal Division, in miami, fla. “Judgesare on the front line,” he says. Leifmanis leading a project with the AmericanPsychiatric Association to train judgesin how to recognize mental illnessand how to address mentally ill de-fendants — a program he hopes toexpand nationally from the 300 to 400judges now signed up.

The goal is to get more people intotreatment as soon as they show up inthe courtroom. But some advocates forthe mentally ill say efforts like this aremerely a reaction that comes too lateto a more serious problem: “Every com-munity needs a local facility wheresomeone with mental problems cango for help before he ends up introuble,” writes journalist and advocate

Pete Earley. His son was arrested forbreaking into a neighbor’s house aftera hospital had turned him away fortreatment of his bipolar disorder duringa manic episode. Earley argues the re-quired treatment often means a hospitalfor someone seriously psychotic — notjust an outpatient clinic. 73

The need for hospital beds after theera of deinstitutionalization is gettingrenewed attention. Recently a groupof medical ethicists from the Universityof Pennsylvania issued a call to “BringBack the Asylum.” 74 for people withsevere psychotic disorders, “who are toounstable or unsafe for community-basedtreatment,” they wrote, “the financiallysensible and morally appropriate wayforward includes a return to psychiatricasylums that are safe, modern andhumane.”

Responding to the lack of local treat-ment facilities in miami-Dade, Leifmanis spearheading an unusual effort toconvert an abandoned mental hospitalinto an inpatient and outpatient treat-ment center. (See sidebar, p. 252.)

But those who have committed vi-olent crimes don’t necessarily have anytreatment alternatives to prison, as NewYork City real estate developer francisJ. Greenburger discovered when hisoldest son was charged with arson.According to Greenburger, his mentallyill son was convinced a drug dealerwas pursuing him, and after gettingno response from the police, he settrash on fire on his stove and calledthe fire department for help. 75

He was convicted and sentenced tofive years. Because there was no alter-native to prison that was secure enoughto satisfy the district attorney, Green-burger decided to build one of hisown. His Greenburger Center for Socialand Criminal Justice is negotiating withthe New York State Office of mentalHealth to license what may be the firsttreatment center of its kind in the country— a 30- to 60-bed locked facility formentally ill people facing felony prisonsentences of at least two years.

But whether such a facility wouldpose a danger to the surrounding com-munity remains a concern. “I think thatdistrict attorneys and judges would bemore inclined to let certain individualsout [of prison for an alternative treat-ment program] if they were in a securefacility,” says D’Emic of the Brooklynmental Health Court, commenting onthe Greenburger proposal.

Increasingly, judges like D’Emic andLeifman are becoming experts on theroot causes — homelessness, drugabuse, mental delusions and poverty— that bring people before them.

“It’s like a social services agency morethan a court,” Cheryl Roberts, executivedirector of the Greenburger Center, saysof D’Emic’s mental health court. Indeed,she says, courts have “become, for betteror worse, the place where our socialproblems — homelessness and mentalillness — are colliding.”

Notes

1 Jeff Gerritt, “mentally Ill Get Punishment Insteadof Treatment,” Detroit Free Press, feb. 5, 2012,http://tinyurl.com/7kk9owc.2 Ibid. Also see Jeff Gerritt, “After ClosingPsychiatric Hospitals, michigan incarceratesmentally Ill,” Detroit Free Press, Nov. 27, 2011,http://tinyurl.com/knnf9l7. Brante E. fries, “Re-port to the Legislature: Independent Study ofmental Health and Substance Abuse, final Re-port,” feb. 16, 2010, http://tinyurl.com/ozku7ro;“majority of mentally Ill Inmates Don’t GetTreatment,” University of michigan, press release,April 12, 2010, http://tinyurl.com/olcwjes.3 Ibid.4 “The Treatment of Persons with mentalIllness in Prisons and Jails: A State Survey,”Treatment Advocacy Center, April 8, 2014, p. 8,http://tinyurl.com/lnwkj7s.5 “Incarceration’s front Door: The misuse ofJails in America,” vera Institute of Justice, feb-ruary 2015, http://tinyurl.com/lyuun67.6 Tom Dart, “How we Shaft the mentally Ill,”Chicago Tribune, July 29, 2014, http://tinyurl.com/mult5bw.7 Ibid.8 On march 5, 38 percent of inmates enteringCook County jail self-identified as mentally ill

