Mental Illness: A Systematic Criminalization

Posted: July 19, 2014 by raphique in Uncategorized

Fayad Raphique

Fordham University Graduate School of Social Service

 

The 1960s were a time of great social reform. The civil rights act was passed, along with new programs to help the poor, aged and disabled. In the mid to late to 1950s there was an international deinstitutionalization movement. Due to the advances in medication and the belief that the mentally ill were not getting the best treatment possible in isolated mental hospitals, there was a move away from institutional care. While hospitals still provided treatment for severe and persistent mental illness, individuals whose symptoms could be managed were expected to live in communities among the general population. This new community integrated treatment model was intended for individuals with support systems in place; therapists, psychiatrist, friends and family. The person living with mental illness would be able to live in their community while relying on their supports. What happens when one does not have these supports?

With the closure of many psychiatric hospitals and the decreased number of beds in those remaining, the justice system has become the catch-all for decompensating mentally ill persons. Lack of treatment, therapy and or medications, and support, ie no family or non-involved family, can lead to a person decompensating, introduce substance abuse, a method of self medicating for many individuals with mental illness, and you have a powder keg waiting for some stressor, some trigger, to set off a massive episode. Decompensating can vary in appearance, but for someone with a severe and persistent mental illness such as schizophrenia, it can prove to be overtly dangerous. An individual carrying a diagnoses of paranoid schizophrenia may hallucinate; see hear and feel things that are not there. Reacting to these hallucinations may result in injury to themselves or others. In an environment that lacks supports such as clinical treatment, supportive friends and family, and positive recreation, some individuals look to illegal substances and alcohol to treat their symptoms, and instead of receiving a steady level of care, that individual is trapped in a revolving door of arrests, hospitalizations and discharges.

Twenty four percent of state prison inmates have a recent history of mental illness. Seventy two percent of these individuals have a substance abuse disorder. (NAMI) At Riker’s Island, inmates with mental illness serve an average of 6 months more than inmates without diagnoses. When is prison, many lose access to psychiatric treatment, and without advocates such as case managers, they face high rates of hospitalization and recidivism. With the high rate of incarceration of mentally ill individuals, one might posit that the arrest of mentally ill persons is beneficial to the general population. The cost of keeping a mentally ill individual incarcerated varies between seven to twelve thousand dollars more than having that same person in community treatment.

In the following paper, I will discuss the grave injustice being perpetrated a nation against it’s own citizens. Citizens that constitute a vulnerable population and should, if official institutions followed the values displayed in the universal declaration of human rights, be protected and cared for. I will present a case example to better explain and explore this problem. After this, I will discuss and apply social work theory to the issue, as well as ways to prevent more individuals from falling victim to the justice system’s flawed method of processing the mentally ill. Finally, I will discuss my experienceof completing this blog.

 

“The criminal justice system has become a place for people that don’t fit anywhere else” – -Ann Schwartzman, executive director of the Pennsylvania Prison Society

Solitary confinement is by definition, a form of torture as described by the United Nations Convention Against Torture. It has been shown to generate symptoms of mental illnesses such as hallucinations, distortions of time and perception, and paranoia (AFSC). Sixty four percent of prisoners in solitary confinement are mentally ill. That is, the majority of people that are put into a torture chamber that elicits mental illness, are already mentally ill. This is not only a detrimental way to punish prisoners who are out of compliance, it is a violation of human rights, a violation in a place that is run by the justice system along with clinicians.

Christopher Lee video

 

Christopher Lee Lopez was an inmate at San Carlos correctional facility. He carried a diagnosis of schizophrenia, which was determined while he was incarcerated. While serving a two-year sentence for trespassing, he assaulted a corrections officer, adding four years to his sentence. Lopez was sent to solitary confinement for a period of nine and a half months. Christopher has a history of 12 involuntary psychiatric hospitalizations, and when diagnoses, believed he was Jesus Christ. As discussed above, solitary confinement has been shown to be a type of torture that elicits psychiatric symptoms similar to those of schizophrenia, yet prison officials saw it fit to use it on an individual who already exhibits such symptoms. Christopher had served 9 months in solitary confinement when he was moved to an observation room due to his exhibition of possible medical conditions. Lee was tied to a chair and left alone in a room where he suffered a grand mal seizure. Recordings show him convulsing in his seat while restrained, his face covered in a spit mask. Prison guards remain oblivious to him, the seizure was not mentioned in any of the 21 official incident reports from the prison. After suffering the seizure, Lopez was moved from his chair to the floor. He remains unresponsive and is given a Haldol injection; a psychotropic medication used for the treatment of schizophrenia. Four minutes after his last breath, the prison’s on call mental health clinician observes him, and asks him questions pertaining to his lying on the floor. The clinician does not enter the room while she tries to talk to the body of the deceased, she even tells the guard on duty that she thinks he “ looks alright…”. Lopez is dead a half hour before paramedics are called and cpr is attempted. Lopez’s family has filed a lawsuit in federal court. The case heavily depends upon the recording of Christopher suffering a seizure and the indifference from prison staff that follows.

