Social Justice Matters: Mental Health and the Prison System

Last month at FWD, I discussed the imprisonment of mentally ill youth in the United States. The issue of mental illness and the prison system goes far beyond juvenile detainees, however. Mental illness is also seen in adult detainees, and it’s just as poorly handled. It’s a symptom of a much larger problem: A system that uses correctional facilities for mental health treatment, that forces people to call the police for help with mental illness because there are no community based interventions available, that decides that committing spending to mental health is not worth it, in a society that stigmatises mental illness.

There is an attitude that people with mental illness are frightening and need to be confined. That mental illness shouldn’t be seen on the street or in the community, and should be tightly controlled with medication. It’s no wonder that there is a long history of compulsory institutionalisation for people with mental illness, and when the great wave of deinstitutionalisations happened, that society should have looked to another institution to fill the gap. The result has been the criminalisation of mental illness.

Laws are passed to mandate incarcerating people for the crime of being mentally ill. Law enforcement are provided with very minimal training when it comes to interacting with people with mental illness. They are authorised to use techniques that are really not appropriate, necessary, or humane. To use just one example of an oft-abused tool in the law enforcement toolbox, the taser is routinely weaponised against people with mental illness. People die as a result of being tasered. Taser use on people with mental illness is questioned, but doesn’t result in meaningful changes in policy.

This isn’t an isolated thing. The problem doesn’t start in prison. It starts long before, with social attitudes about mental illness and policy that promotes incarceration of people specifically because they are mentally ill. It starts with communities getting angry about homelessness and demanding that the scary mentally ill homeless be swept off the streets. It starts with law enforcement being provided with absolutely no information about how to interact with people who are mentally ill. It is all rooted in fear of the Other.

Do you know where the largest facility for the treatment of mental illness in the United States is located?

It’s Rikers Island, in New York. Rikers Island is a prison. I don’t mean that metaphorically.

One in eight prisoners in the United States has mental illness. Or is it one in six? The fact that we can’t even settle on a hard statistic tells you a lot about how mental illness is handled in the prison system. Like the fact that many prisoners with mental illness lack access to psychiatric care. That many have no firm diagnoses and are not allowed to seek and receive treatment. Prisons don’t know what to do with mentally ill prisoners so they put them in solitary confinement. For years.

Access to care very much depends on where you are incarcerated. Think about that. There are a lot of problems when it comes to getting health services in this country; for people who aren’t incarcerated, lack of money, restrictive health care plans, and region can all be limiting factors on obtaining care. But when we are locking people up, ostensibly for the good of society, we owe them a debt. We owe them the debt of treating them like human beings. That means that we need to provide them with health care. I happen to think that everyone deserves access to care and that all barriers to treatment should be removed, but I find it especially repugnant that we criminalise mental illness and don’t even treat it.

In prison, prisoners with mental illness are extremely vulnerable. They are much more likely to be targets of violence and sexual assault. Especially if they have intellectual disabilities or cognitive disabilities, they may find it very difficult to resist abusive treatment. If they attempt to report it, they will not be heeded. Few steps are taken to protect mentally ill prisoners. They are kept in the general population, where they are identified as easy targets by other prisoners.

It should come as no surprise to learn that the prison environment is not healthy for people with mental illness. Suicide rates are higher in prison and for people with existing depression and mental illness, prison can create a spiral of self harming behaviour that can conclude in a suicide attempt. The crowded environment is overwhelming for some prisoners with mental illness, as are the complex social dynamics. The lack of access to fresh air. The poor nutrition. Prison is pretty much the last place you want to be if you have mental illness.

This creates a revolving door system. People with mental illness are imprisoned, not provided with treatment, released, and imprisoned again because they run afoul of society. By being too mentally ill. By trying to survive. Sometimes they are killed by law enforcement, and everyone condemns it as a tragic accident and then files the story away. There is no outrage about what happens to mentally ill prisoners, and ex-prisoners after release.

I would prefer that we not imprison people because they are mentally ill. That community-based treatment be provided and that people who seek help receive it. But I can’t wave a magic wand and stop the imprisonment of people with mental illness. Bearing that in mind, I can ask why it is that we incarcerate people ‘for protection’ and don’t provide them with access to services so that they can, perhaps, stand a chance when they are released again. We spend a lot of money on our prison system. That money is spent extremely inefficiently. Even if you don’t care about human beings, surely you can spare a thought for the monetary waste involved.