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The Imparity of Mental Health Care in Prison

Trapped-Mental-Illness-in-Prison-034For many, jails are the only place to access mental health care, but once inside, the conditions of prison life may exacerbate mental illness and reduce the likelihood of rehabilitation. Mentally ill people should have access to care in prison, and advocacy for mental health care should extend beyond the concerns of prison conditions.

In the New York Times, Nicholas Kristof writes that jails are the de-facto source of mental health care for many. Nationwide, more than three times as many people with psychiatric care needs are housed in prisons and jails as in hospitals, and 40% of people with mental illness are arrested at some time in their lives. Kristof points to a systemically under-resourced mental health care system to explain the management of mentally ill people through law enforcement and jails. Chicago’s Cook County Sheriff remarks that “We’ve systematically shut down all the mental health facilities, so the mentally ill have nowhere else to go. We’ve become the de facto mental health hospital.”

Once inside, the situation for mentally ill prisoners in the US is particularly stark. In isolating, overcrowded prisons, inmates needing psychiatric care are often subject to abuse, neglect, and discipline for not being able to follow the rules. Allen Frances reported in the Huffington Post that psychiatric patients in prisons are frequent rape victims. A Bridgewater (Massachusetts) State Hospital corrections inmate was killed when prison guards untrained in mental health disorders placed him in restraints; an investigation into his death is still incomplete five years later. After finding that mentally ill inmates were “basically incarcerated to death — restrained naked in chairs for hours, left to rot in their own feces and sick in solitary confinement, pepper sprayed profusely, given limited access to mental health counselors,” the state of South Carolina was given 180 days to fully remediate its treatment of mentally ill prisoners.

And prisoners with mental illness are more likely to be held in solitary confinement as a means to manage their behavior. The isolation of this particular punishment has been shown to have particularly adverse effects for psychiatric prisoners. Though brain scientists have not had much access to those in solitary confinement, there is vast amount of knowledge about how the brain responds to aspects of solitary confinement, including the lack of interaction with the natural world, the lack of social interaction, and the lack of touch and visual stimulation. Researchers at the 2014 meeting of the AAAS presented findings to demonstrate that solitary confinement fundamentally alters the brainRobert King, who spoke at AAAS, spent 29 years in solitary confinement in Louisiana, and says that his geographical orientation, eyesight, and general mental health were all compromised by his time “in the hole.”

In news that suggests the prison system is increasingly sensitive to mental health issues, the state of New York announced that it will end the practice of solitary confinement for certain classes of inmates, including youth, pregnant, and mentally disabled prisoners. In Atlanta, after a backlash over the neglect of mentally ill prisoners, prison officials have started a successful treatment-focused “step down” program in Atlanta. And in Augusta, Maine, a newly created intensive mental health unit in a jail is providing key services to inmates, and might begin to relieve some of the burdens of an overcrowded state psychiatric hospital. Finally, in Colorado, Rick Raemisch, executive director of the state Department of Corrections, spent a night in solitary confinement as part of a project to better understand and minimize its use, and wrote about it in the New York Times.

The question remains: Why are there so many mentally ill people in prison, and why are they not getting treatment elsewhere? Brain science research has a role to play in the evolution of more informed mental health care policy, in which prison does not exacerbate mental illness, and rehabilitation is the standard.