Note 2.0

Mentally Ill Inmates

By

M. DeAnna Doherty

December, 2002

Keywords: Mentally Ill Inmates, Violent Offenders, Treatment Programs

  In 1959, nearly 559,000 mentally ill patients were housed in state mental hospitals. A shift to "deinstitutionalize" mentally ill persons had, by the late 1990s, dropped the number of persons housed in public psychiatric hospitals to approximately 70,000. Many mentally ill persons were not adjusting well in the community and were coming under increasing contact with the criminal justice system (Lamb & Weinberger, 1998, p. 1). One in every eight State prisoners was receiving some mental health therapy or counseling services at midyear 2000. Nearly 10% were receiving psychotropic medications (including antidepressants, stimulants, sedatives, tranquilizers, or other anti-psychotic drugs). Fewer than 2% of State inmates were housed in a 24-hour mental health unit (Beck & Maruschak, 2000, p. 1). Unfortunately, few state-run correctional institutions have any substantial capacity for the in-depth psychiatric treatment of inmates who are seriously mentally disturbed. A number of states, however, do operate facilities that specialize in psychiatric confinement of convicted criminals. BJS (Bureau of Justice Statistics) reports that 12 facilities devoted exclusively to the care of mentally ill inmates are operated by state governments throughout the nation, and that another 143 prisons report psychiatric confinement as one specialty among other functions that they perform (Schmalleger, 2001, p. 564). With that being stated, mentally ill inmates make up a vast portion of all inmates housed in State prisons.

The highest rate of mental illness was among white females in state prisons—29%. Almost 40% of the white female state prisoners age 24 or younger were identified as mentally ill. 20% of the black females and 22% percent of the Hispanic females in state prison were mentally ill (Ditton, 1999, p. 1a). Mentally deficient inmates constitute still another group with special needs. Some studies estimate the proportion of mentally deficient inmates at about 10%. Retarded inmates are less likely to complete training and rehabilitative programs successfully than are other inmates. They also evidence difficulty in adjusting to the routines of prison life. As a consequence, they are likely to exceed the averages in proportion of sentence served (Schmalleger, 2001, p. 564).

Inmate History

       When compared with other inmates and probationers, the mentally ill inmates and probationers reported higher rates of prior physical and sexual abuse and higher rates of alcohol and drug abuse by a parent or guardian while they were growing up. Among mentally ill state prisoners, nearly a third of men and three-quarters of women said they had been physically or sexually abused in the past. More than 40% of the mentally ill inmates said their parents had abused alcohol or drugs. More than half said a parent, brother or sister had also been in jail. At some point while growing up, a quarter of mentally ill State prisoners and local jail inmates lived in a foster home, agency or institution. One in six mentally ill probationers reported living in a foster home or institution for a period of time during their childhood (Ditton, 1999, p. 2a). Based on information from personal interviews, state prison inmates with a mental condition were more than twice as likely as other inmates to have been homeless in the 12 months prior to their arrest. Another characteristic common to mentally ill inmates is unemployment. About 38% of mentally ill State and Federal prison inmates and 47% of mentally ill jail inmates were not employed in the month before arrest, while 30% of other State inmates, 28% of other Federal inmates, and 33% of other jail inmates were unemployed. An estimated 30% of mentally ill and 13% of other inmates in State prison received some type of financial support from government agencies prior to their arrest. More than 15% of the mentally ill receive welfare, 17% supplemental security income or other pension, and 3% compensation payments, such as unemployment or workman’s compensation (Ditton, 1999, p. 5b). Mentally ill inmates also exhibited higher rates of alcohol dependence than other inmates. Approximately one-third were assessed as alcohol dependent (http://www.uaa.alaska.edu, 2000). Nearly half of the mentally ill in state prison said they were binge drinkers; 46% reported they had been in physical fights while drinking; and 17% had lost a job due to drinking (Ditton, 1999, p. 2a).