 

In discussing mental illness in the prison setting, I found systems theory to apply best while explaining the problem. To understand the problem of mentally ill individuals in the prison systems, This paper will define systems theory and its elements, then utilize said elements where applicable in the issue of mental illness in the prison setting.

A system is a set of elements that are orderly, interrelated and function as a whole. Through the lens of systems theory, and for the purposes of this paper, the United States will be discussed as a macro element, the prison system as a mezzo element and mentally ill individuals as micro elements. It is in the nature of these elements to interact with one another in every combination, each is effected by each other. Something that happens on the micro level can have an impact on the macro, vise versa and in other combinations including the mezzo level. For example, an individual, micro, with a diagnosis of schizophrenia is arrested for murder while out of treatment, unmedicated, and symptomatic. Legislature is put into place on the federal or state level, macro, to maintain higher levels of treatment compliance for mentally ill individuals living among the general population. This in turn effects policy in local mental health facilities and agencies. This short example displays how a micro element effected a macro element, which in turn determined policy of mezzo elements.

An important element of systems theory that will be discussed in the intervention response section of this paper is feedback. Feedback is information about the system’s performance submitted to the system itself. There are positive and negative forms of this information that ideally help a system to improve its performance.

 

Article five of the Universal Declaration of Human Rights, as well as article 7 of the International Covenant on Civil and Political Rights state that no one may be subjected to torture or to cruel, inhuman or degrading treatment or punishment. The United Nations convention against torture starts off by discussing the inalienable rights of all human beings, and that those rights derive from inherent dignity of the human person.

Article 25.1 of the Universal declaration of human rights states that everyone has the right to a standard of living adequate for his or her well being, including medical care and necessary social services. Many mentally ill individuals in the prison system do not receive the benefits guaranteed to all humans by this section. While in prison, many people do not receive adequate medical care, let alone mental health services. Many people lose benefits that allow them access to mental heath services as well as housing once incarcerated. The recertification process for these benefits is often a daunting task for individuals with severe mental illness; many simply become homeless once released from prison. If our justice system is supposed to be a means of reformation for criminals, a way to remove dangerous individuals from society and help them reflect and learn to be functioning members of society; why is it that mentally ill people who are incarcerated face trauma, maltreatment and barriers to care that increase the likelihood of recidivism? In the prevention section of this paper, I will discuss the alternatives to prison for mentally ill individuals. There are ways of keeping the general population safe while treating mentally ill people with dignity and respect while they receive treatment for the condition that may have led to their crimes.

The convention came before the United Nations General Assembly on December tenth, 1984. The United States became a signatory in 1988. In article 16 of the convention, it is stated that each party, nations signing the document, will undertake to prevent acts of cruel, inhuman, degrading treatment carried out by officials or persons acting in any official capacity. Christopher Lopez’s brother, Mike Lopez, spoke directly and clearly about the treatment by prison officials leading to his death;

“ Nobody goes home and treats their dog like that.”

Watching the recording of Christopher suffering from a seizure and dying while prison guards and even a mental health clinician remain indifferent and even make jokes, one can easily see the severe lack of regard for human dignity held by these officials.

In 1999, New York State passed Kendra’s law, which mandates treatment for mentally ill individuals living in the community who otherwise would not be able to live safely. This law was passed after the death od Kendra Webdale, who died in 1999 after a man with untreated mental illness pushed her in front of an oncoming train in the New York City subway. Assisted outpatient treatment, or AOT, is required for many mentally ill people who are released from prison. I have encountered several cases where Kendra’s Law applied and had a major impact on the lives of the formerly incarcerated. According to research from Columbia University’s Mailman School of Public Health, Kendra’s law lead to a decrease in violent crime. Although the law is controversial due to the seemingly forceful nature of mandated treatment, assisted out patient treatment there appears to be significant benefit to the enrolled and to the general population. Bruce Link, Phd speaks on the study’s findings: “Our study has found that Kendra’s Law has lowered risk of violent behaviors, reduced thoughts about suicide and enhanced capacity to function despite problems with mental illness.”

On the federal level, the affordable health care act, known to many as Obama-Care, has made mental health treatment more accessible. Over sixty million people have seen either a gain in access to mental health care, or an improvement in benefits as a result of the affordable health care act. Including mental health services as an essential service among insurance companies may also serve to reduce stigma. More people may become aware of mental illness and how to seek help if they know that affordable treatment is available.

The deinstitutionalization movement, Kendra’s Law and AOT have brought mental health issues to the forefront of society. Schizophrenia is no longer a problem reserved for discussion among psychology students in a university library or clinicians in hospitals. The general public is not exposed to mental illness in the media on a frequent basis. Mental health has become a hot topic due to the unfortunately high number of violent crimes committed by people with mental illness. It has gotten to the point where mental illness is one of the first things media sources discuss when reporting a tragic incident such as a mass shooting. I have discussed the pitfalls of the justice system regarding mental illness and have touched upon some programs that may be helpful to the mentally ill prison population.

