October 22, 2003, New York Times
By FOX BUTTERFIELD

As many as one in five (20%) 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.

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Note: There is an initiative before the US senate right now to help address the problem of the mentally ill being excessively jailed rather than treated. See story below:

June 6, 2003
NAMI Applauds Visionary Bill to Reduce Criminalization of Mental Illness

Your Advocacy is Needed to Achieve Passage!

As public resources for treatment and services for individuals with
mental illnesses shrink, the use of adult jails and prisons and juvenile
justice facilities as de-facto "psychiatric treatment programs" grows.
On June 5, 2003, identical bills were introduced in the U.S. Senate and
House of Representatives to reverse this disturbing and shameful trend.

The "Mentally Ill Offender Treatment and Crime Reduction Act of 2003"
would authorize new federal funds for jail diversion programs for adults
with serious mental illnesses and juveniles with serious emotional
disturbances, treatment programs for individuals who are incarcerated, and
services to aid people transitioning back into the community.

The Senate bill (S. 1194) was introduced by Senator Mike DeWine
(R-Ohio) and co-sponsored by Senators Patrick Leahy (D-Vermont), Charles
Grassley (R-Iowa), Maria Cantwell (D-Washington) and Pete Domenici (R-New
Mexico). The House bill (HR 2387) was introduced by Representative Ted
Strickland (D-Ohio). The collaboration between Senator DeWine and
Representative Strickland is the continuation of a partnership that first
occurred when the two worked together to pass federal legislation
authorizing Mental Health Courts in 2000.

The "Mentally Ill Offender Treatment and Crime Reduction Act of 2003"
would authorize $100 million to establish a grant program at the U.S.
Department of Justice that can be used by states and communities to:

* Create jail diversion programs;

* Provide treatment to adults with serious mental illness and juveniles
with serious emotional disturbance who are incarcerated;

* Fund cross-training of criminal justice, law enforcement, court and
mental health personnel; and

* Provide mental health services to individuals with serious mental
illnesses upon reentry into the community.

In recognition that programs authorized by this bill will require
extensive cooperation among agencies, providers and stakeholders, S. 1194
and HR 2387 requires successful applicants for grants to demonstrate the
involvement of multiple stakeholders, including mental health, criminal
or juvenile justice agencies, consumers, family members, and others in
all planning and implementation activities.

At a press conference announcing introduction of this bill, Tom Lane,
Director of NAMI's Office of Consumer Affairs, spoke about how the
services available through this legislation could have helped him. "Five
years ago, I was in crisis, suicidal, and in desperate need of access to
mental health services," Lane explained. "I got a law enforcement
response, not a mental health response. What I needed was help from the
mental health system, not entanglement with the criminal justice system.
There simply were no alternatives available at that time. This bill will
create alternatives."

ACTION NEEDED:
Additional sponsors are needed for both the Senate and House bills - as
many as possible. Therefore, please contact your U.S. Senators and your
Congressman or Congresswoman and urge them to co-sponsor S. 1194 or HR
2387. If you are a constituent of Senators DeWine, Leahy, Grassley,
Cantwell, or Domenici, please contact them and thank them for their
leadership. Please urge your friends to make these calls as well. All
Senators and House members can be reached by calling the Capitol Switchboard
toll free at 1-800-839-5276 or at 202-224-3121 or contact them online
now at www.nami.org at:

http://www.nami.org/Template.cfm?Section=Become_An_Advocate

Talking Points:
When urging your Senator(s) and Representative to support S 1194/HR
2387, you may consider making the following points.

* More than 16% of adults incarcerated in U.S. jails and prisons have a
mental illness, and approximately 20 % of youth in juvenile justice
systems have serious mental illnesses. A significant number of these
individuals have co-occurring mental illnesses and substance abuse
disorders. Most of these individuals are not hardened or violent criminals but
rather have committed minor offenses that are a direct consequence of
lack of treatment and services.

* The provision of treatment, rehabilitation, and support services have
proven effectiveness in preventing additional criminal justice
involvement and reducing recidivism among low-level offenders with mental
illnesses or co-occurring mental illnesses and substance abuse disorders.

* Targeting resources for jail diversion, mental health/substance
treatment, and community reentry services ultimately frees up law
enforcement and criminal justice personnel to focus on preventing and fighting
crime rather than responding to adults or juveniles with mental illnesses
in crisis.

* Collaborations among mental health, substance abuse, law enforcement,
criminal justice, consumers, and family members are already in place in
many communities and have shown to be the most effective way to respond
to the needs of adults with serious mental illnesses and juveniles with
serious emotional disturbances in adult and juvenile corrections
facilities, while reducing criminal behaviors among these individuals.

Questions about S. 1194 or HR 2387 should be directed to Ron Honberg,
RonH@nami.org, or Andrew Sperling, Andrew@nami.org.