Thursday 25 February 2010

What should we do for mentally ill prisoners after their release?

In April of this year, I will be addressing the 12th United Nations Congress on the treatment of offenders and criminal justice being held in Salvador, Brazil. This article is the speech I will be giving to the three thousand delegates from around the world who will be attending that Congress.

Prisons are woefully ill-equipped for their current role as any nation’s primary mental health facilities according to Jamie Fellner, the Director of the U.S. Program of Human Rights Watch and I am in complete accord with his view.

Ideally, a mental hospital is the best place for someone who is mentally ill. Unfortunately, in the province of Ontario in Canada, many of our mental hospitals were closed several decades ago and as a result, many of the mentally ill inmates of these facilities were put back onto the streets and left to fend for themselves. A great many of them subsequently ended up in our detention centers and other correctional institutions. It goes without saying that correctional facilities are generally not equipped to handle these kinds of inmates. To make matters worse, prisoners with mental illnesses find it more difficult to adhere to prison rules and to cope with the stresses of confinement than non-mentally ill prisoners do. This results in their mental illnesses becoming worse.

Further, the taxpayers end up paying millions of dollars a year to keep them locked up when they commit new crimes and are sent back to prison because they weren’t properly treated upon their release. This is not cost effective at all.

The American Psychiatric Association, in a study published in 2000, concluded that as many as one in five prisoners were seriously mentally ill, with up to 5 percent being actively psychotic at any given moment. Nine years later, I don’t think those figures have really changed that much since the number of mentally ill prison inmates continues to grow. Over the past few decades, the American prisons and jails have become its default mental health system. On any given day, tens of thousands of male and female inmates in U.S. prisons are psychotic. At least a quarter of a million of these U.S. prison inmates suffer from a number of mental disorders such as bipolar disorders, schizophrenia, and major depression. Those prisons hold three times more people with mental illness than do psychiatric hospitals, and U.S. prisoners have rates of mental illness that are up to four times greater than rates for the general population because they are not given any or alternatively, sufficient psychiatric treatment while they are incarcerated or even after they are released.

Ten percent of all federal offenders in Canada have a significant mental health problem. Canada's ombudsman for prisons has found an "immediate and troubling" shortfall in mental-health-care services for federal offenders and predicts the problem will get worse as the prison populations grow.

What is really happening to these unfortunate people is that they are being merely warehoused until their eventual release which of course doesn't really do anything for them nor does it to anything for the rest of society.

In addition to being highly effective at restoring mentally dysfunctional persons to a wholesome existence and increasing community safety evidenced by fewer arrests, treating these people after their release is far cheaper than re- incarcerating them considering the fact that each inmate in the general prison population costs taxpayers as much as $50,000 per year per prisoner plus an additional $100,000 annually for each chronically ill prisoner who receives special housing, trained guards, and regular treatment. These hefty prison fees come after the cost of police services, legal fees, and court costs.

Mentally ill prisoners who are on remand or waiting for transfer to other facilities or are serving short sentences are incarcerated in detention facilities in the province of Ontario, Canada. If they were mixed in with other prisoners, the mentally ill prisoners would invariably be vulnerable to assault, sexual abuse, exploitation, and extortion. For this reason, mentally ill prisoners in that province’s detention centers are placed in separate wings so at least they are not harassed by the rest of the inmates. Very little however with respect to treatment is being done for them while they are in those facilities.

After I retired, I worked five days a week as a volunteer group counselor in a Toronto detention facility and as such, I worked with many mentally ill inmates. I was aware that many of them were in need of psychiatric treatment but I was amazed at just how much they understood the complexities of life once it was explained to them.

Since all inmates of correctional facilities in Ontario are entitled to appropriate medicine that is required for their needs and is given to them at no cost to them, I have to presume that they were all taking their medicines during the time they were in the facility so their sense of reasoning was considerably improved compared to when they were on the street and not taking their medicine.

Not long ago, Roger Bruyere of West Warwick, Rhode Island used his bed sheets to hang himself in the maximum-security section at that state’s Adult Correctional Institution. He had a lengthy criminal record, including convictions for arson, larceny, and assault with a dangerous weapon. He had an extensive history of mental illness while in prison, including two hospitalizations at the locked Forensic Unit at the state Department of Mental Health Retardation and Hospitals. Similar problems extended to his uncle, Joseph Bruyere, who also hanged himself at the ACI in July 1993 after earning the nickname ‘The Sticker’ for stabbing himself in the abdomen at least 30 separate times during his incarceration. And, at the time of Roger Bruyere’s death, the Department of Corrections spokeswoman, Joy Fox said that he was one of the few prisoners being forced to take mental health medications, thanks to a court order and yet, he still hanged himself. His death makes him the latest illustration of Rhode Island’s failure to adequately treat mentally ill prisoners. He should have also been seeing a psychiatrist.