260 CQ Researcher


according to Cook County Sheriff Thomas J.Dart webpage, http://tinyurl.com/pefxnlk.9 Dart, op. cit.10 Jails are locally run facilities, primarily hold-ing people arrested but not yet convicted orserving a sentence of less than a year.11 Also see Steven Elbow, “City Poised to SueState Over Closing mendota mental HealthInstitute to Detained mental Patients,” TheCapital Times, June 28, 2014, http://tinyurl.com/lbvd9hg.12 “Incarceration’s front Door . . .,” op. cit.13 “Callous and Cruel: The Use of forceAgainst Inmates with mental Illness in U.S.Jails and Prisons,” Human Rights watch, forth-coming.14 See Solitary watch, http://tinyurl.com/mf8fnhz.15 michael winerip and michael Schwirtz, “Rikersto Ban Isolation for Inmates 21 and Younger,”The New York Times, Jan. 13, 2015, http://tinyurl.com/kkjmasv.16 mary Cirincione, “mentally Ill PopulationDoubled Since 2006; Now 20 Percent,” medillNews Service, Oct. 15, 2014, http://tinyurl.com/kzwkl34.17 Ibid.18 See Elizabeth Glazer, “Breaking Point,” veraInstitute of Justice Blog: Current Thinking,feb. 19, 2015, http://tinyurl.com/m4cgcc8.Also See mayor’s “Action Plan,” p. 5. Also Seemargaret Hartmann, “mentally Ill Rikers Inmatesare frequently Attacked by Officers, SaysSecret Study,” New York Magazine, July 14,2014, http://tinyurl.com/lyfmkzl.19 Dominic A. Sisti, et al., “Improving Long-Term Psychiatric Care; Bring Back the Asylum,”JAMA, Jan. 20, 2015, pp. 243-244, http://tinyurl.com/nxmneqa.20 Sarah Glazer, “Sentencing Reform,” CQ Re-searcher, Jan. 10, 2014, pp. 25-48.21 David Cloud, “On Life Support: PublicHealth in the Age of mass Incarceration,” vera

Institute of Justice, November 2014, p. 7,http://tinyurl.com/mvewx4f.22 “Action Plan,” mayor’s Task force on Be-havioral Health and the Criminal Justice System,2014, http://tinyurl.com/mwlpxnr.23 vera, “Incarceration’s front Door,” op. cit.24 Henry J. Steadman, et al., “Prevalence ofSerious mental Illness Among Jail Inmates,”Psychiatric Services, June 2009, pp. 761-765.25 “The Broward County (fort Lauderdale)mental Health Court,” Emerging Judicial Strate-gies for the mentally Ill in the Criminal Case-load, April 2000, http://tinyurl.com/p4d7msj.26 The National Center for State Courts esti-mates that there are about 300 courts. Arecent article estimates “upwards of 400.” SeeSisti, et al., op. cit.27 Henry J. Steadman, et al., “Effect of mentalHealth Courts on Arrests and Jail Days,”Archives of General Psychiatry, february 2011,pp. 167-172.28 J. Peterson, J. Skeem, and P. Kennealy,“How often and how consistently do psychi-atric symptoms directly precede criminal be-havior among offenders with mentalillness?” Law and Human Behavior, vol. 38,no. 5, 2014, pp. 439-449, http://tinyurl.com/kpblh9f.29 Dale mcNiel, et al., “Prospective Study ofviolence Risk Reduction by a mental HealthCourt,” Psychiatric Services in Advance, feb. 16,2015, pp. 1-6, http://tinyurl.com/m2x95pn. Alsosee “Use of mental Health Courts ReducesRisk of Later violence,” Psychiatric News Alert,feb. 18, 2015, http://tinyurl.com/pwmg8d2.30 Ibid.31 Jennifer Gonnerman, “Before the Law,” TheNew Yorker, Oct. 6, 2014, http://tinyurl.com/q3x9p8j.32 Cloud, op. cit., pp. 13-14.33 Adam Geller, “Jailed, Some mentally Ill In-mates Land in Solitary Confinement,” The

