Ill-Equipped: U.S. Prisons and Offenders with Mental Illness Human Rights Watch ____________________________________________________ New York Washington London Brussels Copyright © 2003 by Human Rights Watch. All rights reserved. Printed in the United States of America ISBN: 1564322904 Cover photo: Copyright © 1999 Andrew Lichtenstein Caption: Stiles Unit, Beaumont, Texas, 1999. Cover design by Rafael Jimenez Addresses for Human Rights Watch 350 Fifth Avenue, 34th Floor, New York, NY 10118-3299 Tel: (212) 290-4700, Fax: (212) 736-1300, E-mail: [email protected] 1630 Connecticut Avenue, N.W., Suite 500, Washington, DC 20009 Tel: (202) 612-4321, Fax: (202) 612-4333, E-mail: [email protected] 2nd Floor, 2-12 Pentonville Road London N1 9HF, UK Tel: (44 20) 7713 1995, Fax: (44 20) 7713 1800, E-mail: [email protected] 15 Rue Van Campenhout, 1000 Brussels, Belgium Tel: (32 2) 732-2009, Fax: (32 2) 732-0471, E-mail: [email protected] Web Site Address: http://www.hrw.org Listserv address: To receive Human Rights Watch news releases by email, subscribe to the HRW news listserv of your choice by visiting http://hrw.org/act/subscribe-mlists/subscribe.htm Human Rights Watch is dedicated to protecting the human rights of people around the world. We stand with victims and activists to prevent discrimination, to uphold political freedom, to protect people from inhumane conduct in wartime, and to bring offenders to justice. We investigate and expose human rights violations and hold abusers accountable. We challenge governments and those who hold power to end abusive practices and respect international human rights law. We enlist the public and the international community to support the cause of human rights for all. HUMAN RIGHTS WATCH Human Rights Watch conducts regular, systematic investigations of human rights abuses in some seventy countries around the world. Our reputation for timely, reliable disclosures has made us an essential source of information for those concerned with human rights. We address the human rights practices of governments of all political stripes, of all geopolitical alignments, and of all ethnic and religious persuasions. Human Rights Watch defends freedom of thought and expression, due process and equal protection of the law, and a vigorous civil society; we document and denounce murders, disappearances, torture, arbitrary imprisonment, discrimination, and other abuses of internationally recognized human rights. Our goal is to hold governments accountable if they transgress the rights of their people. Human Rights Watch began in 1978 with the founding of its Europe and Central Asia division (then known as Helsinki Watch). Today, it also includes divisions covering Africa, the Americas, Asia, and the Middle East. In addition, it includes three thematic divisions on arms, children’s rights, and women’s rights. It maintains offices in New York, Washington, Los Angeles, London, Brussels, Moscow, Tashkent, Tblisi, and Bangkok. Human Rights Watch is an independent, nongovernmental organization, supported by contributions from private individuals and foundations worldwide. It accepts no government funds, directly or indirectly. The staff includes Kenneth Roth, executive director; Michele Alexander, development director; Carroll Bogert, associate director; Barbara Guglielmo, finance director; Lotte Leicht, Brussels office director; Maria Pignataro Nielsen, human resources director; Iain Levine, program director; Rory Mungoven, advocacy director; Wilder Tayler, legal and policy director; and Joanna Weschler, United Nations representative. The regional division directors of Human Rights Watch are Peter Takirambudde, Africa; José Miguel Vivanco, Americas; Brad Adams, Asia .The thematic division directors are Steve Goose, Arms, Lois Whitman, Children’s Rights; and LaShawn R. Jefferson, Women’s Rights. Jamie Fellner is director of the U.S. Program. Jonathan Fanton is the chair of the board. Robert L. Bernstein is the founding chair. The members of the board are Khaled Abou El Fadl, Lisa Anderson, Lloyd Axworthy, David Brown, William Carmichael, Dorothy Cullman, Edith Everett, Michael Gellert, Vartan Gregorian, James F. Hoge, Jr., Stephen L. Kass, Marina Pinto Kaufman, Wendy Keys, Robert Kissane, Bruce Klatsky, Joanne Leedom-Ackerman, Josh Mailman, Joel Motley, Samuel K. Murumba, Jane Olson, Peter Osnos, Kathleen Peratis, Catherine Powell, Sigrid Rausing, Orville Schell, Sid Sheinberg, Gary G. Sick, Domna Stanton, John J. Studzinski, Shibley Telhami, Maureen White, and Maya Wiley. Emeritus Board: Roland Algrant, Adrian DeWind, Alice H. Henkin, Bruce Rabb, and Malcolm Smith. ACKNOWLEDGMENTS Human Rights Watch wishes to thank each of the prisoners, correctional staff, mental health professionals, attorneys, and advocates who