In Ontario, our correctional institutions where inmates can be kept up to two years less a day; assist those mentally ill prisoners in need of psychiatric help but unfortunately, this doesn’t apply to the provinces’ detention centers because the prisoners are there for shorter periods of time. However, some of them are there for much longer periods of time while waiting for their trials and those that are in need of getting psychiatric help are not getting it.

In Toronto, there is a special court that was opened in 1998 that hears cases where the accused are suspected of being mentally ill. It is called the Mental Health Court and it is presided by Justice Richard Schneider who sits in that court as a Justice of the Ontario Court of Justice. He previously worked as a criminal defence lawyer, often representing individuals with mental disorders. Between 1994 and 2000, he was Counsel to the Ontario Review Board, a body designated under the Criminal Code to provide annual reviews of persons who have been found unfit to stand trial or not criminally responsible for their crimes on account of a mental disorder. His unique understanding of many of the issues related to mental illness and the courts also stems from his previous experience as a clinical psychologist in an outpatient forensic program in Calgary.

In his capacity as the sitting judge of that special court, he can give community treatment orders which can be extended from six months to a year with automatic reviews to ensure that the treatment is successful and that the individual needing the treatment can be trusted to keep up his treatment.

Mentally ill prisoners are more likely to get into trouble and end up back in prison after they are released because detention centers and prisons turn them loose without the follow-up care they need. Mental patients very often stop taking their medicines and keeping psychiatric appointments soon after their prison or hospital release due to a condition called ‘anosognosia’ that makes it impossible for them to know that they are still sick. The discontinuation of their psychiatric medicine frequently causes these persons to lapse back into psychosis and eventually break the law again. This is why it is so important that those prisoners who are released should be placed on probation or parole so that a follow-up can ascertain as to whether or not they are still taking their medicine as prescribed. It is foolish to simply leave it up to sick people on their own to decide whether or not they should take their medicine, especially after they have just been released from detentions centers or prisons.

In Canada, prisoners can be released after serving a third of their sentence and during the remaining third of their sentence, they are on parole and so it is possible to do follow ups to make sure that they are taking their medicine. However after the parole period is over, they are left to fend for themselves and then many of them stop taking their medicine.

It is morally wrong to put any of our released sick prisoners in the position of being left untreated, resulting in them being jailed again for crimes and/or wandering on our streets as the homeless because they don't have the mental stability to seek help. Seriously mentally ill prisoners who are released untreated are even more likely to hurt themselves than to hurt others and many die during arrest attempts or by suicide and often because of their illness, they succumb to other illnesses because they don’t have the common sense to seek medical help. This is particularly sad because in the province of Ontario, everyone who is a Canadian citizen or a landed immigrant and is severely ill; be he a millionaire or a beggar on the street; is entitled to free hospitalization and free medical treatment; be it brain surgery or an organ transplant, no matter how much it costs the taxpayers.

In 2003, New York City stated that it would provide mentally ill jail inmates with treatment and other services when they were released, under an agreement signed January 8, 2003 that settled a class-action lawsuit. Previously, for many years, most mentally ill inmates at Rikers Island jail were released without assistance of any kind, or dropped off in Queens with a $3 MetroCard and $1.50 in cash which was the routine practice with other inmates. Under the agreement, the city agreed to provide mentally ill inmates access to treatment they need to maintain psychiatric stability after their release. That treatment can include assistance to secure appropriate housing, access to outpatient treatment and medication and the means to pay for those services if the inmate is indigent.

In the City of Toronto, a prison inmate who is released and has no home to go to, may stay at a homeless shelter and later apply for welfare (until they find employment) so that they can live in a home of their own.

There has to be a better way to deal with mentally ill prisoners than merely stuffing them into a detention center where they won’t get psychiatric help. I think that every correctional facility, be it a detention or a correctional facility should have a psychiatrist on staff so that he or she can deal with those prisoners who need psychiatric treatment. Even if a prisoner is being held in the detention facility for a short period of time, he or she should have access to the psychiatrist and also to a social worker. The detention facility that I did my counseling in had two social workers who assisted the mentally ill prisoners in finding a place to live and receive psychiatric treatment after their release.

If we release mentally ill prisoners back into society without first assuring ourselves that they will get psychiatric help and get the medicine they need to help them overcome their psychiatric disorders and further assist them in finding a place to live and a job to go to, then we are not only failing them, but we are also failing society in general. In the long run, society will continue to pay an enormous debt, which is not only the financial costs with respect to the repeated apprehension, trials and incarcerations of these individuals, but also the cost endured by the many victims in society who fall prey to them.

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