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I’m not a trained mental health professional, but that doesn’t disqualify me from knowing when someone isn’t quite right. Most people have an awareness of when, as it’s colloquially put, a person is half a bubble off center. Prisons are magnets for the mentally challenged and have become mental health sanctuaries. What does this mean? What can be done?

I wrote about prison mental health in There Are Crazy People in Prison. In that post, I discussed how I met the emperor of Norway. I was waiting for chow when another inmate announced, loudly and belligerently, that he was an emperor. The guy’s belief about his rank did not welcome jokes or further questioning—but it was clear this was a person who needed mental health intervention that exceeded my ability to listen, empathize, and apply redirection.

I have great empathy for people with mental disorders. As an attorney, I represented victims of sexual abuse, and from those experiences I learned a lot about mental health issues secondary to trauma. In prison, I witnessed the degradation of lives resulting from the conflation of personal internal turmoil with the challenges of society. The results manifested in depleted joy from anything or anyone.

This depletion defines many of the inmates I interacted with during my prison term. I met men who were sexually abused as children— hopelessly addicted men with no discernable world outside of scoring the next fix. What flowed from their conflated worlds were demented misogynistic rants, racial friction, and unadmitted self-disrespect awkwardly exhibited by machismo in the world of confinement and gang influences. To me, many of these men appeared to show signs of depression, anxiety, and a general sense of hatred for anything that could not be instantly understood—conditions that brought on paranoia and fear. Paranoia and fear often result in physical combat that puts inmates and staff in harm’s way.

In her MSNBC report “Prisons Are the ‘New Asylums’ of the US,” Meredith Clark makes the stunning statement that “America’s prisons house ten times more people with mental illnesses than its hospitals, according to a new report.” She refers to the Treatment Advocacy Center’s state survey of serious mental illness, major crimes, and community treatment.

The survey identifies three major findings:

  1. The majority of states do not provide adequate support in the community for individuals with serious mental illness who have committed major crimes, resulting in higher re-arrest rates and all the attendant human and economic costs of re-incarceration.
  2. States vary greatly in how they address reentry from hospitals, jails and prisons into the community for individuals with serious mental illness who have committed major crimes. Although some states have similar programs, no two states implement these programs in the same way, nor do states allocate resources to these programs uniformly.
  3. Data indicate the magnitude of the problem is getting worse. Many state respondents noted significant increases in the number of individuals with serious mental illness involved in the criminal justice system in recent years.

This study underscores the scope of the mental health problems posed by formerly incarcerated people upon reentry into the community. When the criminal justice system steps into the problems of this population, it seems to me to be too little too late. Natural questions flow from the identified problems: What mental health care did these individuals receive during incarceration? What mental health care did these individuals have before being directed into the prison system? The latter question is the focus of this post as we look at what can be done with this population before they enter the penal phase of incarceration.

According to an April 7, 2017, Pew Charitable Trust Report by Michael Ollove entitled “Getting the Mentally Ill Out of Jails,” the genesis of the problem is that  “a dearth of beds at state psychiatric hospitals in many parts of the country and shortages of mental health resources mean that mentally ill people who commit minor crimes often end up languishing in jails, which are poorly equipped to handle their illnesses.”


Mental Health Courts (MHC)


The Congressional Research Service gives the following working definition of mental health court:

A mental health court is a specialized court docket for certain defendants with mental illnesses. This court substitutes a problem-solving model for traditional criminal court processing. Participants are identified through mental health screening and assessments and voluntarily participate in a judicially supervised treatment plan developed jointly by a team of court staff and mental health professionals. Incentives reward adherence to the treatment plan or other court conditions. Nonadherence may be sanctioned, and success or graduation is defined according to predetermined criteria.

The Judicial Council of California, in its 2015 “Mental Health Issues Implementation Task Force: Final Report,” discusses ways MHCs can change the paradigm for persons with mental illness in the state’s court system.

The recommendations focused on the following areas:

  • Community-based services and early intervention strategies that reduce the number of individuals with mental illness who enter the justice system;
  • Court responses that enhance case processing practices for cases involving mental health issues and reduce recidivism for this population;
  • Policies and procedures of correctional facilities that ensure appropriate mental health treatment for inmates with mental illness;
  • Community supervision strategies that support mental health treatment goals and aim to maintain adult and juvenile probationers and parolees in the community;
  • Practices that prepare incarcerated individuals with mental illness for successful reintegration into the community;
  • Practices that improve outcomes for juveniles who are involved in the delinquency court system; and
  • Education, training, and research initiatives that support the improvement of justice responses to people with mental illness.

MHC interventions vary between jurisdictions. There are now more than three hundred mental health courts through which defendants determined to be mentally ill are steered out of the criminal justice system and put into mental health treatment services. The railroad to incarceration is cut off.

For an educational tour of MHC’s evolving interdisciplinary curriculum and learning modules, I recommend watching the video and studying the information on the Justice Center’s website, where you’ll find state standards and training events for teams interested in bringing an MHC to their jurisdiction. It’s an excellent resource.

Mental health in prisons is a serious problem in need of attention by state and federal governments. Caging people with mental illnesses is cruel and unusual punishment. The MHC concept is a good beginning.

In another post, I introduced you to the prison reform work done by Dorothea Dix. Dorothea was an early pioneer for changing the conditions of mentally ill prisoners; her work started in 1841. She made an effort to understand mental health and its significance in general society and in jails and prisons. The trend against humane treatment of mentally ill people in this country got a big boost from the Ronald Reagan administration. At the end of this post you’ll find links to articles that highlight the polemic thinking of Dorothea Dix and that of a president blind to mental health issues. Ironically, Reagan died after suffering for nine years from Alzheimer’s disease.

MHCs are a positive step toward prison reform for the mentally challenged. Not all inmates present as the emperor of Norway. Mental illnesses appear in subtle and complicated ways that are identifiable and treatable by trained mental health clinicians. Mental Health America (MHA), founded in 1909, defines a mental illness as “a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines.”

The MHA reports that “there are more than 200 classified forms of mental illness. Some of the more common disorders are depression, bipolar disorder, dementia, schizophrenia and anxiety disorders. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal.”

MHCs provide a real remedy for intervention to break the mental health/languishing-in-prison cycle that is so prevalent in our culture. Part of prison reform awareness includes recognizing and acting upon the plight of the mentally ill.

Related articles: Ronald Reagan’s Shameful Legacy: Violence, the Homeless, Mental Illness and Did Reagan’s Crazy Mental Health Policies Cause Today’s Homelessness?

I look forward to reading your comments and suggestions.


Image courtesy of 123rf

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