October 22, 2003

Ill-Equipped:

U.S. Prisons and Offenders with Mental Illness

 

     SUMMARY  
The Scope of this Report
A Note on Methodology
II.    RECOMMENDATIONS
Recommendations to the U.S. Congress
Recommendations to Public Officials, Community Leaders and the General Public
Recommendations to Prison Officials and Staff
III.BACKGROUND  
Rates of Incarceration of the Mentally Ill
Deinstitutionalization, Crime and Punishment, and the Rise in the Mentally Ill Prisoner Population
"Criminalizing the Mentally Ill"
Diversion
IV.WHO ARE THE MENTALLY ILL IN PRISON?
Overview of Mental Illness
Examples of  Mentally Ill Prisoners
    MENTAL ILLNESS AND WOMEN PRISONERS
Case Study: R.M. and Seriously Mentally Ill Women Prisoners in Vermont.
VI.SYSTEMS IN TRANSITION  
Reform through Litigation
The Problem of Funding Mental Health Services in Prisons
VII.DIFFICULTIES MENTALLY ILL PRISONERS FACE COPING IN PRISON  
Physical Conditions
Vulnerability of Mentally Ill Prisoners to Abuse by Other Prisoners
Rule-Breaking by Mentally Ill Prisoners
Discipline for Misconduct
I.J., New York
VIII.INADEQUATE RESPONSES AND ABUSES BY CORRECTIONAL STAFF
The Mental Health Role of Correctional Staff
Mental Health Training for Custodial Staff
Correctional Officers' Use of Excessive Force
Other Abuses and Inappropriate Responses by Correctional Officers
Timothy Perry, Connecticut
Y.D., California
Mark Edward Walker, Montana
IX.INADEQUATE MENTAL HEALTH TREATMENT IN PRISONS
Understaffing
Poor Screening and Tracking of Mentally Ill Prisoners101
Lack of Timely Access to Mental Health Staff103
Diagnoses of Malingering106
Medication as the Sole Treatment109
Lack of Confidentiality114
Medication115
Proper Medication115
Delivery117
Medication Discontinuity118
Inadequate Monitoring of Medication Side Effects120
Protecting Prisoners on Medication from Heat Reactions122
Inadequate Efforts to Ensure Medication Compliance125
    INSUFFICIENT PROVISION OF SPECIALIZED FACILITIES FOR SERIOUSLY ILL PRISONERS128
Crisis Care128
Specialized Intermediate Care Units130
Expansion of Specialized Care Facilities133
XI.CASE STUDY: ALABAMA, A SYSTEM IN CRISIS135
V.K., New York141
XII.MENTALLY ILL PRISONERS AND SEGREGATION   145
Overview of Segregation145
Mentally Ill in Segregation147
Impact of Segregation on the Mentally Ill149
Lost in Segregation153
The Lack of Quality Mental Health Services for Segregated Prisoners.154
From Segregation Units to Psychiatric Centers and Back161
Keeping the Mentally Ill Out of Segregation164
R.P., New York169
L.J., New York171
XIII.SUICIDE AND SELF-MUTILATION   174
Self-Mutilation174
Suicide178
Increased Risk of Self-harm and Suicide in Segregation Units179
Suicide Protocols181
Punitive Responses to Suicide Attempts185
Felix Jorge, New York189
XIV.FAILURE TO PROVIDE DISCHARGE SERVICES192
Recidivism   193
Discharge Planning194
Financial Assistance195
States that Confer Eligibility on the Date of Release196
States that Help Prisoners Fill Out Applications197
States that Provide Minimal Help199
Ex-offender Programs199
XV.LEGAL STANDARDS203
International Protections204
The Rights of Prisoners to be Free of Abuse204
The Right to the Highest Attainable Standard of Health206
The United States and International Human Rights Law   207
Constitutional Protections for Prisoners with Mental Illness209
The Right to Mental Health Treatment211
Constitutionally Required Components of Mental Health Services213
Americans With Disabilities Act214
Prison Litigation Reform Act214