Why are mentally ill prisoners ignored?

For many years, I have had a concern about the lack of treatment that mentally ill prisoners are not getting while in prisons or jails. Off and on over a period of 10 years, I was a group counsellor in a large detention centre in Toronto, Ontario in which a great many of the prisoners whom I counselled both in a group and as individuals were suffering from some form of mental illness. What I found rather interesting was that almost all of them were quite rational and had a real understanding as to what was right and what was wrong. What follows are examples of failures in the correctional systems with respect to the treatment of mentally ill prisoners.

Mental illness indirectly affects all Canadians through a family member, friend or colleague. Twenty per cent of Canadians will directly experience a mental illness in their lifetime, with approximately eight per cent experiencing major depression, and approximately one per cent of Canadians experiencing bipolar disorder ('manic depression') and another one per cent will suffer from schizophrenia.

The first time I became aware that something was wrong in our prison system in Ontario with respect to the treatment of mentally ill prisoners occurred about thirty years ago. The mentally ill prisoner (he was not insane) had been sent to the pentitentiary for life as a murderer who murdered a young boy. The judge ordered that he was to receive psychiatric treatment while in prison. When the prisoner spoke to the prison psychiatrist about receiving psychiatric treatment in the prison, the psychiatrist told him that he would be the last person he would ever give psychiatric treatment to. When I learned of this, I wrote the solicitor general of Canada (who was in charge of the federal prisons, the federal police [RCMP] and the National Parole Board) and told him that the psychiatrist had no right to refuse treatment to any prisoner no matter how evil the prisoner was. The solicitor general wrote me back and told me that he agreed with me and that the psychiatrist had subsequently been chastised accordingly and ordered to treat the prisoner.

Now you may ask, why should we care if a lifer isn’t going to receive psychiatric treatment? The answer is obvious. A severely mentally ill prisoner can create havoc while serving time in a prison that is already unstable by virtue of the fact that it houses many violent prisoners.

The treatment and support of inmates who are mentally ill in Canadian prisons is sub-standard, and sometimes almost non- existent, experts say. Compounding this, according to the Annual Report from the Office of the Correctional Investigator of Canada released in 2011, the number of mentally ill offenders in the federal prison system has more than doubled in the last 10 years, an even more critical problem, say leading mental health organizations.

"The Correctional Investigator's report highlights the seriousness of the conclusion by the Senate Committee on Social Affairs, Science and Technology that our prisons have become warehouses for the mentally ill due to funding cuts and closures in community psychiatric facilities," said Penny Marrett, national CEO of the Canadian Mental Health Association "This is an inhumane and unsafe way to address offenders with mental illnesses, especially when they are often serving time for low-level, non-violent crimes that are the result of little to no availability of treatment or support in the community."

Many people with mental illness - often who are low-income, homeless or struggling with substance abuse - cannot access mental health treatment. If they commit a crime, even low-level non-violent offences, punitive sentencing laws in some provinces can result in imprisonment, which will further restrict their access to treatment and support.

"Prisons can be dangerous and destructive places for people who are mentally ill," said Len Wall of the Schizophrenia Society of Canada. "They are victimized and exploited. Prison rules punish mentally ill offenders for symptoms of their illness - such as being noisy or refusing orders, or even self-injury and attempted suicide. Prisoners who are mentally ill are more likely than others to end up housed in especially harsh conditions, such as isolation which, in turn, can place them at risk for acute psychosis or suicide." The mind-bending isolation of a segregation cell brings no peace to a depressed or unhinged mind. Nor does an environment of slamming cell doors, fear and intimidation. Behind bars, effective treatment is rarely more than a promise while the reality of the problem is that there a severe shortage of psychiatric professionals and with a patient population so diverse, the problem can explode when different kinds of inmates mix.

It is estimated that up to 20 per cent of inmates have a mental illness that requires treatment. Of these, seven to nine per cent have a serious mental illness such as schizophrenia, bipolar disorder, and major depression. "If these inmates do not receive hospital-standard psychiatric care, their chances of rehabilitation are extremely low and their risk of re-offending remains high," said Dr. Pierre Tessier of the Royal Ottawa Hospital. "The mental health system needs to step forward and provide federal correctional facilities with the support they need. Allowing inmates to go untreated for their mental illness is a failure of the mental health system on many levels, from community to hospital-based care."

According to the Annual Report of the Office of the Correctional Investigator of Canada, mental health services in federal penitentiaries are woefully deficient. Across the country, prisoners are denied treatment because of a shortage of clinical staff and inadequate mental health facilities for the prison population.
This can be attributed the growing rate of incarceration of the mentally ill to the lack of a national strategy for mental illness and mental health. "This dire situation is a consequence of under-funded, disorganized and fragmented community mental health services," said Marrett. "Correctional systems are being forced to assume the burden of the country's failure to properly diagnose and care for those with mental illnesses and other mental health problems."

"Prison officials are too often asked to do something they aren't trained to do," said Wall. "Prisons are not designed as places to provide comprehensive mental health treatment and services. If people with mental illness must be incarcerated, they should be in facilities designed and funded to meet their mental health needs."
A steep increase in mentally ill offenders is flooding prisons and psychiatric institutions, confounding officials whose job is to find accommodation and treatment for them. The percentage of mentally ill individuals in both systems is growing by 5-10 per cent each year, according to psychiatric experts and available statistics.
How did Canada's prison system turn into a holding tank for mentally damaged individuals?

