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Ill Equipped:
U.S. Prisons and Offenders with Mental Illness

Human Rights Watch

New York, Washington, London, Brussels

Copyright © 2003 by Human Rights Watch.
All rights reserved.

Printed in the United States of America

ISBN: 1564322904

Addresses for Human Rights Watch

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Human Rights Watch is dedicated to
protecting the human rights of people around the world.

We stand with victims and activists to prevent
discrimination, to uphold political freedom, to protect people from inhumane conduct in wartime, and to bring offenders to justice.

We investigate and expose
human rights violations and hold abusers accountable.

We challenge governments and those who hold power to end abusive practices and respect international human rights law.

We enlist the public and the international
community to support the cause of human rights for all.


Human Rights Watch conducts regular, systematic investigations of human rights abuses in some seventy countries around the world. Our reputation for timely, reliable disclosures has made us an essential source of information for those concerned with human rights. We address the human rights practices of governments of all political stripes, of all geopolitical alignments, and of all ethnic and religious persuasions. Human Rights Watch defends freedom of thought and expression, due process and equal protection of the law, and a vigorous civil society; we document and denounce murders, disappearances, torture, arbitrary imprisonment, discrimination, and other abuses of internationally recognized human rights. Our goal is to hold governments accountable if they transgress the rights of their people.

Human Rights Watch began in 1978 with the founding of its Europe and Central Asia division (then known as Helsinki Watch). Today, it also includes divisions covering Africa, the Americas, Asia, and the Middle East. In addition, it includes three thematic divisions on arms, children’s rights, and women’s rights. It maintains offices in New York, Washington, Los Angeles, London, Brussels, Moscow, Tashkent, Tblisi, and Bangkok. Human Rights Watch is an independent, nongovernmental organization, supported by contributions from private individuals and foundations worldwide. It accepts no government funds, directly or indirectly.

The staff includes Kenneth Roth, executive director; Michele Alexander, development director; Carroll Bogert, associate director; Barbara Guglielmo, finance director; Lotte Leicht, Brussels office director; Maria Pignataro Nielsen, human resources director; Iain Levine, program director; Rory Mungoven, advocacy director; Wilder Tayler, legal and policy director; and Joanna Weschler, United Nations representative. Jonathan Fanton is the chair of the board. Robert L. Bernstein is the founding chair.

The regional division directors of Human Rights Watch are Peter Takirambudde, Africa; Josť Miguel Vivanco, Americas; Brad Adams, Asia .The thematic division directors are Steve Goose, Arms, Lois Whitman, Children’s Rights; and LaShawn R. Jefferson, Women’s Rights.

The members of the board of directors are Jonathan Fanton, Chair; Robert L. Bernstein, Founding Chair, Khaled Abou El Fadl, Lisa Anderson, Lloyd Axworthy, David Brown, William Carmichael, Dorothy Cullman, Edith Everett, Michael Gellert, Vartan Gregorian, James F. Hoge, Jr., Stephen L. Kass, Marina Pinto Kaufman, Wendy Keys, Robert Kissane, Bruce Klatsky, Joanne Leedom-Ackerman, Josh Mailman, Joel Motley, Samuel K. Murumba, Jane Olson, Peter Osnos, Kathleen Peratis, Catherine Powell, Sigrid Rausing, Orville Schell, Sid Sheinberg, Gary G. Sick, Domna Stanton, John J. Studzinski, Shibley Telhami, Maureen White, and Maya Wiley. Emeritus Board: Roland Algrant, Adrian DeWind, Alice H. Henkin, Bruce Rabb, and Malcolm Smith.


Human Rights Watch wishes to thank each of the prisoners, correctional staff, mental health professionals, attorneys, and advocates who shared experiences, information, materials, and insights with us in the course of research for this report. We want to acknowledge especially the invaluable assistance from correctional mental health and law experts who generously contributed time to helping us understand and synthesize the concepts addressed in this report, including Professor Fred Cohen, L.L.B., L.L.M., Dr. Jane Haddad, Lindsey Hayes, Dr. Terry Kupers, Dr. Richard Lamb, David Lovell,Ph.D., Steve Martin, Esq., Dr. Jeffrey Metzner, and Professor Hans Toch, Ph.D. Dr. Terry Kupers also participated in a research mission to Indiana with Human Rights Watch in 1997. Several state corrections authorities, convinced of the importance of this project, were particularly helpful in giving us access to their staff and facilities, including: Secretary of the Washington State Department of CorrectionsJoseph D. Lehman; Robert Horel at the California Department of Corrections; Beth Anderson, health services administrator, Washington Department of Corrections; Brett Rayford, Connecticut Department of Correction; Lance Couturier, chief psychologist, Pennsylvania Department of Corrections; and Dr. Thomas Powell, director of clinical services, Vermont Department of Corrections. They were all extremely gracious with their time and energy. We also want to specially note extraordinary assistance from attorneys Donna Brorby, David Fathi, Tara Herivel, Sarah Kerr, Patricia Perlmutter, Antonio Poinvert, Betsy Sterling, and Todd Winstrom, all of whom we interviewed numerous times during the research for this report. In addition, our deepest thanks go to the staff at the Council on State Government and the Correctional Association of New York, who were more than generous in sharing information and ideas with us. Finally, we with to express our great gratitude to Fred Cohen, David Fathi, Craig Haney, Terry Kupers, and Jeffrey Metzner for carefully reviewing and commenting on earlier drafts of this report.

Sasha Abramsky, a consultant to Human Rights Watch, and Jamie Fellner, director of the U.S. Program at Human Rights Watch are the authors of this report. It was edited by Joseph Saunders, deputy program director at Human Rights Watch, and James Ross, senior legal advisor. It is based principally on research by Mr. Abramsky, with additional research by Ms. Fellner. Paul Jacobs, a program associate at Human Rights Watch and Sarah Kunstler, a Human Rights Watch intern, also provided research assistance. Paul Jacobs also prepared the report for publication.

Human Rights Watch is grateful to the Open Society Institute for its support of the U.S. Program that made this report possible.

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October 2003