Supported housing in combination with case management and mental health day programs is, in my experience, one of the best ways to help people with mental illness.

I currently work on a supported housing team that helps homeless individuals living with mental illness, substance abuse, and sometimes a history of incarceration, obtain and maintain housing. Pathways to Housing Inc. proposes a simple model; provide individuals with housing and supportive services to facilitate smother reintegration to communities. Housing is seen as key, as it provides individuals with a sense of self-determination. I have seen, at this agency as well as others, that housing has the potential to completely change one’s life course. Having a place to call home and someone, such as a case manager, as a guide can make an amazing difference. Being incarcerated provides a large amount of life stressors to an individual with mental illness, but being released into a world one is not ready for can be even worse. I have seen individuals come out of prison and live on the streets, only to commit another crime, such as trespassing to sleep indoors, and go back to jail. Working in supportive housing, I have also seen success stories. I once had a client who was incarcerated for over ten years for stabbing someone while he was undedicated and experiencing a psychotic break. This individual was released to the custody of a residential program and mandated to treatment under Kendra’s Law. He was program compliant, worked with his case manager and treatment team, and after two years, graduated to a more independent living situation with more freedom and more integration into his community. I strongly believe in supported housing programs in conjunction with the requirements of Kendra’s law as an alternative to traditional prison sentences for individuals with severe and persistent mental illness. Taking a person living with schizophrenia, and locking them away does nothing productive, it merely take that person out of public view, sweeping a major problem under the rug while the individual suffers with little to no treatment. Having someone in a program designed for their population allows for a better fit treatment to be used, and increases the chance for success and reintegration of that person into the community, which is what our prison system’s ultimate goal is supposed to be.

This issue is a human rights issue. The fact that individuals living with severe and persistent mental illness are put into the prison system with little to no infrastructure designed for them, is nothing short of appalling. Unfortunately, the outrage and disgust experienced by many who are passionate about this problem can only do so much to make changes. In today world, money is the ruling factor for change. If an advocacy campaign were to use saving tax dollars as a platform, I believe, and many would agree, that they would be more successful than a similar group solely using the issue to raise awareness. According to the Pathways To Housing website, it costs $57 dollars per night to maintain an individual in their housing program, that is drastically lower that the $164 it costs to house that same person in jail. The supported housing, not only helps individuals access better treatment, it also takes less of an economic toll on the general population. An improvement that I would like to see; is more effective ways to help formerly incarcerated, mentally ill individuals obtain stable employment. Having a job provides structure, as well as a sense of self-efficacy that, in my experience, is invaluable to the treatment process and reintegration.

Linked are some agencies and programs that assist the mentally ill and incarcerated population :

http://pathwaystohousing.org/our-model/

http://www.catholiccharitiesny.org/what-we-do/supporting-the-physically-and-emotionally-challenged/supporting-more-information/

http://www.ysow.org

http://www.mhawestchester.org

http://newyorkcity.ny.networkofcare.org/mh/services/content.aspx?id=60&parentId=38

Self Reflection:

I learned a lot about different ways to gather information though completing this blog. The Internet proved to be an amazing resource, not only for finding information, but for finding helpful people and organizations as well. I noticed as I was researching, that I was gaining access to a sort of web of information, when I looked one thing up, I would find two more sources, and so on, until I had what seemed to be an endless network of information rich articles and videos. I have definitely developed my researching skills, and found that I need to keep tuning them in order to find more relevant information that is focused and conducive to use in advocacy. I found that having the freedom to choose my own topic for this assignment helped me to develop my thoughts and manage the content of this paper more easily. I would like to have similar assignments in the future for a chance to further develop these skills.

References

Mentally ill Prisoner Died Hooded, Strapped to Chair While Guards Chatted Nearby, Suit Claims. (n.d.). Retrieved from http://www.youtube.com/watch?v=wOqCz6zUUrM

NAMI | The Criminalization of People with Mental Illness – WHERE WE STAND. (n.d.). Retrieved from http://www.nami.org/Content/ContentGroups/Policy/WhereWeStand/The_Criminalization_of_People_with_Mental_Illness___WHERE_WE_STAND.htm

PsychiatryOnline | Psychiatric Services | Persons With Severe Mental Illness in Jails and Prisons: A Review. (n.d.). Retrieved from http://journals.psychiatryonline.org/article.aspx?articleid=81232

Solitary confinement facts | American Friends Service Committee. (n.d.). Retrieved from https://afsc.org/resource/solitary-confinement-facts

UN Convention Against Torture. (n.d.). Retrieved from http://www.hrweb.org/legal/cat.html

Power Point

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