October 22, 2003 - The New York Times

Study Finds Hundreds of Thousands of Inmates Mentally Ill

By FOX BUTTERFIELD

As many as one in five of the 2.1 million Americans in jail and prison are seriously mentally ill, far outnumbering the number of mentally ill who are in mental hospitals, according to a comprehensive study released Tuesday.

The study, by Human Rights Watch, concludes that jails and prisons have become the nation's default mental health system, as more state hospitals have closed and as the country's prison system has quadrupled over the past 30 years. There are now fewer than 80,000 people in mental hospitals, and the number is continuing to fall.

The report also found that the level of illness among the mentally ill being admitted to jail and prison has been growing more severe in the past few years. And it suggests that the percentage of female inmates who are mentally ill is considerably higher than that of male inmates.

"I think elected officials have been all too willing to let the incarcerated population grow by leaps and bounds without paying much attention to who in fact is being incarcerated," said Jamie Fellner, an author of the report and director of United States programs at Human Rights Watch.

But, Ms. Fellner said, she found "enormous, unusual agreement among police, prison officials, judges, prosecutors and human rights lawyers that something has gone painfully awry with the criminal justice system" as jails and prisons have turned into de facto mental health hospitals. "This is not something that any of them wanted."

Reginald Wilkinson, director of the Ohio Department of Rehabilitation and Correction, said the "mere fact that this report exists is significant."

"Some people won't like it, and the picture it paints isn't pretty," Mr. Wilkinson said. "But getting these facts out there is progress."

Many of the statistics in the study have been published before by the Justice Department, the American Psychiatric Association or states. But the study brings them together and adds accounts of the experiences of dozens of people with mental illness who have been incarcerated.

The study found that prison compounds the problems of the mentally ill, who may have trouble following the everyday discipline of prison life, like standing in line for a meal.

"Some exhibit their illness through disruptive behavior, belligerence, aggression and violence," the report found. "Many will simply - sometimes without warning - refuse to follow straightforward routine orders."

Where statistics are available, mentally ill inmates have higher than average disciplinary rates, the study found. A study in Washington found that while mentally ill inmates constituted 18.7 of the state's prison population, they accounted for 41 percent of infractions.

This leads to a further problem - mentally ill inmates who cannot control their behavior are often, and disproportionately, placed in solitary confinement, the study found.

Solitary confinement is particularly difficult for mentally ill inmates because there is even more limited medical care there, and the isolation and idleness can be psychologically destructive, the report says.

Medical care for mentally ill inmates is often almost nonexistent, the study says. In Wyoming, a Justice Department investigation found that the state penitentiary had a psychiatrist on duty two days a month. In Iowa, there are three psychiatrists for more than 8,000 inmates.

There is no single accepted national estimate of the number of mentally ill inmates, in part because different states use different ways to measure mental illness.

The American Psychiatric Association estimated in 2000 that one in five prisoners were seriously mentally ill, with up to 5 percent actively psychotic at any given moment.

In 1999, the statistical arm of the Justice Department estimated that 16 percent of state and federal prisoners and inmates in jails were suffering from mental illness. These illnesses included schizophrenia, manic depression (or bipolar disorder) and major depression.

The figures are higher for female inmates, the report says. The Justice Department study found that 29 percent of white female inmates, 22 percent of Hispanic female inmates and 20 percent of black female inmates were identified as mentally ill.

One reason some experts have suggested for the higher numbers among female prisoners is that psychologists and psychiatrists working in prisons tend to be more sympathetic to women, finding them mentally ill, while they tend to evaluate male inmates as antisocial or bad.

But Mr. Wilkinson said, "I think the differences are real; more female inmates are mentally ill." He suggested that prisons were seeing more severely mentally ill inmates now "only because the volume is greater," meaning that the number of people in prison has increased.

Copyright 2003 The New York Times Company