By Yidi Wu
Seven months after the Sandy Hook shootings in Newtown, CT, Obama encouraged citizens to speak up – not just about gun violence, but about the less tangible problems that can cause it. “There should be no shame in discussing or seeking help for treatable illnesses,” said President Obama at the National Conference on Mental Health last June. “Too many Americans who struggle with mental health illnesses are suffering in silence rather than seeking help.” Dedication to destigmatizing mental illness is admirable, but Obama’s solution misses an important point: many Americans who struggle with mental health issues may be suffering in silence, but they are also suffering in prison.
By default rather than by design, prisons have become the solution to the difficulties at the intersection of mental illness and a lack of accessible and affordable treatment options in the United States. In communities with limited health services, people struggling with mental illness may voluntarily seek incarceration because they or their families believe that prison will provide better psychiatric treatment than they would otherwise receive. Today, the largest mental hospital in the state of Illinois is a Chicago prison, which is home to approximately 11,000 inmates, 2000 of whom suffer from serious psychiatric diseases. More modern mental hospitals could provide an alternative for care, but only if they are able to vastly improve their quality of treatment as well as expand their capacity.
As a result of a movement to deinstitutionalize mentally ill persons, the 1970s witnessed the decline of large state-run mental hospitals. But despite a movement towards progressive solutions for mental illness, the release of patients who had committed no crime other than to bear the burden of mental illness did not always lead to their rehabilitation or to the patients’ successful re-entry into communities. Lacking adequate treatment and support networks, many former patients ran afoul of the criminal justice system.
And while psychiatric disorders themselves are not criminalized, those living with them can often engage in behaviors that appear criminal. Occasionally, those with mental illnesses can experience unprovoked violent outbursts and they are more prone to drug-use. Furthermore, it can be difficult for law enforcement to distinguish between someone with certain mental illnesses and someone who is intoxicated. Police officers are also known to employ “mercy bookings” — picking up visibly disoriented people from the streets. This can occur when police believe that those people are not likely to find treatment outside of the prison system, or that they would be in greater danger on the streets. But mercy bookings, and the misguided incarceration of the mentally ill for minor crimes such as public intoxication, contribute to the reality that the prevalence of mental illnesses is disproportionately high in prisons. According to a 2006 report by the Bureau of Justice Statistics, over fifty percent of prisoners in the American prison system suffer from some form of diagnosed mental illness. As a result, mental illness has become a de facto crime.
But the prevalence of mental illness in prisons shouldn’t indicate that prisons are a solution, even where treatment alternatives are often inaccessible. Prisons can harm the mental well being of all prisoners; they can be a structural barrier to treatment itself and can even exacerbate existing mental illnesses. In America’s overcrowded, underfunded and understaffed prisons, one of the most common consequences for disruptive behavior is solitary confinement. Solitary confinement is a painful punishment, can be as clinically distressing as physical torture and has been shown to provoke the onset of mental illnesses such as depression or PTSD. It can also have devastating consequences on prisoners’ mental health.
Even when prisoners are not punished with solitary confinement, guards are more likely to levy other harmful punishments on mentally ill prisoners. Discipline in prison tends to be meted out far more frequently to those with mental illness — who may be less interested, willing or able to follow rules of orderly conduct — than those without. But it is not just the guards who are at odds with mentally ill prisoners. The mentally ill, especially the women among them, also fall victim to prisoner-on prisoner assault far more often than those who do not have mental diseases. Furthermore, the system can cause mental illness in those without a history of it, especially in minors and young adults.
Both the prison treatment processes and the method of evaluating the mental wellbeing of prisoners are lackluster. Courts use “professional judgment” as the standard to determine whether a prisoner has a serious medical need, but this procedure has inherent problems. Inmate behavior plays a significant role in discovering and diagnosing mental illness in this system, but a prison environment hinders the ability of professionals to make accurate observations and diagnose persons with mental illness. This is especially true considering that expectations of “normal” behavior differ based on factors such as the prisoner’s gender and race. Mental illness is diagnosed at higher rates for groups in which a set of behavior is considered abnormal: for example, women are far more commonly diagnosed with mental illness for violent or aggressive behavior than men are. Conversely, mental illness may be ignored in other groups: African American men are more likely to be incarcerated just for violent behavior rather than be treated for mental illness. The problem is not trite. When prisons incorrectly diagnose inmates, the result may be a grave violation of human rights: In 2012, the state of New York mistakenly imprisoned the wrong man and forcibly medicated him for delusion and schizophrenia — for two years.
After release, prisoners often face additional difficulties due to their criminal records. Many are removed from the Medicaid roll when incarcerated, and will need to tackle a weighty and opaque bureaucracy to re-enroll before they can make appointments or acquire prescription medication. This is especially problematic because illnesses prevalent in the criminal justice system include mental illnesses, HIV, viral hepatitis and substance hypertension — conditions that are wholly unmanageable without treatment. Those who do have the wherewithal to acquire treatment after release, frequently find the task of treating themselves discouraging or simply too difficult, and may end up forgoing treatment entirely. The result is that readjusting to civilian life becomes overwhelmingly difficult, and the vicious cycle of incarceration and release becomes the norm.
Movements to destigmatize mental illness and raise awareness about these conditions abound. But ideological discrepancies between individual organizations often sink any chance for comprehensive reform beneath waves of vitriol. New York Times columnist Nicholas Kristof described conditions for mentally ill prisoners in a recent piece in order to draw attention to the victimization of the mentally ill. A response to Kristof’s piece published in the Huffington Post slammed him for perpetuating the stigmatization of mental illness and arguing that his article reinforced “the notion that the mentally ill are criminals or failures who can’t hold down a job.” It is doubtful that this representation was Kristof’s intention, but it demonstrates how difficult it can be to raise these highly sensitive issues in public discourse. Without agreement on how to approach the discussion, there is little hope for resolution of the problems that face the mentally ill in our society, but one thing is clear: prisons must be a critical part of the discussion.
Americans are overwhelmingly unable to face the truth about our prisons. They are not reformatories, where prisoners are recast into productive members of society. Rather, American prisons share a large part of the blame for cyclical incarceration and the perpetuation of stigmatization against the mentally ill. When the Supreme Court ordered the state of California in 2011 to release 30,000 prisoners because of “serious constitutional violations” due to overcrowding in its prison system, Justice Scalia both denied that prisoners had suffered inhuman treatment and reassured those concerned that the inmates released into the public would not have “medical conditions or severe mental illnesses.” In order to productively move forward, the debate must distinguish between those seeking to ease the conditions of the mentally unwell and those who, intentionally or not, perpetuate the ebb and flow of the mentally ill through the gates of U.S correctional facilities.
Yidi Wu ’17 is a prospective applied math-economics concentrator.