Huffington Post, Sept. 20, 2014, http://tinyurl.com/kdaaeqt.34 “Position Statement on Segregation of Pris-oners with mental Illness,” American PsychiatricAssociation, December 2012, http://tinyurl.com/pt4m2u6.35 See Terry Kupers, Prison Madness (1999),p. 57.36 Ryan Devereaux, “Searching for the Truthabout California’s Prison Hunger Strike,” RollingStone, Aug. 12, 2013, http://tinyurl.com/lujcpkn.37 Terry Kupers, “what to do with the Survivors?Coping with Long-Term Effects of IsolatedConfinement,” Criminal Justice and Behavior,August 2008, pp. 1005-1015, http://tinyurl.com/pathorz.38 See Peter Katel, “Solitary Confinement,” CQResearcher, Sept. 14, 2012, pp. 765-788.39 See Jeffrey metzner and Joel Dvoskin, “AnOverview of Correctional Psychiatry,” PsychiatricClinics of North America, 2006, pp. 761-772,http://tinyurl.com/qjolyut. . . . Also see “Bureauof Prisons: Improvement Needed in Bureauof Prisons’ monitoring and Evaluation of Impactof Segregated Housing,” Government Account-ability Office, may 2013, http://tinyurl.com/q5gu53y.40 Sisti, et al., op. cit.41 Pete Earley, Crazy (2007), pp. 64-65.42 E. fuller Torrey, “Deinstitutionalization: APsychiatric Titanic,” frontline, http://tinyurl.com/2f9osq.43 “The vital Role of State Psychiatric Hospitals,”National Association of State mental HealthProgram Directors, July 2014, pp. 1-3, http://tinyurl.com/mxtmqe9.44 Earley, op. cit., p. 65.45 See Barbara mantel, “mental Health Policy,”CQ Researcher, may 10, 2013, pp. 425-448.Also see Earley, ibid., p. 69.46 for background on how and why themental health centers were never properlyfunded, see Background section in Sarah Glaz-er, “Treating Schizophrenia,” CQ Researcher,Dec. 5, 2014, pp. 1009-1032.47 Cloud, op. cit., p. 8.48 Ibid., p. 9.49 The case is Madrid v. Gomez. “Case Closedon Supermax Abuses at Pelican Bay,” SolitaryWatch, feb. 15, 2011, http://tinyurl.com/lypaxn6.50 Madrid v. Gomez, Jan. 10, 1995, http://tinyurl.com/q8seeyr.

About the AuthorSarah Glazer contributes regularly to CQ Researcher. Herarticles on health, education and social-policy issues also haveappeared in The New York Times and The Washington Post.Her recent CQ Researcher reports include “Treating Autism”and “Treating Schizophrenia.” She graduated from the Universityof Chicago with a B.A. in American history.


51 Katel, op. cit., p. 778. for text of 1995decision in Madrid v. Gomez, see ibid.52 Madrid v. Gomez, op. cit.53 Katel, op. cit., p. 780.54 Amy C. watson and Anjali J. fulambarker,“The Crisis Intervention Team model of PoliceResponse to mental Health Crises: A Primerfor mental Health Practitioners,” Best Practicesin mental Health, December 2012, http://tinyurl.com/kdxpur3. Also see CIT International,http://tinyurl.com/n8nhtj3.55 Bob Katzen, “Beacon Hill Roll Call volume40,” Somerville News Weekly, Jan. 12, 2015,http://tinyurl.com/mpgo9xm. Also see “Gov-ernor Hickenlooper Signs Law Limiting SolitaryConfinement for mentally Ill,” ABC 7, June 6,2014, http://tinyurl.com/kaokqyh.56 Testimony by Jack Beck, Hearing of theNew York Assembly’s Corrections and mentalHealth Committee, The Correctional Associationof New York, Nov. 13, 2014, http://tinyurl.com/mkkqru5.57 Bill introduced by Correction CommitteeChair and NY Assembly member Daniel J.O’Donnell, http://tinyurl.com/k3szfgz.58 New mexico House Bill 376, introducedby Antonio “moe” maestas, http://tinyurl.com/lx9d3dr; montana House Bill 490, introducedby J. Eck, http://tinyurl.com/kls9k7d.59 “Interim Report of the Special Rapporteurof the Human Rights Council on Torture,”U.N. General Assembly, Aug. 5, 2011, http://tinyurl.com/kzf4kyz.60 New Jersey Department of Corrections tes-timony before the New Jersey Senate Lawand Safety Committee, feb. 12, 2015.61 A jail guard was arrested last year in con-nection with the death of Jerome murdoughand the city agreed to a $2.25 million settlementwith his mother. See “Rikers Guard Arrested inConnection with Homeless veteran who Bakedto Death,” The Associated Press/The Guardian,Dec. 8, 2014, http://tinyurl.com/loth8e5.62 “Action Plan,” mayor’s Task force on Be-havioral Health and the Criminal Justice System,2014, http://tinyurl.com/mwlpxnr.63 michael winerip and michael Schwirtz,“New York City Plans focus on mental Healthin Justice System,” The New York Times, Dec. 1,2014, http://tinyurl.com/l2wu557.64 michael winerip and michael Schwirtz,“Even as many Eyes watch, Brutality at RikersIsland Persists,” The New York Times, feb. 21,

