The United States of America has the unfortunate distinction of having the highest incarceration rate in the world. We also have the highest percentage of inmates in jail and prison suffering from serious mental illness (SMI). 

Numerous studies have shown that prisoners who suffer from SMI have a much higher recidivism rate. This problem, like our prison population, has been growing for decades, during which research studies and statistical reports have proven that we have a serious emergency which is reaching epic proportions. And yet little has been done to divert people with SMI away from our overburdened criminal justice system, which does not have the tools to treat the mentally ill, and into community-based treatment.

Many people with SMI wind up in jail or prison for behaviors which are symptomatic of their illness. For example, those without resources to get treatment and medication frequently self-medicate with illegal substances.

In Matt Ford’s article, “America’s Largest Mental Hospital is a Jail,” published in The Atlantic in June 2015, he quotes Elli Petacque-Montgomery, psychologist and deputy-director of mental health policy for the sheriff’s department in Chicago’s Cook County Jail:

Even the drugs of choice will connect to what the mental illness is,” Petacque-Montgomery told me. People with severe depression might use cocaine “to lift their mood.” Those who hear voices and have schizophrenia or bipolar disorder often turn to heroin to regulate their sleep. Marijuana use “is just constant for kids with ADD and depression,” she notes. “I’ll ask, ‘Can you eat or sleep without this?‘ and they’ll say no.’ “

Other behaviors which land people with SMI in jail are what Petacque-Montgomery calls “crimes of survival.” For instance, breaking and entering to find a warm place to sleep or stealing food and other supplies are both crimes which are frequently committed by people with SMI, a large percentage of whom are homeless.

Clearly, when we don’t make funding available for housing, food, medication and treatment for those suffering with SMI we’re paying another way: it is probably more expensive and it’s certainly barbaric to punish people who are too sick to care for themselves by putting them in jail. It’s also illegal; the Eighth Amendment to the United States Constitution prohibits Cruel and Unusual Punishment.



Our Nation Has Gone Backwards in Caring for People Who Suffer from Mental Illness

Far from progressing towards a fair and just society which lives up to the ideals expressed in our Constitution, we have gone backwards in the way we treat the mentally ill, who make up a significant percentage of our population. In a 2014 paper titled “Legitimacy Of Corrections as a Mental Health Care Provider: Perspectives From U.S. and European Systems,” Daniela Peterka-Benton & Brian Paul Masciadrelli explore our history of caring for people who suffer a serious mental illness here in the U.S.

Benton and Masciadrelli state that in the seventeenth and early eighteenth centuries, before we even had a constitution, the Colonies placed people with SMI who did not have family resources in private households subsidized by the government, in jails and poorhouses. In 1773 the Virginia Colony opened the first public mental institution because people with SMI were causing problems in the community. However, despite this beginning, most people with SMI were housed in jails and poorhouses.

Eventually there was a movement to help the mentally ill who suffered deplorable living conditions in jails along with Prison Neglect. In the mid-1800s Dorothea Dix and Horace Mann led what would become known as the State Hospital Movement to improve the plight of those with SMI. By the early twentieth century most people who suffered from SMI were confined to state hospitals.

The early movement was idealistic, and hoped to help people recover from mental illness using a method called “moral management.” Eventually, as the state hospitals grew overcrowded and with diminishing resources such as trained staff, it was conceded that in many cases SMI is a chronic condition for which there is no cure.

As state hospitals devolved to institutions whose primary purpose was to warehouse people with SMI, conditions became as deplorable within these institutions as they had been in jail. In the mid-twentieth century, with the discovery of psychotropic medications which could control symptoms, a new movement towards de-institutionalization was born. By the end of the twentieth century, we had moved away from committing those with SMI to public psychiatric institutions, and most mental hospitals were closed.

Unfortunately, after closing the state hospitals we did not provide other options for those people with SMI who have no resources to care for themselves. Community-based care for mentally ill people is underfunded and has gone through numerous budget cuts nationwide. This leaves few or no options which allow people with SMI to access care, medication, and safe living conditions.

Many of our mentally ill are homeless, and cycle in and out of jail and prison as they struggle to survive. Those people who suffer with SMI who do have a place to live are in danger of losing their housing if they go to jail.

Without medication and treatment, sufferers display symptoms which are frightening to most people and sometimes illegal. Jails and prisons across the nation are now the primary care provider for that significant number of our nation’s population who suffer from a serious mental illness.



Problems Within Correctional Institutions: Jailors are Not Trained to Deal with SMI

A 2017 report published by the Bureau of Justice Statistics showed a shockingly high percentage of inmates in our nation’s jails and prisons are suffering from SMI. This is the most recent statistical report the BJS has made available. The report states that the percentage of inmates who meet the threshold for “serious psychological distress” (SPD) is much higher (25%) than that of people suffering from SPD in the general population (5%).

