The Prison System as a Gulag for People with Serious Mental Illness

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January 10, 2012; Source: The Crime Report | NPQ has previously reported on the fact that, across the nation, prisons and jails have become the de facto repositories for people with serious mental health problems. This dynamic followed a half-finished effort at deinstitutionalization that left chronically mentally ill people without sufficient supports. Many chronically mentally ill people are homeless, of course, but many are also locked up. Some estimates have twenty mentally ill people incarcerated for every one psychiatric bed available in hospital. Now Matthew T. Mangino, a member of the Pennsylvania Board of Probation and Parole, and the former district attorney of Lawrence County, Pennsylvania, has published a searing editorial about the problem, revealing his own distress as a member of a system that cannot possibly attend properly to the needs and rights of mentally ill inmates, and that in fact often responds destructively. He pointed to numerous sources documenting not only the number of incarcerated mentally ill but also the fact that once incarcerated, they are often subject to the harshest of conditions. Mangino points, for instance, to research published in the Harvard University Civil Rights-Civil Liberties Law Review, which finds that mentally ill people typically account for as many as half of all inmates in solitary confinement.

According to a study published in The Crime Report, a 2010 audit of three Wisconsin state prisons reported that “between 55 percent and 76 percent of inmates in segregation [solitary confinement] are mentally ill.”

Once there, according to a recent Associated Press story based on an internal report of a North Carolina Prison, they may be kept in their cells for extended periods without being let out for showers, meals, or recreation. Mangino cites one especially egregious human rights violation in the case of a Utah prisoner who “[l]ast year . . . suffering from schizophrenia and bipolar disorder died of starvation and dehydration after spending four months in the Salt Lake County Jail. A significant period of his incarceration was spent in solitary confinement.

Twenty-year-old Carlos Umana weighed approximately 180 pounds when he entered the jail; when he died, he weighed just 77 pounds.”

In a 2009 statement to Senate Judiciary Committee Subcommittee on Human Rights and the Law, Human Rights Watch called for action on the issue of the incarceration of people with mental illness. An excerpt from that statement reads,

In 2008, the Special Rapporteur on Torture concluded that “the prolonged isolation of detainees may amount to cruel, inhuman or degrading treatment or punishment, and, in certain instances, may amount to torture.” Based on his research, he found that “the key adverse factor of solitary confinement is that socially and psychologically meaningful contact is reduced to the absolute minimum, to a point that is insufficient for most detainees to remain mentally well functioning.” He stated that solitary confinement should only be used “in very exceptional cases” and “only as a last resort”; the Special Rapporteur further noted that holding persons with mental illness in solitary confinement “cannot be justified for therapeutic reasons, or as a form of punishment.”

—Ruth McCambridge

  • Ilene Flannery Wells

    This all started with the Kennedy Administration’s noble, yet incredibly idealistic view that everyone can live and be treated in the community, via the Medicaid Institutes for Mental Diseases (IMD) Exclusion and the Community Mental Health Act of 1964, they effectively denied coverage to Medicaid eligible adults who were being treated in state hospitals, and then subsequent administrations neglected to set up the appropriate community supports for the most seriously ill. Since then, everyone has learned that the miracle cure anti-psychotics, weren’t all that miraculous, and that many people never regained their cognitive functioning.

    The financial burden that the Medicaid IMD Exclusion created has resulted in the states cutting off access to state hospitals – some closing them all together. Michigan has learned their lesson the hard way and now treat the most seriously mentally ill in prison at three times the cost.

    The community mental health system does not interface well with the most seriously ill who lack cognitive functioning to direct their own treatment and many of whom do not realize they are ill. That, in conjunction with lack of access to in-patient treatment, when needed, beyond the 5-8 days the general hospitals allow, is the reason we have this problem.

    The Medicaid Institutes for Mental Diseases (IMD) Exclusion needs to be repealed; there needs to be a greater focus on the most seriously ill who need intense support; Assisted Outpatient Treatment laws need to be enacted and enforced. Only when these common sense reforms are in place will we see real change.

  • Renee Jenson

    Punishing people for symptoms of their illness is cruel and inhuman. The criminalization of mental illness in the US is is an international disgrace.