Prison is not the place to treat mentally ill

by Lee Brett, Civitas Review Online, October 30, 2013.

This week, allegations of abuse emerged from Central Prison.According to the Associated Press:

Lawyers for an inmate who suffers from a serious mental illness say he was abused at North Carolina's Central Prison by guards who repeatedly doused him with pepper spray while he was locked in a tiny cell.

If true, this is a shocking and deplorable incident that reflects poorly on the Department of Corrections. But this case should be understood in a larger context:  Severely mentally ill people are routinely incarcerated instead of treated. A 2005 report by the federal Bureau of Justice Statistics found that 56 percent of state prison inmates suffer from mental illnesses. Approximately 10 percent of prisoners have a severe mental illness.

Before deinstitutionalization, people with severe mental illnesses were treated at state mental hospitals. It was not a perfect system by any means. Abuse of the sort portrayed in One Flew Over the Cuckoo’s Nest led many people to believe that state mental health facilities should be closed. Over the span of decades, states shuttered their hospitals and released former patients back into society. For many people, this was a good thing. But for the severely mentally ill, the system that replaced deinstitutionalization was even worse. Today, many of the people who would have been in a state mental hospital instead find themselves on the street – or in prison.

The inmate at Central Prison, Jerry Williams, is a perfect example of this plight. Williams has paranoid schizophrenia, along with developmental disabilities that classify him as someone with “borderline intellectual functioning.” He also has a lengthy criminal record of trespassing, assault, and burglary. It is hard to identify exactly to what extent Williams’ sickness factors into his criminal record. But as E. Fuller Torrey, an expert in schizophrenia, noted:

…Researchers often find a direct relationship between [a] person’s mental illness and the behavior that led to apprehension. For example, a woman with schizophrenia in New Mexico was arrested for assault when she entered a department store and began rearranging the shelves because of her delusion that she worked there; when asked to leave, she struck a store manager and a police officer… People who suffer from paranoid schizophrenia, in particular, are likely to be arrested for assault because they may mistakenly believe that someone is following them or trying to hurt them and will strike out at that person.

People like Jerry Williams frequently end up in prison as a result of their condition. But prison is no place for mental health treatment. Prisons exist for punishment or “corrections.” They have strict rules designed to enforce the utmost obedience and compliance, and there are penalties for breaking those rules. For example, assaulting a prison guard could mean time in solitary confinement, or even additional time on a sentence. But for people with severe mental illnesses, this structure of incentives is absurd. People undergoing a psychotic break are not capable of making rational judgments and assessments. And yet they are punished as though they could control their actions.

Sometimes those punishments actually worsen their conditions. Solitary confinement, for example, aggravates the symptoms of severe mental illness. It is cruel and senseless to treat mentally ill people in this way.

Spurred on by moral outrage, North Carolina joined the rest of the country in releasing the mentally ill from public hospitals. But there is precious little of that moral outrage today. Deeply troubled people, wracked by mental illness, suffer in silence in jails and homeless shelters, alone and forgotten.