- In July 2008, the Southern California ACLU released a
"Report on Mental Health Issues at Los Angeles County" Jail by
Dr. Terry Kupers, a practicing psychiatrist, an expert on long-term isolated
prison confinement and correctional mental health issues. He's also written
numerous articles on these topics, and been an expert witness on the mental
health crisis behind bars, what he wrote about in his book "Prison
- In May, he toured the LA County Jail system where most
inmates aren't convicted and are awaiting trial - Men's Central Jail (MCJ),
Twin Towers 1 & 2 (TT 1 & 2), and the Inmate Reception Center (IRC).
He interviewed 18 prisoners in private, confidential settings; others in
more casual, cell-front ones; and discussed issues with mental health and
- As in all prisons nationwide, many LA County inmates
suffer "serious mental illness." Incarceration exacerbates it.
They need treatment, but aren't getting it.
- Besides prison confinement harm, state mental hospital
deinstitutionalization took hold in the 1980s, part of Reagan Revolution
policies that whatever government can do, business does better, so let
it. As a result, large numbers of seriously ill patients were discharged,
based on studies indicating community care was superior to state facilities.
The consequences were predictable. The promise was never realized because
of budget cuts, unaffordable housing, and other priorities.
- In 1955, state and VA psychiatric hospitals had about
550,000 patients. In 2008, there were less than 60,000, but given constraints
today on budget strapped states and communities, the numbers are likely
lower and dropping.
- Yet according to a study by the Federal Bureau of Justice
Statistics, over a million individuals suffer from significant mental illness
in jails and prisons. With 20,000 detainees, some call the LA County Jail
system the largest psychiatric hospital in the country (the Men's Central
Jail has 5,000), but, like elsewhere, treatment there's not forthcoming.
- Correctional setting mental illness factors:
- "are complex, including shortcomings in our public
mental health systems, the tendency for post-Hinckley criminal courts to
give relatively less weight to psychiatric testimony, the incarceration
of large numbers of drug offenders including those with dual diagnoses
(substance abuse and mental illness), and the growing tendency for local
governments to incarcerate homeless people for a variety of minor crimes."
- As a result, the prevalence of prison mental illness
is high and rising - about 15 - 30% according to national epidemiological
studies. The 2006 Special Report from the Federal Bureau of Prison Statistics
titled, "Mental Health Problems of Prison and Jail Inmates,"
confirms a high, unprecedented mental illness population behind bars, concluding
that 64% of jail inmates suffer significantly - based on structured interviews,
"not necessarily clinical diagnoses."
- A comparable 1999 study estimated 19%. The 2006 one concludes
that previously homeless inmates are twice as likely to be ill, the result
of living on streets or in unfavorable environments, unconducive to good
- Other epidemiological studies concur with the Bureau
of Justice Statistics, and despite the prevalence of inmate illness, few
prisoners get help, what's provided is inadequate, and medications only
for many are stressed. Even then, they're only given to symptomatic inmates,
then withdrawn when they abate, when it's essential they be continued.
Otherwise, those in need aren't helped.
- Overcrowding and Few Inmate Programs - A Serious Problem
- When the 1970s prison population was much smaller, studies
showed overcrowding caused violence, mental illness, and suicides. Today
it's much worse. "One ha(s) only to tour a jail or prison to understand
how violence and madness were bred by the crowding."
- Imagine a small dormitory expanded to house 150 prisoners
- the situation in LA County Men's Central Jail with bunk beds lined up
in rows. "A prisoner cannot move more than a few feet away from a
neighbor, and lines form at the pay telephones and the urinals."
- It's the same with four men crammed into small cells
with barely enough room to get off bunks for any reason. The cells have
no chairs, desks or any space but bunks to sit or lie on. It's enough to
fray anyones nerves, but with "tough men" in small spaces, altercations
follow, then disciplinary action, greater anger, and inevitable mental
illness for many.
- "In general, as an individual prone to psychosis
becomes angrier, his thinking becomes more regressed and irrational, and
therefore subjecting (these inmates) to conditions that exacerbate irritability
and anger (worsens) their mental illness, often precipitating a state of
acute decompensation or 'breakdown.' "
- For those depression prone, self-imposed isolation to
escape violence or unbearable conditions deepens their problem and "leads
to thoughts of self-harm." Open rage and violence pushes some over
the edge, especially with no remedial treatment. Also, mentally ill prisoners
are prime targets for violence because they're vulnerabe. "The more
violence, the more madness, and the crowding exacerbates both."
- Over the past 30 years, few constructive changes were
made in jail architecture. Most cells are windowless. Recreation for most
is once a month. For many, none at all, even though they're supposed to
have three times a week minimum. Even the Medical Disability/Stepdown area
(6050) is deplorable.
- "Men in wheelchairs, on crutches, and otherwise
disabled were stuffed like sardines into long interconnecting, dark rooms
with far too many bunk beds for them to be able to walk around." Absent
are desks and chairs, and moving between bunks requires others to make
- Under conditions of overcrowding and little rehabilitation,
prisoners are idle - the result being worse traumas and abuse for many.
Loners are especially vulnerable, an easy target for rapists or others
to vent anger without retaliation.
- Imagine a jail complex where 13,000 prisoners enter monthly
in overcrowded quarters, others, of course, being released. But with inadequate
assessments of mental illness and no treatment, inmates are on their own
to survive in a very harsh environment. If they don't follow rules, they're
in trouble, are punished, are abused by other prisoners, and their condition
- "I was stunned by the degree of overcrowding I witnessed
(on) May 8 & 9, 2008." Inmates stay in windowless cells nearly
24 hours a day, with no furnishings except their bunk. They have poor round-the-clock
lighting. It disturbs sleep and hampers reading. They're noisy, fraying
nerves. They eat there with no programs or mental health treatment possibilities.
