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Improvements in mental health services in prison are, unfortunately, heavily dependent on financial resources. Qualified, competent staff cannot be hired and retained in sufficient numbers absent funding. Governors must support adequate funding levels for mental health services and permit corrections officials and mental health staff to argue forcefully, extensively, and publicly on behalf of such funding.

They must present candid analyses to the public of existing problems with correctional mental health treatment, the consequences of those problems and the need for resources to address them. They should encourage legislators to reduce prison populations, by lowering unnecessarily harsh mandatory sentencing laws and by supporting alternatives to incarceration for low-level nonviolent offenders, rather than by cutting indispensable services for those prisoners who must be incarcerated.

Correctional agencies need to act decisively to improve the delivery of mental health services in prisons and prison systems. We recommend they:. Effective training should be provided to all new officers in such areas as: signs of mental illness; different treatments for mental illnesses; side-effects of medications used for the treatment of mental illnesses; effective interaction with mentally ill prisoners; defusing potentially escalating situations; recognition of the signs of possible suicide attempts; and training on the safe use of physical and mechanical restraints for mentally ill offenders.

Additional information pertinent to working with mentally ill prisoners should be provided during in-service training.

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Prisoners with mental illness can have unique difficulties complying with prison rules and may engage in bizarre or disruptive behavior because of their illness. Punitive responses to such conduct do little to reduce or deter it. When prisoners who are on the mental health caseload violate rules, disciplinary procedures should require mental health input to the disciplinary officers regarding whether the prisoner's behavior was connected to or caused by mental illness, and regarding what sanctions might be appropriate.

In specialized units housing only mentally ill prisoners, corrections officials should work with mental health staff to determine whether the normal prison disciplinary system should be suspended, and mental health staff should determine appropriate responses to prisoner misconduct consistent with his or her mental diagnosis and treatment plan. Human Rights Watch opposes the prolonged and unnecessary incarceration of any prisoner in isolated segregation or supermaximum security units. Prisoners with serious mental illnesses, even if they are currently stabilized or asymptomatic, should never be confined for prolonged periods in the harsh isolation conditions typical of segregation or supermax prisons.

There is an unacceptably high risk that the isolation, reduced mental stimulus, lack of structured activities, and the absence of social interaction will provoke a deterioration of their symptoms and increased suffering. We recognize there are some prisoners with mental illness who require extreme security precautions even when under mental health treatment.

U.S. Prisons and Offenders with Mental Illness | HRW

For these individuals, prisons should provide specialized secure units that ensure human interaction and purposeful activities in addition to mental health services. Corrections officials should also make sure that all prisoners in segregated housing have their mental health monitored carefully and continually; that they be able to communicate confidentially with mental health staff; and that they have access to whatever services and therapeutic interventions mental health staff determine are necessary.

To the extent that accommodating mental health needs requires changes in regular rules and protocols governing prisoners in isolation, the changes should be undertaken consistent with reasonable security requirements. Prisons and community mental health systems need to develop comprehensive continuity-of-care protocols and programs to break the cycle of release-recidivism-reincarceration.

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Prisoners that have serious mental illnesses should be released from prison with arrangements in place to provide them with access to medication and mental health services. Moving the prisoners prior to their release to prisons in or near the counties to which they will return will allow prison mental health staff and parole officers to liaise more effectively with local mental health service providers to guard against the prisoner falling through the cracks.

Discharge planning efforts should begin months prior to a seriously mentally ill prisoner's release. Corrections agencies should also establish procedures by which prisoners with mental illness will have access to Medicaid immediately upon release rather than having to wait for months to have the paperwork completed. States and counties should increase the number of programs providing housing and assisted living facilities for newly released prisoners with mental illness.

Michael Mahoney, warden, Montana State Prison [5]. We have unfortunately come to accept incarceration and homelessness as part of life for the most vulnerable population among us. Congressman Ted Strickland [6]. Unnamed prison psychiatrist [7]. A staggering number of persons with mental illnesses are confined in U.

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The causes of this massive incarceration of the mentally ill are many, but corrections and mental health professionals point primarily to inadequate community mental health services and the country's punitive criminal justice policies. While mental health hospitals across the country were shut down over the last couple of decades as part of the process of "deinstitutionalization," the community-based health services that were supposed to replace them were never adequately developed.