These numbers suggest a large proportion of our nation’s mentally ill people are incarcerated. The BJS statistical report validates claims among scholars, criminal justice and mental health professionals that our jails and prisons are serving as mental institutions.

Unfortunately, corrections officers are not adequately trained to deal with psychiatric patients. Especially in privatized prisons, guards are underpaid for the stressful and dangerous job of guarding prisoners.

Shane Bauer, senior reporter for Mother Jones magazine, took an undercover job at a privatized prison in Louisiana in order to report on what goes on inside. He was paid $9/hr (less than $2/hr above minimum wage in 2014) for his job as a prison guard in Winn Correctional Center, a Corrections Corporation of America privatized prison in Winnfield, Louisiana.

Bauer’s training did not include a course on how to recognize and safely guard SMI inmates. In fact, trainers told him that he wasn’t paid enough to break up fights and shankings between inmates and that he should not attempt to do so. Winn and other privatized prisons are understaffed and their guards are underpaid; the privatized prison industry is more concerned about keeping costs down and making money than about prisoner health and safety.

Medical care in these prisons is minimal. One prisoner in Winn, Robert Scott, had lost his legs and his fingers when his serious infection was allowed to fester and gangrene set in.  He asked for help numerous times as his aching legs and fingers “turned black and wept pus.”

Robert Scott was repeatedly told he didn’t have a serious problem by the medical staff at Winn. The prison staff finally took him to the hospital after another inmate who found his worsening condition disturbing threatened to kill him. By that time it was too late to save his legs and fingers.

The prison policy for seriously mentally ill inmates during Bauer’s tenure at Winn was to put them on suicide watch to cut the cost of providing therapy and other treatment. However, suicide watch was considered expensive too because it required extra staffing to monitor these SMI prisoners.

Prisoners on suicide watch were punished by serving them less food and of poorer quality, not allowing them to have books or paper in their cells, and generally the CCA/Core Civic policy is to make suicide watch as unpleasant as possible in order to discourage inmates who need help from acting out or displaying (uncontrollable) symptoms of SMI.  CCA/Core Civic punishes prisoners who cost the company extra money. 

“American Prison” by Shane Bauer is a detailed report on what goes on in a privatized prison such as Winn, from Bauer’s perspective as a prison guard/undercover reporter. The book also chronicles our nation’s cruel history of using prisoners as slave labor.

At the other end of the spectrum, Cook County Jail leads the nation in attempting to help SMI inmates who make up a high percentage of the jail’s population. Other jurisdictions are beginning to make similar efforts and are counting on the savings in lower jail and prison populations to balance the cost of more community resources to keep people with SMI out of jail.

Serious problems created by cycling the mentally ill in and out of jail and prison include

  • Inmate-on-inmate violence
  • Higher rate of punishment for SMI inmates who cannot understand/obey the rules 
  • An epidemic of inmate suicides
  • Dehumanization of inmates, correctional officers and others forced to deal with SMI without sufficient training or resources
  • Overwhelmed mental health professionals within the criminal justice system
  • The financial burden of housing inmates who cost more while incarcerated and have a higher rate of recidivism
  • Cost of litigation for civil rights violations

Many people with SMI are incapable of understanding and/or obeying the rules and staying out of trouble while incarcerated. They suffer harsh punishment on a regular basis for behaviors that they cannot control, especially without adequate treatment which includes regular therapy, counseling and medication. If months and years in solitary confinement and frequent use of physical force—which corrections officers resort to in an effort to control people who are too sick and confused to obey—isn’t cruel and unusual punishment, what is?



It’s Expensive to Cycle the Mentally Ill in and out of Jail and Prison

Besides being immoral and illegal, it’s expensive to cycle people suffering from SMI in and out of jails and prisons.  The cost of inmates with SMI is much higher than that of regular inmates—largely because of the cost of treatment and medication—though other factors, such as increased staffing needs, come into play.

People with SMI have a higher rate of recidivism than the average prisoner. Despite any claims which imply prisons and jails are designed for corrections or rehabilitation, our prison system is designed to punish. Those prisoners who cannot obey the rules for whatever reason are subjected to frequent harsh punishment.

Most corrections officers are not trained to recognize and deal with mental illness. They’re trained to punish insubordination. Solitary confinement and other punishments make somebody with a mental illness sicker.

Moreover, in California, people with SMI are not among those who are being released due to the federal mandate to decrease overcrowding. Somebody who is too sick to obey the rules cannot earn credit towards sentence reduction.

A recent study done by the Stanford Justice Advocacy Project showed the dramatically higher cost per year to the California Department of Corrections and Rehabilitation for incarcerating people with SMI, compared to community-based treatment to prevent entanglement in the criminal justice system.

A California Department of Corrections and Rehabilitation bed for a single SMI prisoner who suffers a mental health crisis costs the taxpayers a whopping $345,000 per year! A state mental hospital bed costs $218,000 per year. The average CDCR inmate costs $75,200 per year. The above statistics are for prison inmates; jail is sometimes more expensive, especially factoring in treatment and medication for SMI inmates.