2015, http://tinyurl.com/k6szj9z.65 michael Schwirtz and michael winerip,“Seeking Drugs and weapons, Rikers LocksDown Inmates for 34 Hours,” The New YorkTimes, march 4, 2015, p. A20, http://tinyurl.com/mclbhkf.66 Ibid.67 “President’s Budget,” Justice Center, Councilof State Governments, feb. 2, 2015, http://tinyurl.com/nt9q6ru.68 Sarah Glazer, “Sentencing Reform,” op. cit.69 Text of the Smarter Sentencing Act of 2015,http://tinyurl.com/ny27n2s.70 See Gregory Korte, “Bipartisan SentencingBill Gets white House Support,” USA Today,feb. 25, 2015, http://tinyurl.com/nte63oj. Also

see Jacob Sullum, “The Tougher-Than-ThouSenator,” Reason, feb. 25, 2015, http://tinyurl.com/oxpjvg3.71 “President’s Budget,” op. cit.72 funding for state mental health agenciesfell $4.4 billion from fY 2010-fY2013. See“The vital Role of State Psychiatric Hospitals,”National Association of State mental HealthProgram Directors, July 2014, p. 22, http://tinyurl.com/mxtmqe9.73 Earley, op. cit., p. 356.74 Sisti, et al., op. cit.75 matt A. v. Chaban, “from a father’s AnguishComes a Plan to Help mentally Ill Inmates,”The New York Times, Oct. 6, 2014, http://tinyurl.com/ln9tabf.

FOR MORE INFORMATIONAmerican Civil Liberties Union National Prison Project, 915 15th St., N.w.,7th floor, washington, DC 20005; 202-393-4930; https://www.aclu.org/prisoners-rights.Advocacy program that challenges the constitutionality of placing mentally ill pris-oners in solitary confinement.

Council of State Governments Justice Center, 100 wall St., 20th floor, NewYork, NY 10005; 212-482-2320; http://csgjusticecenter.org/. Advisory group thatoffers strategies to policymakers in reducing corrections spending and respondingto people with mental illness in the criminal justice system.

National Alliance on Mental Illness, 3803 North fairfax Dr., Suite 100, Arlington,vA 22203; 703-524-7600; www.nami.org. Grassroots organization on mental healththat advocates for access to services, treatments and research.

National Center for State Courts, 300 Newport Ave., williamsburg, vA 23185;800-616-6164; www.ncsc.org. Independent court-improvement organization thatoffers extensive information on mental health courts.

National Sheriffs’ Association, 1450 Duke St., Alexandria, vA 22314; 800-424-7827; www.sheriffs.org. Professional association representing thousands of sheriffs,deputies and law enforcement professionals.

Solitary Watch, P.O. Box 11374, washington, DC 20008; [email protected]; http://solitarywatch.com. website sponsored by a coalition of civilrights groups critical of solitary confinement; provides breaking news and re-search in the field.

Treatment Advocacy Center, 200 N. Glebe Rd., Suite 801, Arlington, vA 22203;703-294-6001; www.treatmentadvocacycenter.org. Advocacy group that focuses oneliminating barriers to the effective treatment of people who are mentally ill.

Vera Institute of Justice, 233 Broadway, New York, NY 10279; 212-334-1300;www.vera.org. Research group that works with government to improve servicesaffecting criminal justice and public safety.