As a consequence, many of the mentally ill, particularly those who are poor and homeless, are unable to obtain the treatment they need. Ignored, neglected, and often unable to take care of their basic needs, large numbers commit crimes and find themselves swept up into the burgeoning criminal justice system.

Jails and prisons have become, in effect, the country's front-line mental health providers. Most of the mentally ill who end up in prison are initially incarcerated in jail as pretrial detainees. By all accounts, jails across the country are even less able to care for mentally ill prisoners than prisons. Absent adequate mental health screening and services in jails, the prison systems inherit exacerbated mental health problems when the pretrial detainees suffering from mental illnesses are ultimately sentenced and moved from jail into prison.

Indeed two of the largest mental health providers in the country today are Cook County and Los Angeles County jails, both of them urban entry points into the burgeoning prisons systems of Illinois and California respectively. Persons with mental illness are disproportionately represented in correctional institutions.

While about 5 percent of the U. On any given day, between 2. A substantial percentage of inmates exhibit symptoms of other disorders as well, including between 8.

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In , the federal Bureau of Justice Statistics, drawing on a survey in of adult prisoners, estimated that 16 percent of state and federal adult prisoners and a similar percentage of adults in jails were mentally ill. As these numbers suggest, prisons have become warehouses for a large proportion of the country's men and women with mental illness.

In September , Congressman Ted Strickland informed his colleagues on the House Subcommittee on Crime that between 25 and 40 percent of all mentally ill Americans would, at some point in their lives, become entangled in the criminal justice system. According to the American Psychiatric Association, over thousand mentally ill Americans are processed through either jail or prison each year. Individual prison systems report high percentages of mentally ill offenders.

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For example, the California Department of Corrections estimated that as of July , 23, prisoners were on the prison mental health roster, representing over 14 percent of the California prison population. In Kentucky, There are no national statistics on historical rates of mental illness among the prison population.

Some states, however, report a significant increase in recent years in the proportion of prisoners diagnosedwith serious mental illnesses. For example, the mental health caseload in New York prisons has increased by 73 percent since , five times the prison population increase. Fifty years ago, public mental health care was based almost exclusively on institutional care and over half a million mentally ill Americans lived in public mental health hospitals. Beginning in the early s, states began to downsize and close their public mental health hospitals, a process called "deinstitutionalization.

The first generation of effective anti-psychotic medications were developed, which made successful treatment outside of hospitals a real possibility. Litigation increased due process safeguards in mental hospital involuntary commitment and release procedures, which meant far fewer people could be committed or kept in the hospitals against their will.

Today, fewer than eighty thousand people live in mental health hospitals and that number is likely to fall still further. Deinstitutionalization freed hundreds of thousands of mentally ill men and women from large, grim facilities to which most had been involuntarily committed and in which they spent years, if not decades or entire lives, receiving greatly ineffectual, and often brutal, treatment. Proponents of deinstitutionalization envisioned former mental health hospital patients receiving treatment through community mental health programs and living as independently in the community as their mental conditions permitted.

This process was catalyzed by passage of the federal legislation providing seed funding for the establishment of comprehensive mental health centers in the community. Unfortunately, community mental health services have not been able to play the role the architects of deinstitutionalization envisioned. The federal government did not provide ongoing funding for community services and while states cut their budgets for mental hospitals, they did not make commensurate increases in their budgets for community-based mental health services.

Chronically underfunded, the existing mental health system today does not reach and provide mental health treatment to anywhere near the number of people who need it.

Mental health delivery system is fragmented and in disarray…lead[ing] to unnecessary and costly disability, homelessness, school failure and incarceration…In many communities, access to quality care is poor, resulting in wasted resources and lost opportunities for recovery. More individuals could recover from even the most serious mental illnesses if they had access in their communities to treatment and supports that are tailored to their needs.

Today's mental health care system is a patchwork relic - the result of disjointed reforms and policies. Instead of ready access to quality care, the system presents barriers that all too often add to the burden of mental illnesses for individuals, their families, and our communities. The Commission also found that minority communities were particularly underserved in or inappropriately served by the current mental health care system.

It noted that "significant barriers still remain in access, quality, and outcomes of care for minorities…. The professionals in the [mental health] system know much about how to meet the needs of the people it is meant to serve.