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Ill-Equipped: U.S. Prisons and Offenders with Mental Illness

NCJ Number
Sasha Abramsky; Jamie Fellner
Date Published
223 pages
Drawing on interviews with correctional officials, mental health experts, inmates, and attorneys, this study documents the plight of mentally ill inmates in U.S. prisons and offers recommendations for improving services and prison conditions for them.
There are between 200,000 and 300,000 men and women in U.S. prisons with mental disorders, some with serious mental illnesses. In many of the prisons in which they reside, mental health services are far from satisfactory due to understaffing, insufficient facilities, and limited programs. Without necessary care, mentally ill inmates live with painful symptoms and deteriorating mental conditions. Although mentally ill prison inmates generally suffer under poor conditions in prison, some U.S. prison systems have achieved significant advances in mental health services; however, they continue to face persistent obstacles due to the punitive nature of prison regimens and the current fiscal crisis in States across the country. Recommendations to the U.S. Congress are to enact the Mentally Ill Offender Treatment and Crime Reduction Act currently pending before Congress, which could catalyze significant reforms in the way the criminal justice system responds to people with mental illness; to improve access to public benefits that cover all needed mental health services; and to amend or repeal the Prison Litigation Reform Act, which hinders inmates in their efforts to remedy unconstitutional conditions in State correctional facilities. Recommendation to public officials, community leaders, and the general public are to reduce the incarceration of persons with mental illness; set high standards for prison mental health services; improve confinement conditions; establish effective performance reviews by independent experts; establish comprehensive internal quality review mechanisms for each prison system and prison; solicit and heed inmates' concerns; and support funding for appropriate prison mental health services. Recommendations to prison officials and staff are to provide sufficient numbers of qualified prison mental health staff; provide mental health training for correctional staff; ensure sufficient specialized facilities for seriously mentally ill inmates; ensure mental health input and impact in prison disciplinary proceedings; exclude the seriously mentally ill from segregated confinement or supermax prisons; and develop and expand continuity-of-care protocols between prison and the community. This report contains a case study of the Alabama prison system, which is a system in crisis, and has special sections on inmate suicide and self-mutilation, the failure to provide discharge services, and national and international standards for services and conditions for mentally ill inmates. 783 notes