Are Jails the New Asylums? - Searching for Sanity
Jamycheal Mitchell was a 24-year-old who suffered from paranoid schizophrenia and mood disorders. He died of starvation on August 19, 2015 after being neglected in a Virginia jail cell, having waited four months for a hospital bed to open up in a state mental hospital.
The systematic failure of mental healthcare within the United States has left those with mental illnesses without a bed in a proper mental health facility and free entry into what has become the new major asylum: prison.
According to Mental Health America, 20.1 percent of adults with mental health illnesses reported that they are unable to get the help that they need. Out of the approximately 7.9 million U.S. adults with a mental illness, about 1.6 million of them go without treatment. The Inspector General for Behavioral Health and Developmental Services in Virginia released a report in 2011 stating that approximately 200 individuals determined to pose a threat to themselves or others were turned away from mental health facilities because there were no beds available.
"If a person has inadequate resources, meaning insurance or financial means, it’s a very dicey system—a hit or miss,” said Eric Kothari, American University’s psychologist in residence. “If you’re of limited means, it’s almost nonexistent.”
Approximately 20 percent of inmates in jails and 15 percent of inmates in state prisons have a serious mental illness (SMI), according to the Treatment Advocacy Center (TAC), totaling nearly 356,000 people. On average, state hospitals only house 35,000 individuals with SMI at a time, meaning there are currently 10 times more people with SMI found in jails and prisons than in state-run mental facilities.
Howard Zonana, a professor of psychiatry at Yale University, explained that there is a major time lag between when those with SMIs begin to need treatment and begin to receive treatment.
“People who develop major psychiatric disorders such as schizophrenia often don’t get to treatment until after they’re symptomatic for two years,” Zonana said. “If they get treatment earlier, they tend to do better.”
This delay in treatment can lead to dangerous behavior, such as violent crime. TAC reports that approximately 1,000 homicides among the estimated 20,000 total homicides in the U.S. are committed each year by people with untreated schizophrenia and bipolar disorder. Additionally, people with untreated psychiatric illnesses spend twice as much time in jail as those without mental illnesses, and are more likely to commit suicide.
The decline of mental health care access for those diagnosed with a mental illness began in the 1960s with deinstitutionalization—the policy of moving people with mental illnesses out of state institutions and then permanently closing those institutions in an attempt to move individuals with mental health needs to community-based mental health treatment programs. However, there was little to no success in community-based mental health institutions due to poor funding and attention. Today, the same problems persist.
One TAC study found that in 1955, there was one psychiatric bed for every 300 Americans. In 2005, there was one psychiatric bed for every 3,000 Americans.
“I don’t think anybody currently believes that long term, lifelong hospitalization was a great solution,” Zonana said. “On the other hand, there are a number of people who have great difficulties surviving out in the community without major supports—the illness just intrudes so much, and there’s not so much control.”
Today, only those with sufficient financial means have access to proper mental health treatment.
“There is a tremendous difference between if you’re upwardly mobile and you have insurance, or if you’re poor, lack insurance, lack financial means and [therefore] lack access to good care,” Kothari said. “Lots of times in prison systems, you’ll see lots of individuals who come from poor neighborhoods.”
The American Psychological Association found that African Americans are just as much at risk for mental illness as their white peers, yet receive substantially less treatment. U.S. Census Bureau data show that in 2005, African Americans were 7.3 times more likely to live in high-poverty neighborhoods with limited or no access to mental health services, leaving many adults untreated.
“If we spend more funds on mental health services in the community, those that have mental illnesses will have better access to the services they need, ” said Nicole Johnson, director of forensic services in the District of Columbia’s Department of Behavioral Health. “They will be able to get treatment instead of just being funneled through the criminal justice system.”
Further research from TAC indicated a very strong correlation between states that have more mentally ill persons in the correctional system and states that spend relatively less money on mental health services.
