Their Stories
People with mental illnesses often come into contact with the
criminal justice system. * Steven, 28, has bipolar disorder. He
can maintain a normal family life and a job as a landscaper. He
had never had problems with the law or any history of violent
behavior. One night while he was driving, the police pulled him
over. He heard voices telling him to keep going. He did, was
shot in the hand, bitten by police dogs and arrested. He spent
four months in jail, without the medication that had kept him
stable. Eventually, he was found not guilty by reason of
insanity and was hospitalized; the charges were dismissed.
(Health Foundation of Greater Cincinnati , 8/00) A man with a
mental illness who was homeless was arrested in Florida for
shoplifting an ice-cream sandwich that cost $ 1.16, then
imprisoned because he lacked the $25 bail for release.
(Sun-Sentinel, Ft. Lauderdale , 11/98)
Many lack access to adequate services through the public mental
health system. * Roy was so desperate for mental health
treatment that he showed up at the courthouse and signed his
commitment papers. On the day of his hearing, he packed, ready
for a hospital stay, but the hospital couldn’t take him for two
months. “What am I supposed to do until then,” he asked. No
other services were offered him. Seven weeks later, Roy walked
into the woods, strapped his belt around a low branch and
stepped off a plastic bucket. His body was found a week later,
on the day his mother got a call that the hospital was ready for
him. (Time, 7/00) * Seeking help for their 20-year-old son who
was exhibiting unexplained paranoia, a Latino family called the
community mental health crisis line. Nine hours later a mental
health professional arrived with police. After a brief exam the
mental health worker said the young man may need hospitalization
and the officers agreed to take him to a mental health facility.
Although they had found him passively sitting on a sofa, the
officers used physical force, beating him with nightsticks and
ultimately pepper-spraying the apartment. The family watched,
stunned. The young man was diagnosed with schizophrenia and more
than a year later remains withdrawn and unable to return to his
job. His family is discouraged about accessing any public
services. (Report from a Washington DC suburb, 4/02)
The criminal justice system is used to fill the void. * A man
with a history of epilepsy was arrested after appearing confused
and disrupting service on a city bus. Upon release, he was found
outside the jail banging his head on a wall and crying. He was
then admitted to hospital, where he threatened people with
pencils. Hospital staff called the police and allowed them to
enter patient areas with firearms. After the man became agitated
from complications associated with epileptic seizures, he was
shot dead by a police officer. His family had brought his
seizure medication to the hospital the day before, but they
spoke only Spanish and no one could communicate with them. The
medicine was set aside. (Mental Health Weekly, 6/01)
Once people are in the criminal justice system, their mental
health needs are not met. * An Oregon man with a mental illness
gouged out his eyes as he waited in a Portland jail cell for a
psychiatric hospital bed. (The Oregonian 6/12/02 ) * Romus was
arrested and brought to the Orange County jail in New York ,
shouting gibberish. As a result of budget cuts, no psychiatrist
was on call, so Romus was pepper-sprayed and shackled to a
restraint chair, where he sat shouting, twisting and kicking for
hours. Eventually, an officer dragged Romus , in the chair, to
the jail’s mental health unit and pushed him in. (Middletown
Times Herald-Record, NY, 7/01) * Shawn, 20, diagnosed with
schizophrenia, depression and bipolar disorder, has been in and
out of state hospitals. He was arrested after punching a
security guard who tried to stop him from stealing. While in
jail awaiting a court hearing, Shawn has tried to kill himself
at least four times. “I use razors, floor tiles, nails, screws,
glass, anything,” he says, “I want to die.” When he tries to
hurt himself, the jail locks him in the medical observation
cell. “When I get locked up like that, all I do is cry, punch
myself in the face, bang my head against the wall.” Guards then
strap him in a restraint chair. “There is not a day…that I
don’t think of killing myself,” he told a reporter. “I just want
help. I want this to end. I’ve come to the conclusion that death
is the only way out.” ( Portland Press Herald, 11/01) Criminal
justice and mental health systems have not collaborated well. *
Paul, 24, was arrested for breaking and entering. While
processing him, police saw that he was highly agitated and his
behavior was strange. Concerned, the arresting officers called
the area mental health center, a hospital, the state police and
the District Attorney’s office to find out what to do. While the
various organizations argued over who should take him, Paul
hanged himself in his cell. (Health Foundation of Greater
Cincinnati , 8/00) * Joseph is deaf, has a serious mental
illness and cannot speak. He was arrested on a misdemeanor
charge. Although the charges were dropped, he remained in the
detention center for two years, lost somewhere between the
city’s criminal justice and mental health bureaucracies. (The
Washington Post, 9/01)
Collaboration between mental health and criminal justice can
lead to better outcomes. * Richard, 43, has schizophrenia. He
has been arrested 137 times for petty crimes such as trespassing
and panhandling. Unwilling to take medication on his own, he was
caught in a dangerous cycle, from jail to hospital to
homelessness. Thresholds, a nonprofit rehabilitation agency,
convinced a judge to release Richard to their custody. Now he
has a single room the group provides for him, food, money and
constant support. It took time, but Richard has been able to
break his cycle of living on the streets or in prison. Over a
year later, he remains arrest-free and says he has never felt
happier. Thresholds costs $25 a day, while jail costs $75 a day.