A combustible environment is inevitable, and it erupts daily.
- In one Administrative Segregation Unit (2904), cells
are also small (about 5 x 6 feet) with no windows and solid doors always
closed. Isolation produces claustrophobia, suffering, and serious psychiatric
- "Throughout the Men's Central Jail (MCJ), the cells
and dormitories violate minimum standards in terms of both social and spacial
density (including) compensatory out-of-cell time for jail prisoners confined
in substandard cells or dormitories. (It's) intolerable to leave prisoners
in harsh, crowded conditions that we know cause psychiatric breakdown."
- Conditions also affect staff. They get impatient, angry,
and take it out on inmates for minor infractions. They, in turn react,
and the longer they're incarcerated awaiting trial (at times years), the
worse their condition becomes.
- Like the MCJ, conditions in the Twin Towers are poor.
Yet some positive mental health programs are in place, including inpatient
beds in the Forensic Inpatient Program (FIP), crisis intervention/observation
capabilities in TT 1, a step-down or subacute mental health unit, mental
health housing, pre-release linking with community mental health services,
and Jail Mental Evaluation Teams (JMET). The latter are "excellent
in concept," but inadequate in implementation, prisoners outside mental
health housing units saying they're not helped.
- For the most part, little besides psychotropic medications
are provided. Yet prisoners complain about not getting them or having them
discontinued, their charts corroborating their accounts. Most inmates needing
help wait weeks or months to be seen, that at best lasts a few minutes.
Others are never seen because of too few staff to handle large numbers
- "I was told repeatedly by prisoners that there is
nothing available in the way of mental health treatment except the prescription
of psychiatric medications. This is far from adequate mental health treatment....There
is a Pattern of Failure to Diagnose and Inappropriately Down-grad(e) the
Diagnoses of Prisoners who Cannot be Accommodated in Mental Health Housing."
- Some inmates are never diagnosed despite complaining
of "significant psychiatric history." Others, seriously ill,
are "un-diagnosed;" for example, Schizophrenia to a personality
disorder, an "adjustment disorder," or "malingering."
Without treatment, symptoms inevitably worsen, often jeopardizing inmate
- "It is important to note that serious mental illnesses
are, mostly, lifetime conditions that pursue a waxing and waning course.
An individual suffering from Schizophrenia might go into remission,"
especially if properly medicated, but it doesn't mean he's cured. Future
eruptions can happen anytime and do. Under LA County Jail conditions, a
complete breakdown or suicide can result.
- "It is striking how indifferent mental health staff
are to evidence of serious mental illness by history - past hospitalizations,
Social Security Disability benefits, or even competency evaluations."
Instead, they focus only on current symptoms, and do it poorly by misdiagnosing.
- Disciplinary Housing Exacerbates Mental Illness and the
Potential for Suicide
- A "disproportionate number of prisoners with serious
mental illness predictably wind up in punitive segregation." Besides
harming them further, it contributes to a greater pandemonium level throughout
the prison population because of their screaming and irrational actions
like throwing feces at guards.
- "Human beings require some degree of social interaction
and productive activity to establish and sustain a sense of identity and
to maintain a grasp on reality." Absent these, paranoia and an inability
to control rage increases.
- Segregated inmates do what they can. Some pace relentlessly.
Others read and write letters, but many are illiterate. They fare worst
in isolation. Anxiety, hallucinations, anger, obsessions, and/or despair
- In isolation, previously healthy inmates develop psychiatric
symptoms, including anxiety; rage; claustrophobia; panic attacks; headaches;
lethargy; heart palpitations; violent fantasies; depression; and/or trouble
focusing, remembering or sleeping.
- Conditions "that cause emotional distress in relatively
healthy prisoners cause psychotic breakdowns, severe affective disorders
and suicide crises in prisoners who have histories of serious mental illness,
as well as in (some) who never suffered a (previous) breakdown...."
- Enough stress can break anyone, and "once an individual
crosses a line into psychosis or depressive despair, it is very possible
that (removing harsh isolation won't be able) to bring him back to a normal
- Staff abuse is also a major problem. Based on widespread
inmate reports, they're excessive, including severe beatings, compounded
by the stress of overcrowding and inmate-on-inmate violence.
- Recommended Remedies
- They're often made but ignored, including:
- -- reduce overcrowding;
- -- increase mental health treatment by competent staff;
- -- provide diversion for seriously ill prisoners;
- -- institute early release programs for outside treatment;
- -- address forced idleness, lack of recreation, and the
need for more time out of cells - in day rooms, cafeterias, anywhere for
- -- improve lighting and provide desks and chairs;
- -- remove mentally ill prisoners from overcrowded, toxic
- -- create more housing for treatment and improved safety
for the mentally ill;
- -- keep them out of segregation and disciplinary housing;
they need mental health treatment in a proper setting;
- -- greatly expand mental health housing;
- -- halt harmful diagnosis down-gradings;
- -- properly evaluate psychiatric histories;
- -- improve JMET interventions and provide better outpatient
services in the general prison population and other jail areas;
- -- provide a range of mental health services;
- -- have enough competent staff to serve needs;
- -- increase substance abuse treatment;
- -- provide more comprehensive post-release planning,
including housing, medication, and other social services;
- -- increase staff training;
- -- take steps to reduce custodial abuse; and
- -- other remedial measures.
- Whatever the cost, it's small compared to readmissions,
a larger inmate population, and the toll on society when ill or abused
prisoners return to communities.
- Stephen Lendman lives in Chicago and can be reached at
email@example.com. Also visit his blog site at sjlendman.blogspot.com
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