FOR MORE INFORMATION

262 CQ Researcher

Selected Sources

BibliographyBooks

Clear, Todd R., and Natasha A. Frost, The PunishmentImperative: The Rise and Failure of Mass Incarcerationin America, New York University Press, 2014.A Rutgers criminal justice expert (Clear) and a Northeastern

University criminologist (frost) take a critical look at thenation’s historical cycle from rehabilitation to punitive sentencingpolicies.

Earley, Pete, Crazy: A Father’s Search Through America’sMental Health Madness, Berkley Books, 2007.when the son of former Washington Post reporter Pete

Earley broke into a neighbor’s house during a manicepisode, Earley decided to investigate how the mentallyill fare in jail.

Kupers, Terry, Prison Madness: The Mental Health CrisisBehind Bars and What We Must Do About It, Jossey-Bass Publishers, 1999.A psychiatrist who testifies as an expert witness for plaintiffs

interweaves research with his own encounters with mentallyill prisoners.

Articles

Chaban, Matt A. V., “From a Father’s Anguish Comes aPlan to Help Mentally Ill Inmates,” The New York Times,Oct. 6, 2014, http://tinyurl.com/ln9tabf.New York City developer francis Greenburger, whose

mentally ill son was sentenced to five years for arson, plansto build a locked treatment facility for similar defendants —the first of its kind.

Devereaux, Ryan, “Searching for the Truth about Califor-nia’s Prison Hunger Strike,”Rolling Stone, Aug. 13, 2013,http://tinyurl.com/lujcpkn.when 30,000 California prisoners staged a hunger strike

over solitary confinement, it spurred a debate between prisonofficials, who said solitary is essential for safety, and psychiatrists,who said it is psychologically damaging.

Gonnerman, Jennifer, “Before the Law,” The New Yorker,Oct. 6, 2014, http://tinyurl.com/q3x9p8j.After a teenager spent two out of three years in solitary

confinement at New York City’s Rikers Island, he emergedto suffer flashbacks and twice attempt suicide.

Winerip, Michael, and Michael Schwirtz, “Even as ManyEyes Watch, Brutality at Rikers Island Persists,” The NewYork Times, Feb. 21, 2015, http://tinyurl.com/k6szj9z.Despite city officials’ vows of reform, Rikers Island guards

continue to beat inmates, The Times reports.

Reports and Studies

“Alone and Afraid: Children Held in Solitary Confinementand Isolation in Juvenile Detention and Correctional Fa-cilities,” American Civil Liberties Union, June 2014 (re-vised), http://tinyurl.com/lnu7dj5.Placing children under 18 in solitary confinement should

be banned, says a civil liberties group.

Cloud, David, and Chelsea Davis, “Treatment Alternativesto Incarceration for People with Mental Health Needsin the Criminal Justice System: The Cost-Savings Impli-cations,” Vera Institute of Justice, February 2013, http://tinyurl.com/axuxsad.A study summarizes favorable research findings on the ef-

fectiveness and cost savings of programs to keep the mentallyill out of jail.

Fellner, Jamie, “Callous and Cruel: The Use of Force AgainstInmates with Mental Illness in U.S. Jails and Prisons,”Human Rights Watch, forthcoming in April 2015.The lack of mental health training for guards contributes

to a needless use of force against mentally ill prisoners, ahuman-rights group finds.

McNiel, Dale E., et al., “Prospective Study of ViolenceRisk Reduction by a Mental Health Court,” PsychiatricServices in Advance, Feb. 16, 2015, pp. 1-6, http://tinyurl.com/m2x95pn.mentally ill felony defendants who went through the San

francisco mental health court were far less likely to commitviolence than similar defendants in other courts.

Peterson, Jillian K., et al., “How Often and How Con-sistently Do Symptoms Directly Precede Criminal Be-havior Among Offenders With Mental Illness?” Law andHuman Behavior, vol. 38, no. 5, 2014, pp. 439-449, http://tinyurl.com/kpblh9f.Only 18 percent of crimes committed by mentally ill offenders

could be traced directly to psychiatric symptoms, raisingquestions about whether psychiatric treatment alone canprevent criminal behavior.

Steadman, Henry J., et al., “Prevalence of Serious MentalIllness Among Jail Inmates,”Psychiatric Services, June 2009,pp. 761-765, http://tinyurl.com/q8j9mke.A study of five jails finds that 14.5 percent of men and

31 percent of women suffered from serious mental illness.