The Stanford report concluded:

Despite success in reducing prison overcrowding in California, recent reforms have failed to adequately address the role of mental illness in the criminal justice system. The number of prisoners with mental illness in California is on the rise and the seriousness of their psychiatric conditions is worsening. Furthermore, the state prison system remains under federal court order for insufficient staffing, improper security procedures for inmates with mental illness, and failing to provide adequate psychiatric treatment.

The Stanford report stated that a community-based mental health bed costs taxpayers $21,900 per year. Click on the above link for the full report.



Alternating Between Extremes vs. Balance: Finding a Middle Ground

California Governor Gavin Newsom signed Assembly Bill 32 into law in October 2019. The state had turned to private prisons to comply with the federal mandate to end overcrowding in state prisons. Along with a ban on renewing contracts with Core Civic and the GEO Group, AB 32 will gradually phase out all use of privatized prisons by the year 2028.

It costs California taxpayers around $31,000/year per inmate in a privatized prison. Some reports estimate state-run prisons currently cost an average of $81,000/year per inmate. For SMI inmates, the cost is much higher. Because privatized prisons are cheaper, this new law is estimated to cost taxpayers over $100 million dollars a year.

If, during this same time frame, California diverts resources towards community-based services for people suffering from SMI, and begins to release non-violent offenders with SMI into programs which provide housing and treatment for mental illness, it could alleviate the financial burden of banning for-profit prisons and immigrant detention centers.

California has a huge financial incentive to address the problem of using jail and prison as a substitute for treatment for the mentally ill. By diverting people with serious mental illness away from the criminal justice system into community-based services, it could offset the cost of eliminating privatized prisons. Cycling people with SMI through jails and prisons is far more expensive than providing these people with the community-based help they need.



This Problem Has Been Debated for Years with Nothing Being Done

According to the Stanford Report, the problem of holding people with Serious Mental Illness in California jails and prisons is rapidly growing worse, despite an effort to comply with a federal mandate which was mainly targeted to protect the rights of SMI inmates. If California could divert detainees with SMI away from the criminal justice system entirely, it would likely save the taxpayers millions of dollars.

As detailed in the SAMSHA implementation guide, other jurisdiction are moving towards mental health screening and diversion to community-based programs and away from a cycle of incarceration for people with SMI. California can learn from what these jurisdiction are doing and begin the task of transitioning SMI inmates into more appropriate, legal and ethical community-based treatment.



Whistleblower Report filed by CDCR Chief Psychiatrist in Ongoing Class Action Lawsuit

California Department of Corrections’ Chief Psychiatrist, Dr. Michael Golding, filed a whistleblower report against the CDCR in October 2018. The report stated that prison officials were providing misleading data to a federal court regarding compliance with a mandate to provide adequate treatment to inmates who suffer from SMI. The mandate was in response to an ongoing class-action lawsuit, Coleman v. Brown, filed in 1995 on behalf of all California inmates with serious mental illness.

In the 25 years since the lawsuit was filed, conditions have not improved significantly for SMI inmates in California. California prisons are overwhelmed by SMI inmates and also have a shortage of psychiatrists and other mental health treatment providers. Among the worst consequences of this crisis, suicide rates have continued to climb among California inmates.

One hopes that the common-sense solution of finding alternatives to jail and prison for nonviolent offenders with SMI will become obvious to state legislators facing a budget crunch. Civil litigation and huge settlements for seriously injured SMI inmates whose civil rights have been systematically disregarded may be the nudge lawmakers need to implement drastic changes to how we care for our mentally ill Californians.

U.S. District Judge Kimberly Mueller recently ruled that California needs to adhere to a realistic plan to comply with the Constitutional rights of SMI inmates. On page 472 of the transcript, Judge Mueller states, “If there is a transformational and realistic alternative to the prison as de-facto mental health hospital, this Court is all ears. At the same time, I’m not a dreamer.”

Police abuse of their authority takes many different forms. Read different types of Police Misconduct.



Call the Sehat Law Firm if You or Your Loved One is a Victim of Jail Medical Neglect

If you or your loved one who has been diagnosed with a serious mental illness suffers an injury while in a California jail or prison, contact the Sehat Law Firm without delay. Your injury is very likely because of the CDCR’s ongoing violations of prisoners’ Eighth Amendment protection against Cruel and Unusual Punishment. California has long fallen short of obeying federal standards.

Hello, my name is Cameron Sehat. It is my life’s work to protect and uphold the Civil Rights and Liberties which are guaranteed to all, including our nation’s most vulnerable citizens. The United States Constitution guarantees us all to have basic human rights. When a state or local agency violates the U.S. Constitution in the way it treats its citizens, including those who are serving time in jail and prison, it is operating outside the law.

More about: Preventable Jail Suicides