In March 2007, the nonprofit Disability Law Center sued the state of Massachusetts over its treatment of hundreds of mentally ill inmates. Prisoners with emotional problems who are unruly in some way are kept in 23 hour solitary confinement, which, according to a November 10 Boston Globe article, has "led to self-mutilations, swallowing of razor blades, and numerous suicides."
In response to these grave concerns the Patrick administration, in an out-of-court negotiation, proposed building special treatment units for mentally disturbed inmates. Now, that proposal is off the table; citing the budget crisis, those units will not be built. So it's back to court in an effort to force the state to give its incarcerated citizens their constitutional protection against "cruel and unusual punishment."
Massachusetts isn't alone in facing the problem of caring for mentally ill inmates. Every state has had to confront this growing trend which started in the 1960s and accelerated in the 1980s, when the system of large state psychiatric hospitals was shut down even though, as Oliver Sacks states in his bittersweet eulogy to these former mental hospitals ("The Lost Virtues of the Asylum" New York Review of Books, 9-24-2009), it was obvious that these closings created "as many problems as they solved." Communities weren't prepared, and still aren't prepared, to absorb and meet the needs of what he calls "sidewalk psychotics."
With these closings, along with the current "tough on crime" policies, it shouldn't surprise anyone, then, that these same people-- alone, unsupported, often self-medicated with drugs and alcohol-- increasingly end up behind bars, despite the fact that jails aren't set up to help people deal with emotional problems, problems that confuse their judgments and impel them to destructive actions
No doubt these are hard choices in hard economic times for any state. Yet, once again, as municipalities struggle to come up with innovative ways to deal with the money crunch, the one formula that never gets recalibrated is that the people with the greatest need and the least resources take the biggest hit.
Being locked up is hard enough. Being "crazy" in an already crazy system is the worst. In jail you get "props" from the other inmates for being a "badass" but not for being disturbed. They have names for you-- 730, forensic, Gucci gown (at least in the county penitentiary where I taught; if you're put on the forensic unit, you spend your days in a paper gown that the inmates have branded "Gucci"); along with bugged, psycho, mental.
Attitudes aren't much better among most of the correctional staff. They treat you as though your mental illness is a part of your crime. You might have had a choice not to carry that gun, or get into that stolen car. But you don't have a choice about your mood swings, or the voices you hear, or your paranoia, conditions that, when you have your medication, are usually under control. It doesn't help that when you get locked up those medications stop. The medical information might be taken when you're booked, but too often it gets "lost."
I worked with a seventeen-year-old boy in my jail classroom who found himself in that situation. Lamont was a friendly, polite, quiet student. He sat in the back of the room, away from everybody else. He had pretty good judgment, in my opinion: he was eager to learn and wasn't interested in hanging out with the knuckleheads. But, as the weeks went by, I noticed that he sat further and further back in the room, his back to the door and the rest of the group. The darker the corner he sought out, the darker the expression on his face became. I knew something wasn't right.
Most days Lamont stayed behind after class. I got the feeling that he didn't want to give up the safety and security of the classroom for the chaos of the block. He always had a question or a comment about what we had done that day. He never talked about himself, his charge, or what kind of time he was looking at. He had that hooded look that I remembered so well from my years working in a psych hospital-- as though he was a denizen of two worlds. Yet he stuck around. He clearly needed to talk. Since I knew education was important to him, I suggested he meet with our school social worker and discuss what he'd like to do with his life-- anything to get him into her office.
That afternoon Kay, the social worker, thanked me for recommending Lamont to her. Then she told me a story I'd heard a number of times during my ten years in jail.
Lamont was bipolar. Usually it was well controlled with medication. But since he had been sent to the county lockup he hadn't gotten them. He had requested them, but got nowhere. His mother had done the same, and got nowhere.
Kay didn't have to say what I knew already. All kinds of treatments don't get done, are delayed, or forgotten. "You didn't do the paperwork right." "You're on the list." Or "The doctor's only here every other Tuesday." All tactics to save money. (At least, I've always hoped that that was the reason and not the more disturbing one: pure neglect because someone just didn't give a damn about the people in their charge.)
"It's amazing that Lamont talked to me. He's real paranoid by now," Kay said. "But he can feel himself getting crazier and crazier everyday without his meds, and he's terrified of what he'll do. I'm going to see about getting them for him."
Luckily Lamont was in touch with reality enough to know that he was slipping; and luckily Kay had enough jailhouse capital to get him what he needed.
But it doesn't always happen that way. Things escalate quickly on the overcrowded, noisy, smelly blocks. Anything can push a kid like Lamont into the ring. Words, looks, or nothing at all can suddenly lead to a fight. Then some guy loses control or his tentative grip on reality breaks, and the emergency response team gets called. They come storming in, shouting, dressed in black with combat boots, the reflective visors on their helmets mirroring back to the inmate the confusion and fear that got him into this mess in the first place, pushing at him with their plastic shields, crowding him, shoving him to the floor, screaming in his face. A paranoid's dream-- and nightmare. Finally, cuffed, dazed and more than likely bruised, the inmate is led away, his head shoved down in submission, and he's put in isolation where everybody hopes he'll just calm down, shut up, go to sleep; where, once again, he's left alone with a life, and mind, out of control.
Of course, not every inmate who has a fight is mentally ill, although the level of instability is high with a prison population used to living the high voltage life of the street combatant in and out of jail. However, there are enough volatile situations that could be avoided if these locked up men and women struggling to maintain their emotional balance were given what they needed-- decent living conditions, medications when needed, compassion, and viable therapy, or any therapy at all. It would, if nothing else, save municipalities money in the long run.