Subramanian, Ram, et al., “Incarceration’s Front Door:The Misuse of Jails in America,”Vera Institute of Justice,February 2015, http://tinyurl.com/nfm8v6d.Jails have become “de facto mental hospitals” for the mentally

ill, according to a policy group.


Alternative Programs

Cassidy, Megan, “New Phoenix team tackles recidivism ofthose with mental illness,” The Arizona Republic, Jan. 27,2015, http://tinyurl.com/qfew5z8.Intervention teams that work with mentally ill repeat offenders

have successfully prevented 85 percent of clients from returningto prison in Arizona’s most populous county.

Cortez, Marjorie, “S.L. County fears criminal justice re-forms could become unfunded mandate without Medicaidfix,”Deseret News, March 3, 2015, http://tinyurl.com/q74ebdb.The Utah House of Representatives passed a bill that would

require drug offenders to participate in community mental healthprograms in exchange for reduced prison sentences.

Napoleon, Carrie, “Sheriffs look for funding to takemore prisoners,” Chicago Tribune, Feb. 3, 2015, http://tinyurl.com/nwgmnw2.Indiana lawmakers expanded county prison systems’ role

in housing low-level offenders.

Mental Health Courts

Cosgrove, Jaclyn, “Residents with mental illness get secondchances when arrested — in some Oklahoma counties,”The Oklahoman, Jan. 29, 2015, http://tinyurl.com/oy5gpgv.Only 16 out of 77 Oklahoma counties have implemented

mental health courts to work with nonviolent, mentally illoffenders, but counties that use them have reported significantreductions in recidivism and hospital stays for clients.

Chanen, David, “Hennepin County’s mental health courtbecomes model approach,”The Minneapolis Star-Tribune,Feb. 5, 2015, http://tinyurl.com/qhj8rg5.Numerous minnesota counties have replicated the mental

health court model developed by Hennepin County in 2003,which helps defendants find housing, employment and therapyand tracks their success in taking medications.

Krueger, Joline Gutierrez, “Mental Health Court provideshelp all around,” Albuquerque Journal, Dec. 17, 2014,http://tinyurl.com/nlkncqp.The Albuquerque metropolitan mental health court system

offers defendants legal and mental health advice and allowsthem to periodically meet with judges to avoid jail time.

Recidivism

Voorhees, Josh, “How to Fix America’s Recidivism Crisis,”Slate, Sept. 16, 2014, http://tinyurl.com/n7j5l4b.Iowa’s “Central Pharmacy Pilot Project” provides newly re-

leased mentally ill inmates with 90 days’ worth of medicationsto ease their transitions into society and lower recidivism.

Cason, Mike, “Bill to reduce Alabama’s prison populationdraws praise, raises concerns about costs,”The Huntsville(Ala.) Times,March 4, 2015, http://tinyurl.com/nvpqu78.Alabama sheriffs and county officials raised concerns over

the costs of a bill proposed by a Republican state senatorthat would send mentally ill criminals to county programs.

Reid, Wilson, “Tough Texas gets results by going softeron crime,” The Washington Post, Nov. 27, 2014, http://tinyurl.com/nb37c2s.Recidivism in Texas has declined from 28 to 22.6 percent

since 2008 following a series of reforms.

Solitary Confinement

Sifferlin, Alexandra, “What 28-Years of Solitary Confine-ment Does to the Mind,” Time, July 29, 2014, http://tinyurl.com/qh47qhl.Prisoners who spend three months or more in solitary con-

finement can experience heightened anxiety.

Melamed, Samanta, “Deal aims to end solitary confinementfor seriously mentally ill prisoners in Pa.,” The Philadel-phia Inquirer, Jan. 8, 2015, http://tinyurl.com/qgsdxob.A settlement between Pennsylvania’s corrections department

and a disability rights advocacy group will replace the useof solitary confinement for mentally ill inmates with separatehousing facilities.

Sheriff, Natasja, “A tough cell: US to defend solitary con-finement use before UN,”Al Jazeera America, Nov. 11, 2014,http://tinyurl.com/l7egt5u.A United Nations committee expressed concerns to U.S. officials

about the country’s use of “prolonged isolation” in prisons.

The Next Step:Additional Articles from Current Periodicals

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9, 701-732.

CHICAGO STYLE

Jost, Kenneth. “Remembering 9/11.” CQ Researcher, September

2, 2011, 701-732.

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