Violent Offenders

Offenders identified as mentally ill were more likely than other offenders incarcerated or on probation to have committed a violent offense. An estimated 13 percent of the mentally ill State prisoners had committed murder; 12 percent rape or sexual assault; 13 percent, robbery; and 11 percent, assault. Nearly 1 in 5 violent offenders in prison or jail or on probation were identified as mentally ill. They were also more likely to have been under the influence of alcohol or drugs at the time of their current offense and more than twice as likely to have been homeless in the 12 months prior to their arrest (20% vs. 9%) (Ditton, 1999, p.1-2a). 53% of prisoners considered mentally ill, compared to 46% of all other prisoners, had committed a violent offense. Mentally ill inmates also tended to have longer prior criminal histories. Among the mentally ill, 52% reported three or more prior sentences (http://www.uaa.alaska.edu ,2000). The mentally ill inmates were more likely than other prisoners to have a prior sentence for a violent offense (Ditton, 1999, p. 2a). Also, people recently discharged from mental hospitals are likely to be more violent than the general population. The most violently mentally ill people are lower class, young males (Jacoby, 2002, p.1048).

Judicial Processing

When the offense is minor and the suspect is mentally ill, the police exercise their discretion to either make an arrest or refer the suspect for mental health treatment. Defendants charged with crimes may claim they are incompetent to stand trial (IST), an assertion that they are unable to understand the charges against them nor assist in their own defense. Defendants found IST may be committed temporarily to a mental health facility. Criminal charges are dropped for defendants remaining incompetent. Defendants who recover sufficiently during temporary commitment may be tried on original charges. Criminal defendants found IST are hospitalized for about as long as convicted defendants are incarcerated in jail or prison. Defendants found IST on minor misdemeanor charges are frequently hospitalized longer than defendants convicted and jailed on similar charges (Jacoby, 2002, p. 1047). The competency of a defendant can be questioned prior to, during and before the end of a trial. The defense attorney or prosecutor presents evidence to the court that the defendant is mentally ill or mentally retarded, and does not have the capacity to understand the proceedings against them, or to assist their attorney in their own defense. The court will then order that a competency evaluation be performed by a psychiatrist or psychologist. Upon completion of the evaluation a report is submitted to the court concerning the defendant’s capacity to understand the proceedings against them, and to assist their own attorney in their own defense. The report also indicates the defendant’s need for treatment if they are found incompetent. If the court finds the defendant IST, the court will order that the defendant receive treatment to restore their competency, and they shall be transferred to a secure hospital setting (http://www.safe-trak.com, 1999). Two other ways the mentally ill can plead are not guilty by reason of insanity (NGRI) and guilty but mentally ill (GBMI). In the case of NGRI, mentally ill defendants may escape conviction by confessing factual guilt but asserting that they should not be held responsible because their crimes were caused by mental illness. This legal strategy is rarely employed or successful. A study of arrest outcomes in twenty-four states in 1985 found one NGRI verdict for every 10,217 arrests (Jacoby, 2002, p. 1047). The guilty but mentally ill verdict stems from the NGRI verdict. This verdict provides for conviction and imprisonment of offenders who are mentally ill and might otherwise escape imprisonment by pleading NGRI. GBMI verdicts seldom occur. GBMI verdicts lead to longer prison terms than do guilty or NGRI verdicts for the same offenses. Offenders declared GBMI are not more likely to receive treatment for their mental illness (Jacoby, 2002, p. 1047).

Treatment

The most common treatment for mentally ill inmates is psychotropic medications and least common is counseling (Jacoby, 2002, p. 1048). An estimated 60% of the mentally ill in State and Federal prison received some form of mental health treatment during their current period of incarceration. Fifty percent said they had taken prescription medication; 44% had received counseling or therapy; and 24% had been admitted to a mental hospital or treatment program. Among jail inmates, 41% of those identified as mentally ill had received some form of mental health services since admission. Just over half of mentally ill probationers had received treatment since their sentence to community supervision. Counseling was the most common form of treatment (44%), followed by medication (37%), and an overnight stay in a mental hospital or treatment program (12%). Female mentally ill inmates are more likely than males to report treatment. Nearly 70% of mentally ill females in State prison, 77% of those in Federal prison, and 56% on local jails received mental health services while incarcerated, while 60% of males in State prison, 57% in Federal prison, and 38% in local jails reported treatment. White mentally ill inmates reported higher rates of treatment than black or Hispanic offenders. About 64% of white State prison inmates identified as mentally ill had received treatment, compared to 56% of black offenders and 60% of Hispanic offenders (Ditton, 1999, p. 9b). The 2000 census identified 155 facilities that specialize in mental health/psychiatric confinement. Twelve of these facilities reported that their primary function was mental health confinement. In some states these facilities are used to house mentally ill inmates separately from the general population; in other states they are used to remove inmates in response to acute episodes for a short term. The most severely mentally ill may be transferred to outside agencies for long-term treatment (Beck & Maruschak, 2001, p. 4).

