Compassionate Care For Incarcerated Individuals with Mentally Illness

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When I first walked past R.’s cell, I thought that nobody lived there. The concrete walls were barren; the mattress lay folded and stacked on the bed. On the floor, huddled under a green blanket, R. raised his head. Incarcerated people in neighboring cells said that he had been sitting and sleeping on the floor for the past several days, refusing to leave for showers, recreation and even meals. Other incarcerated persons passed pieces of fruit or bread through the bars. According to a correction officer, R. had stopped taking his mental health medication and refused to speak with a counselor. Neither the correction officer nor the mental health staff knew what to do with him.

R. is just one of New York State’s 7,400 incarcerated individuals on the mental health caseload. Like the vast majority of mentally ill incarcerated individuals, he resides in the general prison population. Some mentally ill incarcerated persons are able to assimilate, maintained on medication, and lead functional lives in the prison “community.” Others, like R., languish in their cells, while still others may hallucinate and act out violently, earning them months if not years in disciplinary lockdown. Figures from the Department of Correctional Services show that 23% of incarcerated persons in disciplinary lockdown units are on the mental health caseload—an alarmingly high rate for any state prison system and a clear indication that more options should be available for incarcerated individuals with mental illness.

The Prison Visiting Project recently completed two years of research on the quality of mental health services in New York State prisons. Staff made site visits to 20 prisons and conducted structured interviews with nearly 500 incarcerated individuals. During these visits, incarcerated individuals, correctional and mental health staff raised concerns about the high number of mentally ill incarcerated individuals in general population and the impact it has on prison management.

“Dealing with mentally ill incarcerated people is a major, ongoing challenge that’s gotten worse over the years as the number has grown,” said a sergeant at Sing Sing with 15 years on the job. “Just last week, we had a guy who burned down his cell.”

It was encouraging, however, to spend time in the Intermediate Care Programs (ICPs), residential units where incarcerated people with mental illness receive intensive treatment and can participate in a range of therapeutic activities, from substance abuse treatment to gardening. The state prison system has eleven ICPs staffed by correctional and mental health professionals as well as energetic Inmate Program Assistants who help organize activities and serve as big brothers and mentors to the mentally ill. ICPs provide residential care to incarcerated individuals deemed victim prone and/or unable to cope in the general prison population because of mental illness. All ICP incarcerated individuals receive regular therapy in group and individual sessions. The average length of stay is approximately two years.

Interviews with 213 ICP incarcerated individuals confirmed that these men are among the system’s most vulnerable. The majority suffer from a serious psychiatric disorder (53% reported schizophrenia; two-thirds reported prior admission to a psychiatric hospital), and more than half (54%) had committed an act of self harm or attempted suicide while in prison. Nearly 50% reported incidents of being victimized by other incarcerated persons in prison, such as having their property stolen (34%) or being physically assaulted (25%). They reported that the ICP gives them access to mental health services and protects them from the more aggressive incarcerated individuals in general population. Many of the incarcerated individuals told us they were afraid to move off the unit.

The problem with ICPs is that there are not enough of them. Space only exists for some 500 incarcerated individuals throughout the state system. Corrections officers and mental health staff tell us that with 7,400 incarcerated persons on the mental health caseload, 500 beds is clearly insufficient. Unless and until correction officials expand ICP capacity, the vulnerable mentally ill incarcerated individuals who live in general population with little treatment or protection are at risk for decompensation and injury to themselves or staff. With research documenting that ICPs are a viable solution to this problem, the Prison Visiting Project has made the expansion of these units a leading advocacy issue.