Mental Health Services in Prison: A Matter of Public Safety

June 6, 2013

About a week ago, around 3 a.m., I was stirred out of my sleep by a man screaming out his cell door, “I’m tired of all this! I can’t do it anymore. Why won’t God let me go?” A couple of hours later, he began again with more screaming, but this time it was unintelligible ranting.

My cellie asked me if I heard that.

“Yes,” I replied. “It seems he’s cracked.”

My cellie laughed, “Cracked, Juanito?”

“Yeah, Yayah. He’s lost touch with reality.”

Since I’ve been locked up, this is the third time in three years that I’ve witnessed a man lose touch with reality.

To most of the guys, this odd and erratic behavior seems comical—a man losing touch, not making any sense. Maybe it is, to some extent. However, I just can’t find humor in watching a man deteriorate mentally. I find it scary and saddening at the same time. What I find fearful is the fact that in prison, mental health services are reactively based. The mentally ill cannot get help unless he or she suffers from a behavioral episode. The sad thing is that in a deteriorated state of mind, they can refuse help. Even sadder is the fact that a mentally unsound person in today’s society has the added problem of seeking help in an environment that’s already over-burdened.

A recent Associated Press article claims nearly one out of five dollars spent on pharmaceuticals in the state prison system in spent on anti-psychotics. The May 1 report states: “The comparatively high use of the drugs in California is feeding a debate between doctors and the attorneys representing inmates over whether mentally ill prisoners receive too much medication or not enough. California’s poor treatment of inmates with mental health problems prompted a federal court takeover of that operation and persuaded federal judges to order the prison population sharply reduced to improve prisoner care.”

The progressive newspaper Community Alliance recently published an article examining Fresno County Jail’s mental health delivery system. Mental health experts told Community Alliance that the system is a revolving door, catch-22 environment for the mentally ill created by California’s criminal justice policy.

After reading this piece, I find it hard to believe that such cruelty could exist in the 21st Century, and I’m amazed at the awe-struck, uninformed average citizen when it comes to how society treats offenders in our jails and prisons. However, cruel and unusual punishment is not an argument that this screaming man cares about. He can’t because he’s deliriously out of touch with this world. He’s in the custody and care of the California Department of Corrections and Rehabilitation, and will only be guided by the capabilities of the mental health system.

Just this scary morning, a man was wandering up and down the tiers of North Block at San Quentin, speaking gibberish. The correctional officers, not trained to handle these situations, did all they could do to help him.  They sounded the alarm, and everybody squatted down and once they realized this man was not himself. They’ve seen him regularly as they’ve been assigned to North Block for some time. The correctional officer subdued him without violence and delivered him to the proper authorities.

Now the man is back on the mainline. I don’t know what type of mental health services he received. All I know, he’s back in his old cell. He’s quietly walking around, not bothering anyone. Who knows when he may have another episode?

I wonder if the scenario I just described is a small part of a larger problem.

Hard-core history:

The deinstitutionalization of the mentally ill from state mental hospitals beginning in the 1960s has had a tremendous impact on society in and outside of the prison system. Untold numbers of these released mentally ill patients have committed violent acts against innocent people, ending them up in jail or prison.

It’s worst for juveniles in detention centers: “Many of these kids could be effectively treated in their communities, and not detained,” says Dr. Linda Teplin, professor and vice chair of research in the department of psychiatry and behavioral sciences at Northwestern, in a newspaper report last year.

The report states: “In 2003, she found that two-thirds of the boys and three-fourths of the girls in Chicago’s Cook County Juvenile Temporary Detention Center suffered from one or more types of psychiatric illness. And many of these youth continue to suffer with the illnesses five years after being released.”

The rates of mental illness in juvenile detention centers are not unique to Cook County. Statistics from Louisiana, Texas and Washington show the same, according to the report.

Viewers of mainstream media see the innocent victims of these violent acts far too much. The details of the crime, amount of jail time the offender receives, and the victim’s plight are the focus of mainstream broadcasts, while the mental health of the perpetrator is not central to the story and is generally painted in a negative light. (See Mental Illness: Lighter and Darker in the June 3rd edition of The Nation.)

Shouldn’t public safety policymakers direct more resources toward mental illness in prison, considering that about 90 percent of people jailed will return to the streets—a large percentage with continuing mental health concerns?

Some people in public office recognize this, like Sheriff Paul Fitzgerald of Story County, Iowa. In a recent newspaper article Fitzgerald said, jails are often the worst places for the mentally ill, for they’re prone to outbursts and misbehavior. As a result of disruptive behavior, they’ll be in county jails longer and cost taxpayers more money.

Then there’s New York City Mayor Michael Bloomberg. Bloomberg has begun an initiative focusing on treatment programs for the mentally ill, rather than incarceration. The plan entails creating centralized teams that would compile an offender’s mental health history then provide risk assessments to judges as quickly as possible. The assessments would be to help judges make informed decisions regarding bail availability, placement in community-based treatment programs, or other possible choices that might be considered.

Mental health should be thought of as preventive medicine in prison, not repair work. The state seems to be able to repair only those men who have cracked. But by then it is often to late. Offenders should be given psych evaluations before they even reach a general population facility. In this way it will save the state the unnecessary burden of cleaning up the mess after a psychotic incident, not to mention the behavioral problems these individuals cause to the mainline population.

I thank my friend Tommy Winfrey for helping me on this post.

Juan Haines is an inmate at San Quentin State Prison. He is Managing Editor of the San Quentin News and works as a jailhouse attorney. He is a regular contributor to the LOTL blog.

The image for this post is from Jenn Ackerman’s and Tim Gruber’s photo essay, Trapped: Mental Illness in America’s Prisons.

Life of the Law © 2019