People with Serious Mental Illnesses in Jail and Prison

Their Stories				In Jails : 101,000 individuals with mental illnesses
People with mental illnesses often come into				were inmates in local jails at year-end 2000. Of
contact with the criminal justice system.				these, 63,000 had a severe mental illness.
- Steven, 28, has bipolar disorder. He can maintain				5 Jails are locally operated facilities that hold
a normal family life and a job as a landscaper. He				people pending arraignment or awaiting trial,
had never had problems with the law or any				conviction or sentencing. Sentencing is either to
history of violent behavior. One night while he was				probation or incarceration in jail (generally under a
driving, the police pulled him over. He heard voices				year) or prison. There are 3,365 local jails.
telling him to keep going. He did, was shot in the				6
hand, bitten by police dogs and arrested. He spent				- In Prisons : 201,000 individuals with mental
four months in jail, without the medication that				illnesses were inmates in state (191,000 or 16.2%)
had kept him stable. Eventually, he was found not				and federal (10,000 or 7.9%) prisons at year-end
guilty by reason of insanity and was hospitalized;				2000. Of these, 132,000 had a severe mental
the charges were dismissed. (Health Foundation of				illness.
Greater Cincinnati , 8/00)				7 There are 1,558 adult correctional facilities
A man with a mental illness who was homeless				housing state prisoners and 110 facilities housing
was arrested in Florida for shoplifting an ice-cream				federal prisoners.
sandwich that cost $ 1.16, then imprisoned				- On Probation : 614,000 individuals (16%) with
because he lacked the $25 bail for release.				mental illnesses were on probation at year-end
(Sun-Sentinel, Ft. Lauderdale , 11/98)				2000. Of these, 315,000 had a severe mental
Many lack access to adequate services through				illness.
the public mental health system.				8 Probation represents a more moderate sanction
- Roy was so desperate for mental health				than incarceration. It is generally given to
treatment that he showed up at the courthouse				offenders with few or no prior convictions or to
and signed his commitment papers. On the day of				those guilty of less serious offenses.
his hearing, he packed, ready for a hospital stay,				Description of the Population
but the hospital couldn't take him for two months.				New Department of Justice data confirm previous
"What am I supposed to do until then," he asked.				research findings that most individuals with mental
No other services were offered him. Seven				illnesses in the criminal justice system have had
weeks later, Roy walked into the woods,				extensive experience with both the criminal
strapped his belt around a low branch and				justice and mental health systems and have a
stepped off a plastic bucket. His body was found				severe mental disorder and poor functioning.
a week later, on the day his mother got a call				As seen in this table on offenders with mental
that the hospital was ready for him. (Time, 7/00)				illnesss, on every item, in all settings-jails, state
- Seeking help for their 20-year-old son who was				prisons, federal prisons and probation-offenders
exhibiting unexplained paranoia, a Latino family				with mental illnesses are more likely than other
called the community mental health crisis line. Nine				offenders to have the reported problem.
hours later a mental health professional arrived				1. Based on admission rates reported in Bureau of
with police. After a brief exam the mental health				Justice Statistics Bulletin, Census of Jails, 1999
worker said the young man may need				(August 2001, NCJ 186633, p. 5) multiplied by the
hospitalization and the officers agreed to take him				percentage of jail inmates with a mental illness
to a mental health facility. Although they had				(16.3%) reported in Bureau of Justice Statistics
found him passively sitting on a sofa, the officers				Special Report, Mental Health Treatment of
used physical force, beating him with nightsticks				Inmates and Probationers (July 1999, NCJ
and ultimately pepper-spraying the apartment. The				174463).
family watched, stunned. The young man was				2. Calculated using the respective rates of mental
diagnosed with schizophrenia and more than a				illness reported in Bureau of Justice Statistics
year later remains withdrawn and unable to return				Special Report, Mental Health Treatment of
to his job. His family is discouraged about				Inmates and Probationers (NCJ 174463) and
accessing any public services. (Report from a				year-end jail and prison population numbers
Washington DC suburb, 4/02)				reported in Bureau of Justice Statistics Bulletin,
The criminal justice system is used to fill the void.				Prisoners in 2000 (August 2001, NCJ 188207) and
- A man with a history of epilepsy was arrested				probationers reported in Bureau of Justice
after appearing confused and disrupting service on				Statistics press release of August 26, 20001.
a city bus. Upon release, he was found outside				3. Bureau of Justice Statistics Special Report,
the jail banging his head on a wall and crying. He				Mental Health Treatment of Inmates and
was then admitted to hospital, where he				Probationers (NCJ 174463).
threatened people with pencils. Hospital staff called				4. Id.
the police and allowed them to enter patient areas				5. Based on self reports by inmates and
with firearms. After the man became agitated				probationers and, for severity, on overnight
from complications associated with epileptic				admissions to a mental hospital or treatment
seizures, he was shot dead by a police officer. His				program.
family had brought his seizure medication to the				6. Bureau of Justice Statistics Bulletin, Census of
hospital the day before, but they spoke only				Jails, 1999 (August 2001, NCJ 186633).
Spanish and no one could communicate with them.				7. Bureau of Justice Statistics Bulletin, Prisoners in
The medicine was set aside. (Mental Health				2000 (August 2001, NCJ 188207).
Weekly, 6/01)				8. Bureau of Justice Statistics Special Report,
Once people are in thecriminal justice system,				Substance Abuse and Treatment of Adults on
their mental health needs are not met.				Probation, 1995 (March 1998, NCJ 166611).
- An Oregon man with a mental illness gouged out				9. Bureau of Justice Statistics Special Report,
his eyes as he waited in a Portland jail cell for a				Mental Health Treatment of Inmates and
psychiatric hospital bed. (The Oregonian 6/12/02 )				Probationers (July 1999, NCJ 174463).
