Severe mental illness, such as schizophrenia or bipolar disorder, affects approximately four percent of the general U.S. population. That figure jumps to approximately 15 percent when examining individuals in jails across the nation. In comparison to inmates who don’t have a serious mental illness, those who do tend to stay in jail longer. This is attributed to their higher rates of exposure to the physical and emotional traumas of incarceration, which then often leads to violence and self-harm.
While incarcerated, prisoners have a constitutional right to adequate health care. This includes treatment for mental health; yet jails are so overwhelmed by the growth of inmate populations that they are strained to respond to their health needs. The difficult position the correctional system is in to adequately respond to the needs of mentally ill inmates can be attributed to a combination of things: the growing population of mentally ill inmates, incarceration itself complicates psychiatric assessments and treatment, and the fact that America’s jails are severely understaffed in terms of mental-health providers.
Bureaucratic, fiscal, and political intricacies certainly make it more difficult to reform the nexus of mental health and criminal justice. Yet, it is the collective stigma against those with serious mental illness that really prevents us from pushing proper reform forward.
Criminal justice-reform advocates call for the end of incarcerating the mentally ill, however this solution over-simplifies the problem. Excluding those with serious mental illness from the arrest process is not only impractical, it also perpetuates the misperception that these individuals do not have the capacity to make choices about their behavior and are incapable of functioning in American society and participating in its laws. Yet, leaving the system as it is, and subjecting those with serious mental illness to the harshness of the criminal justice system without additional protection would be offensive to human decency.
Now the question: is this type of reform not only possible, but also feasible in a nation with the highest incarceration rate in the world? If we look to New York City as an example, the answer is yes.
The hub of the New York City jail system is on Rikers Island. Not long ago, the mental health units were little more than isolated warehouses where the inmates rarely saw a clinician and violence abounded. No one wanted to work there. This changed in September of 2013 when Elizabeth Ford, the Chief of Psychiatry for Correctional Health Services for New York City’s Health and Hospitals, heard about Bradley Ballard, a 39-year-old man who died after being locked in his cell for several days. Bradley, who was found dead surrounded in his own excrement and with a string tied tightly around his genitals, suffered from Schizophrenia.
Dr. Ford took it upon herself to extend her project of improved care at the Bellevue Hospital Psychiatric Prison Ward to Rikers Island. Now, three years after she first heard about the unfortunate death of Bradley Ballard, Dr. Ford has utterly transformed the mental health unit on Rikers Island, making it home to one of five highly specialized and intensive mental health units. These units, called the Program for Accelerating Clinical Effectiveness (PACE), have hospital-level staffing, follow a rehabilitative philosophy, and have officers and clinicians working together with the inmates as a team. When comparing these PACE units to regular mental health units, PACE units have over 50 percent fewer “uses of force.” They also have a 40 percent increase in medication adherence, 50 percent fewer self-injuries, and there has not been a suicide in over a year.
The nation needs to indicate a serious commitment to improving the conditions of confinement, to thinking beyond the physical space and staffing resources necessary. If we can change our collective philosophy about incarceration, then this kind of humanizing, safe, and respectful care that PACE units offer and represent would be a model that can, and should, work anywhere.
If you would like to learn more about the Department of Correction in New York City and their goals for 2017, click here.
Ford, E. (2017, May 17). Why We Shouldn’t Stigmatize Mentally Ill Prisoners. Time. Retrieved from http://time.com/4782404/prison-mental-health-stigma-suicide/
Morris, N.P. (2016, April 18). What I Learned Treating Psychiatric Patients at Rikers Island. Time. Retrieved from http://time.com/4286829/mental-health-care-prisons/
Ponte, J. (2017). Department of Correction. PRELIMINARY MAYOR’S MANAGEMENT REPORT, 73-80. Retrieved from http://www1.nyc.gov/assets/operations/downloads/pdf/pmmr2017/doc.pdf
Steadman, H. J., Osher, F. C., Robbins, P. C., Case, B., Samuels, S. (2009). Prevalence of Serious Mental Illness Among Jail Inmates. Psychiatric Services, 60(3), 761-765. Retrieved from http://ps.psychiatryonline.org/doi/full/10.1176/ps.2009.60.6.761