(Health Foundation of Greater Cincinnati , 8/00) Individuals
with Mental Illnesses in Jail and Prison
Data * Nearly two million new jail admissions are of people with
mental illnesses–35,000 individuals a week. 1 * At the end of
2000, nearly one million individuals with mental illnesses were
in the criminal justice system. 2 * More than 16% of jail
inmates have a mental illness, according to the United States
Department of Justice. 3 * Seventy percent of jail inmates with
mental illnesses are there for nonviolent offenses. 4 Offenders
with Mental Illness * In Jails : 101,000 individuals with
mental illnesses were inmates in local jails at year-end 2000.
Of these, 63,000 had a severe mental illness. 5 Jails are
locally operated facilities that hold people pending arraignment
or awaiting trial, conviction or sentencing. Sentencing is
either to probation or incarceration in jail (generally under a
year) or prison. There are 3,365 local jails. 6 * In Prisons :
201,000 individuals with mental illnesses were inmates in state
(191,000 or 16.2%) and federal (10,000 or 7.9%) prisons at
year-end 2000. Of these, 132,000 had a severe mental illness. 7
There are 1,558 adult correctional facilities housing state
prisoners and 110 facilities housing federal prisoners. * On
Probation : 614,000 individuals (16%) with mental illnesses were
on probation at year-end 2000. Of these, 315,000 had a severe
mental illness. 8 Probation represents a more moderate sanction
than incarceration. It is generally given to offenders with few
or no prior convictions or to those guilty of less serious
offenses. Description of the Population New Department of
Justice data confirm previous research findings that most
individuals with mental illnesses in the criminal justice system
have had extensive experience with both the criminal justice and
mental health systems and have a severe mental disorder and poor
functioning. As seen in this table on offenders with mental
illnesss, on every item, in all settings–jails, state prisons,
federal prisons and probation-offenders with mental illnesses
are more likely than other offenders to have the reported
problem.
1. Based on admission rates reported in Bureau of Justice
Statistics Bulletin, Census of Jails, 1999 (August 2001, NCJ
186633, p. 5) multiplied by the percentage of jail inmates with
a mental illness (16.3%) reported in Bureau of Justice
Statistics Special Report, Mental Health Treatment of Inmates
and Probationers (July 1999, NCJ 174463).
2. Calculated using the respective rates of mental illness
reported in Bureau of Justice Statistics Special Report, Mental
Health Treatment of Inmates and Probationers (NCJ 174463) and
year-end jail and prison population numbers reported in Bureau
of Justice Statistics Bulletin, Prisoners in 2000 (August 2001,
NCJ 188207) and probationers reported in Bureau of Justice
Statistics press release of August 26, 20001.
3. Bureau of Justice Statistics Special Report, Mental Health
Treatment of Inmates and Probationers (NCJ 174463).
4. Id.
5. Based on self reports by inmates and probationers and, for
severity, on overnight admissions to a mental hospital or
treatment program.
6. Bureau of Justice Statistics Bulletin, Census of Jails, 1999
(August 2001, NCJ 186633).
7. Bureau of Justice Statistics Bulletin, Prisoners in 2000
(August 2001, NCJ 188207).
8. Bureau of Justice Statistics Special Report, Substance Abuse
and Treatment of Adults on Probation, 1995 (March 1998, NCJ
166611).
9. Bureau of Justice Statistics Special Report, Mental Health
Treatment of Inmates and Probationers (July 1999, NCJ 174463).
——————————————- Policy to Address
Issues Regarding People with Serious Mental Illnesses in the
Criminal Justice System Impact
The increase in the number of individuals with serious mental
illnesses who come in contact with law enforcement officers or
are booked into jail or sentenced to incarceration means that
more and more individuals suffer significant harm. For example:
* They experience great trauma in connection with arrest,
booking or detention. * They are unnecessarily stigmatized by
involvement with criminal justice. * They are penalized in their
eligibility for housing, employment and public benefits as a
result of–and long after–arrest or detention. The various
parts of the criminal justice system also face major problems,
including: * repeated use of significant police time and
judicial resources; * significant stress among law enforcement
personnel (for example, when individuals with depression try to
encourage the officer to shoot them); * occupancy of jail beds
needed for more serious offenders; * management problems in
jail, often requiring suicide watch or causing major disruptions
for jail staff; * challenges to probation and parole officers
who lack special training or are too few in number to work with
people with serious mental illnesses; * a scarcity of financial
resources as a result of these and other issues. Taking a
Different Approach What is needed is a new approach to policy
that will: * assure that individuals with serious mental
illnesses do not end up in the criminal justice system when a
mental health approach would be more appropriate or because of
prior failures to make mental health services accessible; *
effectively move people with serious mental illnesses out of the
criminal justice system more expeditiously; and * ensure that
those who have been arrested or incarcerated do not return.
Goals for Policy
Such policies will result in: * better outcomes for the
individual with mental illness; * greater safety for all–the
community, law enforcement officers, correctional staff, the
individual with a mental illness and his or her family; a more
efficient criminal justice system; * greater cost-effectiveness
across the criminal justice and mental health system, as mental
health issues are addressed earlier and in a more appropriate
forum; a more pleasant community for all. Approaches That Have
Been Tried
Many communities have adopted programs that will divert people
with serious mental illness from the criminal justice system at
various stages of the process: * time of arrest (pre-booking
diversion); * as the individual’s case is initially processed in
the jail (pre-booking diversion); * following booking, but
without a trial (post-booking diversion); * at adjudication or
the trial stage (court-based diversion); or * following
incarceration (re-entry programs) Diversion is most likely to
succeed, to violate individual rights less and to be less costly
to the criminal justice system if it occurs in the early stages
of criminal justice processing. However, depending on the
seriousness of the crime or the individual’s prior history in
the criminal justice system, this may not be feasible.
