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

TABLE OF CONTENTS

1. SUMMARY
The Scope of this Report
A Note on Methodology


2. RECOMMENDATIONS
Recommendations to the U.S. Congress
Recommendations to Public Officials, Community Leaders and the General Public
Recommendations to Prison Officials and Staff


3. 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


4. WHO ARE THE MENTALLY ILL IN PRISON?
Overview of Mental Illness
Examples of Mentally Ill Prisoners


5. MENTAL ILLNESS AND WOMEN PRISONERS
Case Study: R.M. and Seriously Mentally Ill Women Prisoners in Vermont.


6. SYSTEMS IN TRANSITION
Reform through Litigation
The Problem of Funding Mental Health Services in Prisons


7. 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

8. 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

9. INADEQUATE MENTAL HEALTH TREATMENT IN PRISONS
Understaffing
Poor Screening and Tracking of Mentally Ill Prisoners
Lack of Timely Access to Mental Health Staff
Diagnoses of Malingering
Medication as the Sole Treatment
Lack of Confidentiality
Medication
Proper Medication
Delivery
Medication Discontinuity
Inadequate Monitoring of Medication Side Effects
Protecting Prisoners on Medication from Heat Reactions
Inadequate Efforts to Ensure Medication Compliance

10. INSUFFICIENT PROVISION OF SPECIALIZED FACILITIES FOR SERIOUSLY ILL PRISONERS
Crisis Care
Specialized Intermediate Care Units
Expansion of Specialized Care Facilities

11. CASE STUDY: ALABAMA, A SYSTEM IN CRISIS
    
    
V.K., New York

12. MENTALLY ILL PRISONERS AND SEGREGATION
Overview of Segregation
Mentally Ill in Segregation
Impact of Segregation on the Mentally Ill
Lost in Segregation
The Lack of Quality Mental Health Services for Segregated Prisoners.
From Segregation Units to Psychiatric Centers and Back
Keeping the Mentally Ill Out of Segregation


R.P., New York

L.J., New York

13. SUICIDE AND SELF-MUTILATION
Self-Mutilation
Suicide
Increased Risk of Self-harm and Suicide in Segregation Units
Suicide Protocols
Punitive Responses to Suicide Attempts


Felix Jorge, New York

14. FAILURE TO PROVIDE DISCHARGE SERVICES
    
    Recidivism
    Discharge Planning
    Financial Assistance
    States that Confer Eligibility on the Date of Release
    States that Help Prisoners Fill Out Applications
    States that Provide Minimal Help
    Ex-offender Programs
    
    

15. LEGAL STANDARDS
    
    International Protections
    The Rights of Prisoners to be Free of Abuse
    The Right to the Highest Attainable Standard of Health
    The United States and International Human Rights Law
    Constitutional Protections for Prisoners with Mental Illness
    The Right to Mental Health Treatment
    Constitutionally Required Components of Mental Health Services
    Americans With Disabilities Act
    Prison Litigation Reform Act
    
    
    TESTIMONIES
    
    COLOPHON
    
    ACKNOWLEDGEMENTS
    

September 2003     ISBN: 1564322904