september 2013

Mental Illness and Sexual Abuse Behind Bars

© California Department of Corrections and Rehabilitation eople with mental illnesses left many thousands of people who needed are drastically overrepresented in help without access to services. U.S. prisons and jails. In a recent P study, the Bureau of Justice Sta- Deinstitutionalization is the chief factor be- tistics (BJS) found that 36 percent of pris- hind the dramatic rise in incarceration rates oners and 43 percent of jail inmates had for the mentally ill. Contrary to widespread “There’s no therapy for rape Pa mental health disorder.1 A person with belief, most people who have a mental dis- a serious mental health problem is more order are not violent. Many are locked up for victims in prison. The prison than three times more likely to wind up in minor offenses, like theft, drug use, or dis- system is incompetent to handle a prison or jail than a hospital.2 turbing the peace. It is often the case that a mentally ill person’s offense is related directly the mentally ill, and in fact Once behind bars, people with mental to his or her illness. For example, studies have causes the mental illness that it illness rarely receive adequate care. Even found that people with paranoid schizophre- worse, many are targeted for sexual abuse. nia frequently are arrested for trespassing, should be treating.” In its 2013 study on adult facilities, the disorderly conduct, and other nonviolent - Scott, a survivor of sexual abuse BJS found that prisoners showing symp- charges that encompass behaviors associated toms of severe psychological distress were with their disease.4 in an Illinois prison nine times more likely than those with no such symptoms to be sexually abused by Prisons and jails have become de facto psy- another inmate. Among jail inmates, peo- chiatric hospitals, yet few have the trained ple who exhibited such symptoms were staff or the resources to offer adequate men- preyed upon at five times the rate of those tal health care. Corrections mental health who did not.3 staff describe having caseloads that include hundreds of inmates. As a result, many Mental Illness and Incarceration inmates who desperately need help simply go untreated. The overincarceration of the mentally ill is largely the result of a policy shift that The Vulnerability of Mentally Ill Inmates began in the 1950s. Back then, people with erious psychiatric disorders were In detention, just as in the community, cer- mostly treated in state-run mental hos- tain groups of people are more vulnerable pitals. Many of these facilities were over- to sexual abuse than others. For example, crowded and had appalling conditions; inmates who are young, LGBT, or who with the emergence of new medications are perceived to be “feminine” are at a high for mental illness, policymakers consid- risk for abuse. Perpetrators also target in- ered it sensible to shut them down. But mates who they feel confident won’t speak the closing of psychiatric hospitals — a out — or won’t be believed if they do. The policy known as deinstitutionalization — alarming vulnerability of people with mental

just detention international 1 september 2013 | fact sheet fact sheet illness is clear. The BJS found that, of the in- traumatize people with mental illness, in- Tips for Advocates mates with serious psychological distress who creasing their feelings of fear, depression, and were sexually abused by another inmate, a suicidal ideation. staggering 80 percent were assaulted more • People who are severely mentally ill often than once.5 The Role of Mental Health Providers have trouble focusing and may experi- ence intrusive thoughts — two common trauma reactions. Many mentally ill in- Sadly, abusers have good reason to think that Fortunately, the Department of Justice’s Pris- mates are also on powerful medications people with mental illness won’t be taken se- on Rape Elimination Act (PREA) standards that cause unpleasant side effects, includ- riously if they report sexual abuse. Their pleas — which are binding on prisons, jails, youth ing slowed or slurred speech and memo- for help are too often seen as lacking cred- facilities, lockups, and halfway houses — will ry problems. This can combine to make ibility. Speaking out is difficult, and often help ensure that mentally ill inmates get the survivors’ accounts seem rambling, out dangerous, for any inmate regardless of their support that they need and deserve. of order, or incoherent. Be patient with mental health. But for inmates with psycho- the survivors. Allow ample time for them logical disorders, the obstacles to getting help The PREA standards mandate that any in- to share their story. Use simple language, are even greater. mate who reports sexual abuse be provided and repeat back what you hear to check with emergency medical services and ongoing that you understand. Prisoner rape is a crime that has a devastat- mental health care. The standards also require ing physical and emotional impact. For peo- facilities to give inmates the option to report • Be aware that many people with mental ple with mental illness, the trauma of sexual abuse to a third party, and they pave the way illnesses have been told repeatedly that abuse interacts with the symptoms of their for trained community advocates to deliver they lack credibility. Listening without mental health problems, making the effects services inside facilities. judgment can go a long way toward es- more severe and longer lasting. Worse still, tablishing trust. being victimized is itself a leading risk fac- Crucially, the standards explicitly recognize tor for further abuse. Thus, many mentally ill that people with mental health problems • If a survivor says things that seem to be inmates are trapped in a vicious cycle where are vulnerable to prisoner rape. Under the part of a delusion, remember that your their illness makes them more vulnerable standards, facilities have to ask inmates role is not to investigate. Respond sup- to abuse which, in turn, exacerbates their about their history of mental illness — and portively to the feelings you perceive, not illness. Additionally, the default reaction of other risk factors — and to take that infor- to the content of a delusion. most detention facilities to reports of sexual mation into account in housing and program- abuse — to isolate survivors — can further ming decisions.6 • People can and do live successfully with mental illness and do heal from sexual abuse. It is important to share this mes- sage of hope with all survivors.

Endnotes JUST DETENTION INTERNATIONAL 1Allen J. Beck, et al, Sexual Victimization in Prisons and Jails Reported by Inmates, 2011-12 (Bureau of Justice is a health and human rights orga- Statistics, May 2013), available at www.bjs.gov/content/pub/pdf/svpjri1112.pdf. 2E. Fuller Torey, M.D, et al, More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States nization that seeks to end sexual (The Treatment Advocate Center and National Sheriffs’ Association, May 2010), available athttp://www.treat - abuse in all forms of detention. mentadvocacycenter.org/storage/documents/final_jails_v_hospitals_study.pdf. 3 Allen J. Beck, et al, Sexual Victimization in Prisons and Jails Reported by Inmates, 2011-12 (Bureau of Justice HEADQUARTERS Statistics, May 2013), available at www.bjs.gov/content/pub/pdf/svpjri1112.pdf. 3325 Wilshire Blvd., Suite 340 4PBS Frontline, “Deinstitutionalization: A Psychiatric Titanic,” from The New Asylums, available at Los Angeles, CA 90010 http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html. 5Allen J. Beck, et al, Sexual Victimization in Prisons and Jails Reported by Inmates, 2011-12 (Bureau of Justice Tel: (213) 384-1400 Statistics, May 2013), available at www.bjs.gov/content/pub/pdf/svpjri1112.pdf. Fax: (213) 384-1411 6National Standards To Prevent, Detect, and Respond to Prison Rape, 28 CFR 115 (Department of Justice, 2012), §§ 115.41, available at www.federalregister.gov/a/2012-12427. EAST COAST OFFICE 1900 L Street NW, Suite 601

This project is supported by Grant No. 2011-TA-AX-K100, awarded by the Office on Violence Against Women, U.S. Washington, DC 20036 Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this document are those Tel: (202) 506-3333 of Just Detention International and do not necessarily reflect the views of the Department of Justice, Office on Violence Fax: (202) 506-7971 Against Women. [email protected] www.justdetention.org just detention international 2 september 2013 | fact sheet