Treating the Mentally Ill in prison

So, how are the Mentally Ill treated in prison?

Basically, they are treated poorly. However, for some, this is better than their free world care because in the free world they get no care and can generally not afford any kind of care.

Why are the Mentally Ill treated poorly in prison? Perhaps it is because the unspoken model in prison is a skewed perception of the free world. In the free world, the Mentally Ill are treated poorly. MI folks are treated poorly because they are not easily understood. The simple descriptor "crazy" is a sloppy way of understanding and dismissing people who are different. Many MI folks are "different." What we presently understand about the organic basis of hallucinations and delusions tell us the MI see a different world, experience a different world, and feel differently about the world that is uniquely theirs. There is a great gulf fixed between the world of the MI and the world of those who are schizophrenic, or psychotic or profoundly unstable in mood.

The MI can be a little scary at times. The actively psychotic person can inspire a fear in us that is both sobering and wise. Being drawn in to the psychotic's experience can raise profound concerns in us about our perception and processing of reality which can raise momentary doubts about our own anchor holding in the face of challenging times. More than that, we tend to respond in fear to the experiences we do not understand but sense are anguishing to the person into whose world we have been drawn.

In the free world we have interesting ways of fleeing what makes us afraid. Moving away or moving "them" away. Both are isolating and except in very few instances can be experienced as abandonment.

So, in the prison setting, moving away and moving "them" away is very limited. In prison, MI offenders become the possession on the Mental Health Department. Largely, I think, security and administration don't feel a need to understand the MI because "they" are Mental Health's problem.

In some ways, the indigent MI have a "fair" existence in prison. Promised a dry bed, meals, clothes, psychiatric treatment, medications and monitoring is often above and beyond what they would get if left on their own to fend for themselves.

The downside of prison for the MI is they are often victimized by the "stronger." Their stuff is always at risk, their resources may be extorted and they may be used for sport. Additionally, unlike the free world, psychotropic meds may be the only sure supply of mind altering and mood altering fixes accessible to the non MI (which requires an exhausting kind of additional work from Mental Health providers because of the rewards of pretending to be MI). Offenders have found numerous ways to take legal medications and adapt them to act like the coke, marijuana, and other substances they used and sold in the world. Indigent MI may even find that "selling" their meds can give them a little "money" to spend. So some take a dose and sell a dose.

Finally, the MI become ensnared in a web that has up to an 80% recidivism rate. That means when they get out, it is rather difficult to stay out. The severely MI once sent to prison may stay in a cycle of returning and returning until they become "habitual."

When the governments of the US decided that institutionalize the MI was too extreme for most, they did not provide sufficient alternatives for those who needed services, structure, and supervision. So pt's moved from "state hospitals" to state prisons over time. For the taxpayer paying the bill, the people put at risk by their lack of supervision, and the prison alternative, this sad approach needs to be rethought.

While the MI are largely a benign group, most every law enforcement agency across the country has a least one death of an officer killed in the line of duty because of encountering a MI person who was not compliant with their treatment or a "never diagnosed" but should have been.

More and better choices would serve the public, the MI and the state better than what we currently provide.

Like the poor, the MI are going to be with us for a long time. It's about time we did a better job with their care.