- Romus was arrested and brought to the Orange				Policy to Address Issues Regarding People with
County jail in New York , shouting gibberish. As a				Serious Mental Illnesses in the Criminal Justice
result of budget cuts, no psychiatrist was on call,				System
so Romus was pepper-sprayed and shackled to a				Impact
restraint chair, where he sat shouting, twisting and				The increase in the number of individuals with
kicking for hours. Eventually, an officer dragged				serious mental illnesses who come in contact with
Romus , in the chair, to the jail's mental health unit				law enforcement officers or are booked into jail
and pushed him in. (Middletown Times				or sentenced to incarceration means that more
Herald-Record, NY, 7/01)				and more individuals suffer significant harm. For
- Shawn, 20, diagnosed with schizophrenia,				example:
depression and bipolar disorder, has been in and				- They experience great trauma in connection
out of state hospitals. He was arrested after				with arrest, booking or detention.
punching a security guard who tried to stop him				- They are unnecessarily stigmatized by
from stealing. While in jail awaiting a court hearing,				involvement with criminal justice.
Shawn has tried to kill himself at least four times.				- They are penalized in their eligibility for housing,
"I use razors, floor tiles, nails, screws, glass,				employment and public benefits as a result of-and
anything," he says, "I want to die." When he tries				long after-arrest or detention.
to hurt himself, the jail locks him in the medical				The various parts of the criminal justice system
observation cell. "When I get locked up like that, all				also face major problems, including:
I do is cry, punch myself in the face, bang my				- repeated use of significant police time and judicial
head against the wall." Guards then strap him in a				resources;
restraint chair. "There is not a day...that I don't				- significant stress among law enforcement
think of killing myself," he told a reporter. "I just				personnel (for example, when individuals with
want help. I want this to end. I've come to the				depression try to encourage the officer to shoot
conclusion that death is the only way out." (				them);
Portland Press Herald, 11/01)				- occupancy of jail beds needed for more serious
Criminal justice and mental health systems have				offenders;
not collaborated well.				- management problems in jail, often requiring
- Paul, 24, was arrested for breaking and entering.				suicide watch or causing major disruptions for jail
While processing him, police saw that he was				staff;
highly agitated and his behavior was strange.				- challenges to probation and parole officers who
Concerned, the arresting officers called the area				lack special training or are too few in number to
mental health center, a hospital, the state police				work with people with serious mental illnesses;
and the District Attorney's office to find out what				- a scarcity of financial resources as a result of
to do. While the various organizations argued over				these and other issues.
who should take him, Paul hanged himself in his				Taking a Different Approach
cell. (Health Foundation of Greater Cincinnati , 8				What is needed is a new approach to policy that
00)				will:
- Joseph is deaf, has a serious mental illness and				- assure that individuals with serious mental
cannot speak. He was arrested on a				illnesses do not end up in the criminal justice
misdemeanor charge. Although the charges were				system when a mental health approach would be
dropped, he remained in the detention center for				more appropriate or because of prior failures to
two years, lost somewhere between the city's				make mental health services accessible;
criminal justice and mental health bureaucracies.				- effectively move people with serious mental
(The Washington Post, 9/01)				illnesses out of the criminal justice system more
Collaboration between mental health and criminal				expeditiously; and
justice can lead to better outcomes.				- ensure that those who have been arrested or
- Richard, 43, has schizophrenia. He has been				incarcerated do not return.
arrested 137 times for petty crimes such as				Goals for Policy
trespassing and panhandling. Unwilling to take				Such policies will result in:
medication on his own, he was caught in a				- better outcomes for the individual with mental
dangerous cycle, from jail to hospital to				illness;
homelessness. Thresholds, a nonprofit rehabilitation				- greater safety for all-the community, law
agency, convinced a judge to release Richard to				enforcement officers, correctional staff, the
their custody. Now he has a single room the				individual with a mental illness and his or her
group provides for him, food, money and				family;a more efficient criminal justice system;
constant support. It took time, but Richard has				- greater cost-effectiveness across the criminal
been able to break his cycle of living on the				justice and mental health system, as mental
streets or in prison. Over a year later, he remains				health issues are addressed earlier and in a more
arrest-free and says he has never felt happier.				appropriate forum;a more pleasant community for
Thresholds costs $25 a day, while jail costs $75 a				all.
day. (Health Foundation of Greater Cincinnati , 8				Approaches That Have Been Tried
00)				Many communities have adopted programs that
Individuals with Mental Illnesses in Jail and Prison				will divert people with serious mental illness from
Data				the criminal justice system at various stages of
- Nearly two million new jail admissions are of				the process:
people with mental illnesses-35,000 individuals a				- time of arrest (pre-booking diversion);
week.				- as the individual's case is initially processed in the
1				jail (pre-booking diversion);
- At the end of 2000, nearly one million individuals				- following booking, but without a trial
with mental illnesses were in the criminal justice				(post-booking diversion);
system.				- at adjudication or the trial stage (court-based
2				diversion); or
- More than 16% of jail inmates have a mental				- following incarceration (re-entry programs)
illness, according to the United States Department				Diversion is most likely to succeed, to violate
of Justice.				individual rights less and to be less costly to the
3				criminal justice system if it occurs in the early
- Seventy percent of jail inmates with mental				stages of criminal justice processing. However,
illnesses are there for nonviolent offenses.				depending on the seriousness of the crime or the
4				individual's prior history in the criminal justice
Offenders with Mental Illness				system, this may not be feasible.
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Integrail

People with Serious Mental Illnesses in Jail and Prison