One study states that corrections officers in US jails and prisons typically use punishment as a means of controlling the behavior of mentally ill inmates with aggressive disciplinary problems. This approach tends to be ineffective, creating ever-increasing tensions among inmates, officers, and heath care workers in a corrections facility. An approach by the Connecticut Department of Correction appears to counter that escalation, giving inmates who have been diagnosed with various mental illnesses and who exhibit aggressive behavior with disciplinary problems the coping skills and medications needed to live in more general corrections populations. The cornerstone of the program is the Intensive Mental Health Unit (IMHU), an 11-cell section of Garner Correctional Institution. The inmates in the IMHU come from Northern Correctional Institution-a "super max" facility housing about 470 inmates who are considered to be the most dangerous and aggressive members of the state’s prison population. A basic overview of this treatment plan is: the inmates are placed at Level 1 where they spend 23 hours a day for a minimum of 60 days in locked-down single cells. They get 1 hour a day for showers and recreation. About 2-3 hours a day the inmates meet with therapists or physicians and nurse. These people teach them how to control impulsivity. If the inmate is successful, then he/she is moved up to Level 2. In Level 2, the inmate is confined for a minimum of 21 days. Inmates in this phase are allowed to leave the unit and take recreation in the general mental health unit. If the inmates comply with the rules and respond to medication properly, then they are propelled to Level 3. In this level, the inmates are moved from the IMHU to the general mental health unit. For 30 days they are locked in single cells, and then given a cell mate. Also in this level, inmates are allowed contact visits (Mitka, 2001, p. 3). This study did show significant results, but has not been conducted with enough inmates to be sure that it works. It seems like a good idea, but it is going to take a lot of money to fund a program like this nationwide.

Conclusion

In conclusion, mentally ill inmates make up a large portion of total inmates. They are definitely special needs cases. Though the corrections officers have not found exactly the right treatment plan for these inmates, they are working on it. Several different treatment plans are being evaluated. Some of the treatments for the mentally ill seem almost inhumane. Steps should be taken to lower the rate of mentally ill inmates and better treatment programs should be devised, but there has to be sufficient time and money spent on an effort such as this. Prisons and jails should try to eliminate the excessive use of medications for these inmates, but it is a fast and easy, although temporary, solution to the problem of mentally ill inmates. Treatments for the criminal acts themselves should be devised to help lower the rates of recidivism in the mentally ill. Basically, more time and money has to be spent before the mentally ill will get any better.

References

Beck, Allen J. and Laura M. Maruschak (2001, July). Mental Health Treatment in State

Prisons, 2000. Bureau of Justice Statistics Special Report. Available: http://www.ojp.usdoj.gov/bjs

Ditton, Paula M. (1999a, July). More than a Quarter Million Prison and Jail Inmates are

Identified as Mentally Ill. Bureau of Justice Statistics. Available:  http://www.ojp.usdoj.gov/bjs/pub/press/mhtip.pr

Ditton, Paula M. (1999b). Mental Health and Treatment of Inmates and Probationers.

Bureau of Justice Statistics Special Report. Available: http://www.ojp.usdoj.gov/bjs/

Jacoby, Joseph. (2002). "Mentally Ill Offenders". Encyclopedia of Crime and Punishment

Vol. 3. David Levinson, Editor.

Lamb, Richard H. and Linda E. Weinberger. (1998). Persons with Severe Mental Illness

in Jails and Prisons. Available: http://www.nicic.org/services/special/mentally-ill

Mitka, Mike. (2001). Innovative Program for Mentally Ill Inmates. Available:

http://www.jama.ama-assn.org/issues/v285n21/ffull/jmn0606-2.html

(2000). Corrections and the Mentally Ill. Available:

http://www.uaa.alaska.edu/just/forum/f184wi02/d _corrmental.html

(1999). Competency to Stand Trial. Available: www.safe-trak.com/main/competencyl.htm

This page available at: http://www.iejs.com/Corrections/Mentally_Ill_Inmates.htm