Mad or Bad?

According to PBS Frontline, there are over one million mentally ill inmates who will be released from prison in the United States within the next 18 months; the majority of these will not be able to function outside of a supervised environment, and will therefore be rearrested, after either causing havoc or harm to themselves or others.

We have similar problems; Corrections Canada cites research from 2004 that suggests "about 11 per cent of newly arriving prisoners had a mental disorder in 2004, compared with about seven per cent in 1997." And Capital News Online claims that "in 2007, 2,219 male inmates and 133 female inmates were identified at admission to federal institutions across Canada as having mental health problems, which marks an increase of 71 per cent and 61 per cent respectively since 1997."

Why do so many offenders have mental health problems? Well, to begin with, there was a strong civil rights movement on behalf of psychiatric patients back in the 1970s. In a well-intentioned attempt to better serve these people in the community, rather than to warehouse them, perhaps for a lifetime, the patients were deinstitutionalized. Theoretically, this could have been a good thing if the appropriate community supports had been in place, but they weren't.

As a result, many people with mental health issues, particularly those with psychotic features such as paranoid schizophrenics and those with bipolar illness, often stopped taking their medication when they weren't in the hospital. This is easy to understand because sometimes meds need to be administered three times a day. That's hard enough for a high functioning person to manage and extremely difficult, if not impossible, for someone who doesn't have the skills to carry around a daily planner, a pillbox, or to make appointments in advance with the doctor and the pharmacy to refill prescriptions.

Often the mentally ill are arrested for small infractions initially, Frontline states in two fascinating documentaries on the plight of the mentally ill in prison: The New Asylums (2004) and The Released (2009), both of which are available to watch in their entirety online: http://www.pbs.org/wgbh/pages/frontline/released/view/. They may steal something at the 7-11 or commit a robbery or break into a house because they're convinced that bin Laden is there or someone is trying to kill them. Since long-term psychiatric care and rehabilitation are a thing of the past, these people are frequently jailed and then put into minimum security. They don't often do well there, having difficulty following orders or simply feeling too agitated and restless to comply with a strict regimen, and may increase their aggressiveness or violence, forcing the system to put them in maximum security. And, of course, the penitentiary is not equipped to deal with anyone who is suicidal, self mutilating or hallucinating.

Sadly, one of the best ways for someone with psychotic episodes who is breaking the law to get help is within the institution rather than the community. This has to change. Otherwise, there will be a continual revolving door of the mentally ill, who clearly do not belong in prison, going back and forth. Frontline interviewed several of these people, notably black men, who did very well inside the penitentiary but instantly decompensated when they were released because they stopped taking their meds, lost them or ran out, and ended up being homeless. When someone is homeless, they can't receive Social Security benefits (or welfare and disability in Canada), and things predictably go from bad to worse.

What's the solution? "We need to have something that starts from the intake, the assessment, even to the community release," said Dr. Francoise Bouchard, Director General of Health Services for the Correctional Services of Canada. n
True enough. But we also need adequate community resources and psychiatric care, diagnosis and treatment to help those with mental challenges, and prevent them from entering the penal system in the first place.