“A lot of people with mental health illnesses are being arrested for minor charges,” Johnson said. “People need to be educated on the difference between whether someone needs to be imprisoned or whether that individual needs treatment.”
Despite high demand, prisons are unable to provide those with mental illnesses the help that they need due to a lack of equipment and manpower.
“[Prisons] are supposed to provide adequate care, so you can’t be deliberately indifferent to the mental health needs of prisoners,” Zonana said. “But there is still is a gap between what people can get and where.”
One survey from the U.S. Department of Justice reports that 22 out of 40 state correctional systems did not have an adequate mental health staff. Because of this, 83 percent of jail inmates reported that they did not have access to needed treatment.
Kothari witnessed firsthand the poor mental health care available in Maryland.
“Once a month the psychiatrist would come in,” he said of one prison that he visited. “He was contracted to come in one day a month for two hours. He would sit at a desk, like this. The men would line up—there would be a line snaked for 150 yards. And he saw as many people as he could see. And I mean, literally, you had 30 seconds with the guy. That was psychiatric services. Whoever got to see him saw him, and whoever didn’t—too bad.”
Currently, 44 out of the 50 states and the District have at least one prison or jail that is holding more individuals with a serious mental illness than that state’s largest mental facility, according to TAC. The overcrowding of those who need mental health care in prisons diminishes already scarce resources.
“Most correctional facilities aren’t accredited because they don’t meet the standards,” Zonana said. “So the amount and quantity of available treatments can be quite low.”
The effects of overcrowding those with mental health needs in prisons became apparent in the 2011 U.S. Supreme Court case Brown vs. Plata, which determined that the overcrowding prisoners faced in California amounted to cruel and unusual treatment.
Forty-five percent of prisoners in California are mentally ill, and this number has doubled since 2000, according to a study by Stanford Law. Once in prison, they receive little to no treatment; overcrowding only worsened this problem.
“Even though they were diagnosing people appropriately, they weren’t able to move to the appropriate level of care,” Zonana said. “They were often just held at the same place for over a year because [prisons] were so overcrowded.”
The overall state of prisons, in conjunction with poor mental health care within prisons, has only shown to exacerbate preexisting mental illnesses and lead to an increase in suicide rates.
Harvard psychiatrist Stuart Grassian conducted interviews of the inmates sentenced to solitary confinement at the Pelican Bay State Prison. He found that “solitary confinement induces a psychiatric disorder characterized by hypersensitivity to external stimuli, hallucinations, panic attacks, cognitive deficits, obsessive thinking, paranoia and a litany of other physical and psychological problems.”
For people who are already suffering from a mental illness, solitary confinement may be life-threatening. In 2009, Anthony Gay was arrested in Illinois on a minor probation violation charge. After consecutive disturbances of throwing urine and feces, porison staff moved him to solitary confinement. There, he began self-mutilating—cutting parts of his arms, legs, and genitalia with pieces of metal or broken glass found within his jail cell. However, instead of treatment or psychiatric evaluation, he received more time in solitary confinement--a total of 97 years.
Gay isn’t the only one. Between half and three-quarters of prison inmates in solitary confinement are mentally ill, and one-third engage in cutting or other forms of self-mutilation, according to The Real Cost Weblog. The National Crime Information Center estimates that more than 90 percent of suicides in the correctional system are associated with mental or addictive disorders and that approximately two-thirds of individuals who commit suicide are depressed at the time of their deaths.
Kothari explained how he views the correctional system’s ideology towards prisoners.
“If you break the law, you deserve to be punished,” he said. “And that means, we [the prison system] don’t owe you much...If you chose to participate lawfully then you gain society’s blessing, but if you don’t, you incurse society’s punishment. So you’re no longer treated as an individual with rights.”
Though Kothari does not share this ideology, he recognizes that it is embedded in the system.
“Prison is not about rehabilitation or care,” he said. “It’s merely about warehousing. This is the state of the prison system.”