01.13.11

Loughner and the Incarcerated Mentally Ill

Jared Lee Loughner could soon join the ranks of mentally ill prisoners across the country, if convicted. Mansfield Frazier on how prisons have become the last resort for the mentally ill.

Jared Lee Loughner could soon join the ranks of mentally ill prisoners across the country, if convicted. Mansfield Frazier on how prisons have become the last resort for the mentally ill. Plus, 19 signs Loughner was about to blow.

The only place in America where health care is constitutionally guaranteed is behind bars. And for many in need of mental-health services, our nation’s prisons have become the provider of last resort.

While other facilities can shutter their doors, or choose and limit the number of mentally ill patients allowed in, prisons cannot. But the delivery of mental-health services behind bars can, at times, be problematic.

And that may be what Jared Lee Loughner, the man charged with killing six innocent people and severely wounding Arizona Congresswoman Gabrielle Giffords, will ultimately face behind bars.

Full coverage of the Arizona shootingThe most dangerous period for prisoners is usually immediately after arrest, while they are still in a county jail. Soul singer Sean Levert, son of lead O'Jays singer Eddie Levert, died while in custody a couple of years ago. For six days, county jailers refused to give him his prescribed anti-anxiety medication, Xanax, and when he eventually began to hallucinate, jailers strapped him into a restraint chair. When his condition worsened, he was taken from the Cuyahoga County jail in Cleveland to a local hospital where he died within the hour.

Jeannette Halton-Tiggs, the mother of Timothy Halton, a paranoid schizophrenic who killed a Cleveland Heights police officer, said that on numerous occasions she had to rush to a jail where her son was being held to provide proof of the medications he had been prescribed. “They won’t believe someone in custody, they think they are faking just to get high, and sometimes it can take weeks before the medical staff determines the person is in dire need of their medication,” she said.

Prisons can still be a nightmare for the mentally ill, who, in many cases, were found guilty only because they could not avail themselves of adequate treatment on the street.

The explosive growth in the number of mentally ill prisoners over the last four decades can be traced directly back to several factors: poverty and transient lifestyles, the closing or downsizing of state hospitals, the chronic underfunding of public services, restrictive insurance policies, the lack of an adequate range of community support programs, and the likelihood of adults with serious mental illness who have a substance-abuse disorder, according to the National Institute of Corrections, a division of the U.S. Department of Justice.

The result? More than 16 percent of prison inmates had a mental condition or had been hospitalized overnight in a mental hospital, according to the U.S. Bureau of Justice Statistics. This number is still an underestimation. It’s based on self-reporting by prisoners and some mental-health professionals say the figure could be substantially higher.

“A new prisoner may enter a correctional system either known to be mentally disordered or not.  Even if they are, they will still have to go through a new set of assessments and classification for treatment and placement in the correctional system,” said criminologist Roberto Hugh Potter, who monitored health-care delivery systems in Georgia prisons, where recent prison riots took hold.  

Depending on how severe the inmate’s disorder, s/he may simply be thrown into the general population, but with medication and medical supervision. The chances of any sort of counseling or talk therapy are pretty low—sometimes just because of staffing issues and the sheer number of sick prisoners.

Treating mentally ill patients varies state to state. So from Arizona to Georgia to New York, the level of care fluctuates. But cost is always a looming factor. For the more acutely ill, and in larger-system states, Potter said there may be some specialty prison facilities where the prisoner-patient can be monitored and more medicated than in others.  The medications are likely going to be generics though, not “cutting-edge” drugs unless the psychiatrist makes the argument that such prescriptions are needed.   

Still, depending upon the level of care in the state, the care received in prison may be as good as—or better than—what they might have received in the community, he said.

This was not always the case.

Many of the improvements in conditions and treatment are the result of prisoner lawsuits filed in recent decades. The 1993 Dunn vs. Voinovich federal class-action in Ohio quintupled the number of mental-health professionals in the state’s 31 institutions and significantly improved staff quality, developed effective screening for new prisoners, and trained guards to identify and deal with the seriously mentally ill—all in the hope of avoiding or minimizing confrontations and speedy treatment.

But even with improved conditions, prisons can still be a nightmare for the mentally ill, who, in many cases, were found guilty only because they could not avail themselves of adequate treatment on the street. 

“Overcrowding, the lack of privacy, temperature and noise levels, victimization, and other environmental conditions in prisons can easily exacerbate the symptoms of mental illness for some people,” according to the NIC. “In fact, the prison environment itself can contribute to increased suicide and the inability of inmates with serious mental illness to adjust.”

Then there is the high cost. “Incarcerating the mentally ill is a very expensive and often inhumane proposition,” said Terry Collins, the former director of Ohio’s prison system. “Guards oftentimes don’t know how to handle this population, so additional training has to be provided for corrections staffers, and then we have to bring in additional medical staff, and in a locked institutional setting the delivery costs for services are compounded—they’re much more expensive than in other settings. And because departments of corrections have to take everyone the courts send them, funds are diverted to prisons that could be better used for programming in the community. So when people do get out of prison, oftentimes there is no continuum of care... the services just aren’t readily available. In many of these cases, with adequate supervision the mentally ill can live in a community setting and in some cases actually thrive. Sending sick people to prison just makes no sense … and it darn sure isn’t cost effective.”

And so it remains to be seen what Loughner’s fate in the quagmire of the prison system for the mentally ill will be.

Mansfield Frazier is a native Clevelander and former newspaper editor. His regular column can be seen on CoolCleveland.com. An avid gardener, he resides in the Hough neighborhood of Cleveland with his wife Brenda and their two dogs, Gypsy and Ginger.