shared experiences, information, materials, and insights with us in the course of research for this report. We want to acknowledge especially the invaluable assistance from correctional mental health and law experts who generously contributed time to helping us understand and synthesize the concepts addressed in this report, including Professor Fred Cohen, Dr. Jane Haddad, Lindsey Hayes, Dr. Terry Kupers, Dr. Richard Lamb, David Lovell, Ph.D., Steve Martin, Esq., Dr. Jeffrey Metzner, and Professor Hans Toch, Dr. Terry Kupers also participated in a research mission to Indiana with Human Rights Watch in 1997. Several state corrections authorities, convinced of the importance of this project, were particularly helpful in giving us access to their staff and facilities, including: Secretary of the Washington State Department of Corrections Joseph D. Lehman; Robert Horel at the California Department of Corrections; Beth Anderson, health services administrator, Washington Department of Corrections; Brett Rayford, Connecticut Department of Correction; Lance Couturier, chief psychologist, Pennsylvania Department of Corrections; and Dr. Thomas Powell, director of clinical services, Vermont Department of Corrections. They were all extremely gracious with their time and energy. We also want to specially note extraordinary assistance from attorneys Donna Brorby, David Fathi, Tara Herivel, Sarah Kerr, Patricia Perlmutter, Antonio Poinvert, Betsy Sterling, and Todd Winstrom, all of whom we interviewed numerous times during the research for this report. In addition, our deepest thanks go to the staff at the Council on State Government and the Correctional Association of New York, who were more than generous in sharing information and ideas with us. Finally, we with to express our great gratitude to Fred Cohen, David Fathi, Craig Haney, Terry Kupers, and Jeffrey Metzner for carefully reviewing and commenting on earlier drafts of this report. Sasha Abramsky, a consultant to Human Rights Watch, and Jamie Fellner, director of the U.S. Program at Human Rights Watch are the authors of this report. It was edited by Joseph Saunders, deputy program director at Human Rights Watch, and James Ross, senior legal advisor. It is based principally on research by Mr. Abramsky, with additional research by Ms. Fellner. Paul Jacobs, a program associate at Human Rights Watch and Sarah Kunstler, a Human Rights Watch intern, also provided research assistance. Paul Jacobs also prepared the report for publication. Human Rights Watch is grateful to the Open Society Institute for its support of the U.S. Program that made this report possible. 5 CONTENTS I. SUMMARY 1 The Scope of this Report 5 A Note on Methodology 6 II. RECOMMENDATIONS 9 Recommendations to the U.S. Congress 9 Recommendations to Public Officials, Community Leaders and the General Public 10 Recommendations to Prison Officials and Staff 12 III. BACKGROUND 16 Rates of Incarceration of the Mentally Ill 17 Deinstitutionalization, Crime and Punishment, and the Rise in the Mentally Ill Prisoner Population 19 “Criminalizing the Mentally Ill” 23 Diversion 26 IV. WHO ARE THE MENTALLY ILL IN PRISON? 30 Overview of Mental Illness 30 Examples of Mentally Ill Prisoners 34 V. MENTAL ILLNESS AND WOMEN PRISONERS 38 Case Study: R.M. and Seriously Mentally Ill Women Prisoners in Vermont. 42 VI. SYSTEMS IN TRANSITION 46 Reform through Litigation 46 The Problem of Funding Mental Health Services in Prisons 49 VII. DIFFICULTIES MENTALLY ILL PRISONERS FACE COPING IN PRISON 53 Physical Conditions 53 Vulnerability of Mentally Ill Prisoners to Abuse by Other Prisoners 56 Rule-Breaking by Mentally Ill Prisoners 59 Discipline for Misconduct 60 I.J., New York 70 VIII. INADEQUATE RESPONSES AND ABUSES BY CORRECTIONAL STAFF 75 The Mental Health Role of Correctional Staff 75 Mental Health Training for Custodial Staff 76 Correctional Officers’ Use of Excessive Force 78 Other Abuses and Inappropriate Responses by Correctional Officers 82 Timothy Perry, Connecticut 87 Y.D., California 89 Mark Edward Walker, Montana 91 IX. INADEQUATE MENTAL HEALTH TREATMENT IN PRISONS 94 Understaffing 95 Poor Screening and Tracking of Mentally Ill Prisoners 101 Lack of Timely Access to Mental Health Staff 103 Diagnoses of Malingering 106 Medication as the Sole Treatment 109 Lack of Confidentiality 114 Medication 115 Proper Medication 115 Delivery 117 Medication Discontinuity 118 Inadequate Monitoring of Medication Side Effects 120 Protecting Prisoners on Medication from Heat Reactions 122 Inadequate Efforts to Ensure Medication Compliance 125 X. INSUFFICIENT PROVISION OF SPECIALIZED FACILITIES FOR SERIOUSLY ILL PRISONERS 128 Crisis Care 128 Specialized Intermediate Care Units 130 Expansion of Specialized Care Facilities 133 XI. CASE STUDY: ALABAMA,