Treatment Behind Bars: Mental Health Care in the Criminal Justice System

Adam Hall began exhibiting signs of many mental illnesses, including bipolar disorder, at a young age. After bouncing from one psychiatric facility to another as a child, he was convicted of a minor felony as a teenager, and given a relatively short prison sentence.

Adam received no treatment for his disorder when he arrived at prison. He was immediately placed in solitary confinement for 22 hours a day, where in-prison offenses caused by his untreated mental illnesses added decades to his sentence. He is still in prison.

Adam Hall is no outlier. His story is not unique. Rather, it is representative of the greater system of mental health care – or the lack thereof – in the American criminal justice system.

American rates of incarceration have been steadily increasing in recent years, and are the highest in the world. The United States represents less than 5% of the world’s population, but it is home to more than 22% of the world’s prisoners. While physical health is the primary focus of health care facilities within prisons, one area of health care is extremely crucial yet frighteningly underfunded among imprisoned populations: mental health care.

Despite being significantly underfunded, prisons have become America’s single largest provider of mental health care. The nation’s three largest psychiatric facilities are within prisons in Chicago, New York, and Los Angeles. Years of deinstitutionalization of mental facilities have pushed those suffering from mental illness into our prison system. Recidivism and ‘recycling’ – when prisoners are simply shuffled in and out of facilities over many years due to inadequate care both inside and outside of prison – have trapped these mentally ill people within the prison system. Additionally, long-lasting stigma around mental health issues has made the process of reform even slower.

With over 500,000 people in public psychiatric hospitals in 1955, America’s state-asylum system became unsustainable in the mid-20th century. Presidential policies, especially those of Jimmy Carter under the Mental Health Systems Act, slowly broke down these public psychiatric facilities and left the country with a lack of proper infrastructure to deal with the mentally ill. These psychiatric hospitals were very controversial, practiced outdated measures, and surely required reform. However, when they were eliminated, more than half of the “community-based health centers” that were proposed to replace them were never built. This severe lack of treatment options left a vacuum in the place of mental health care; thus, as the mentally ill population received inadequate care, many began to come into conflict with the law, causing a huge portion of the mentally ill population to be diverted to prisons.

As this deinstitutionalization proceeded, people with mental health issues often found themselves wrapped up in petty criminal offenses, and then placed in prison for a short amount of time. A report by the Treatment Advocacy Center estimated that more than 350,000 people with serious mental illnesses today are imprisoned, 10 times more than the 35,000 people in the care of state hospitals. However, the atmospheres and forms of “treatment” inside of prisons for mental health issues often exacerbate these conditions, causing prisoners to gather added time, until they find themselves wrapped up in a vicious cycle, in a system that was built to entrap them. The story of Andre Thomas of Austin perfectly demonstrates this vicious cycle; after being convicted of a violent crime, Thomas was immediately pushed into the prison system, where his mental illness became more and more obvious. Rather than receiving treatment, however, Andre spent 23 hours in isolation, in a six-by-ten cell, where he attempted suicide multiple times and his mental illness continued to slip. He is just one example of the larger system that deprives the mentally ill of health care and traps them within a system of imprisonment.

For many mentally ill prisoners, their first offense is virtually a life sentence. Rates of recidivism in the US have skyrocketed in recent years, with more than three fourths of prisoners being arrested again within five years of release. People are simply pushed through the criminal justice system, from courts to jails to prisons, without ever receiving the proper rehabilitative mental health care that they so desperately need in order to escape the cycle. This recidivism speaks to the state of mental health care outside of the criminal justice system as well, as formerly incarcerated people simply cannot find access to quality mental health care when they’re released. This cycle is exacerbated by the fact that other forms of imprisonment, especially solitary confinement, tend to disproportionately affect populations with serious mental health issues. They are more frequently placed in solitary confinement, which has been shown to significantly worsen the conditions of these populations. Thus, their place within the vicious cycle of courts, jails, probation, and prisons that has come to be second nature within our criminal justice system is solidified.

While criminal justice reform is picking up momentum and mental health is slowly becoming destigmatized, the particularly unglamorous intersection of the two remains severely overlooked. It is a massive issue with worrisomely few advocates; however, it is simply unsustainable in terms of America’s prison and health care systems, and something must be done. So where do we look to move forwards? While much of the US’s criminal justice system may seem plagued by these issues, there is progress being made around the country. For example, Steve Leifman, a Florida judge, has created a program that redirects mentally ill people convicted of a nonviolent misdemeanor from the prison system to treatment. The program has resulted in vastly lower recidivism rates, lower spending for prisons, and successful rehabilitation for thousands of prisoners.

Other activists around the country are taking a quantitative, rather than qualitative, approach to the issue. HarrisLogic, a technology company based out of Dallas, has been synchronizing data between jails, prisons, hospitals, psychiatric facilities, emergency services, and more to track exactly how and when these mentally ill people are placed into prison. Once they enter the system, the company automatically alerts public defenders, and coordinates operations among courts, prisons, and health care systems in order to identify issues before they arise and before people become stuck in the system. While examples like Leifman and HarrisLogic may be few and far in between, they represent the changes that can begin on an individual level and eventually require institutional support to alter the course of this vicious cycle that has come to be an epidemic in America. To even begin to confront the issue, cooperation among the judicial, prison, and health care systems will be necessary, as well as individual empathy and compassion for a historically underrepresented population.

Photo: “Prison Jail Detention Fence Wire”