Many officials trace it to the deinstitutionalization of psychiatric patients over the past 30 years. Patients wound up on the street when neighbourhoods shunned them and social-service agencies failed to provide adequate housing or care. In many cases, their mental state deteriorated, and they turned to crime, everything from the mundane to murder. Inadequate community response to the needs of the mentally ill population and insufficient public policy protections have resulted in over-representation of mentally ill within prison and jail populations.

Part of the blame for this problem in Ontario is that many years ago, the province closed down most of the psychiatric hospitals and released the vast majority of the mentally ill inmates back into society. Unfortunately, these former inmates couldn’t cope with the strain of a competitive society and ended up homeless and badly in need of psychiatric treatment. It follows that a great many of them ended up in detention centres or prisons and naturally, they didn’t get any psychiatric treatment in them so their illnesses just continued to linger in their minds.

The cost to society is immense. After clogging cell blocks for months or years, untreated prisoners often are released only to get into trouble all over again.

Less than an hour's drive west of Toronto, Maplehurst is a sprawling complex guarded by high fences and overhead mesh (designed to foil slingshot delivery of drugs to inmates in the exercise yard) that primarily houses offenders on trial or waiting out adjournments. About 200 of its 1,200 inmates have a serious mental impairment, including schizophrenia, bipolar disorder, brain injuries and the effects of fetal alcohol syndrome. Others suffer from dementia or low intelligence and a lack of coping skills. The most floridly psychotic inmates are kept under suicide watch in bunker-like cells. The trouble there sick inmates are facing is that the government isn’t really attempting to treat these inmates since their stay in the correctional facility is more or less short.

On a 50-man range reserved for the most severe cases, offenders float quietly between their cells and a narrow corridor with tables bolted to the floor. Like a herd of deer, they appear docile, yet leery; most are heavily medicated.

On another range, 50 inmates with brain damage or subnormal intelligence gaze warily at strangers. All they have in common is the fact that, in prison, they're highly vulnerable. Some are chronic bedwetters. Others are old, scraggly and demented. Some are hulking men, but behave like school kids.

Guards and nursing staff on the mental-health ranges appear genuinely caring, referring to inmates by name and keeping elaborate charts of any change in behaviour that may point toward a suicide attempt or sudden attack. However, they are not always trained in the finer points of mental illness.

The developmentally delayed are the forgotten population. It is like putting four-year-olds in custody. They cry all day for their mommies. Social workers give them colouring books and crayons. These unfortunate people shouldn’t be in jail. They should be in a institution for the mentally ill or alternatively, the mentally retarded. Unfortunately, Ontario closed one of its largest institutions for the mentally retarded and naturally, thee released inmates couldn’t cope with the stresses of life outside the institution so many ended up in jail where the stresses are even worse.

In 2009, it was established that there were an estimated 45.1 million adults aged 18 or older in the United States with any mental illness in the previous year. The United States is faced with the same problem that Canada is. The largest facilities housing psychiatric patients in the United States are not hospitals but jails and prisons.

It was established that in 2011, as many as 1 in 5 mentally ill people are held in US prisons, often because there is nowhere else for them to go. So serious is the problem that one jail in Los Angeles has become in effect the biggest mental institution in the country. Twin Towers Jail is in central Los Angeles, which Los Angeles county sheriff's department calls the biggest known jail in the world. This jail has become a national symbol of the crisis. About 2,000 mentally ill prisoners, recognizable by yellow shirts and the letter M on their name tags, make up almost half its intended occupants. The jail has come under fire from human rights advocates as a central focus in the use of psychiatric drugs to control prisoners.

Roughly 65 percent of Michigan prisoners diagnosed with a severe psychiatric illness did not receive treatment while incarcerated, a 2007 University of Michigan study found. This would mean that when most of them were or are going to be released, they will have been or still will be suffering from some form of severe psychiatric illness, an illness that probably put them in prison in the first place.

Researchers interviewed 618 inmates across the state between May 1, 2008 and Sept. 30, 2009, and also reviewed MDOC mental health records. They found that overall, 20 percent of males and 25 percent of females had severe psychiatric symptoms and that 16 percent and 29 percent, respectively, received mental health services. However, when the study group compared its assessment with the MDOC’s mental health records, it found that 65 percent of prisoners with mental health symptoms, or an estimated 9,711 statewide, (out of 47,888 inmates) did not receive psychiatric services during the study.

The male general population had the highest percentage of untreated mental illness at 77 percent, the study showed. The female general population reported more depression and other mental illness, but also had a higher percentage of treated patients at 54 percent. The male special units had the lowest percentage of untreated mental illness at 12 percent, as many of those special units are mental health treatment programs.

When measuring the relationship between major offenses, the presence of mental health symptoms, and whether symptoms were treated, the researchers found that 20 percent of crimes were committed by individuals with mental health symptoms, and 63 percent of those crimes were committed by prisoners who weren’t receiving treatment for symptoms.

The rest of this article is going to be about the suicides of mentally ill prisoners.

According to the National Institute of Mental Health, as many as 90 percent of individuals in the United States who died by suicide had a diagnosable mental illness or substance abuse disorder. Certain psychiatric diagnoses increase the risk of suicide substantially, such as major depression, bipolar disorder, and schizophrenia. Co-occurring mental illness and substance abuse exacerbate the risk of suicide. Many individuals who are homeless meet many of the criteria for elevated suicide risk, such as untreated mental illness, social isolation, poverty, and substance abuse. Studies have found that individuals who are homeless for longer than six months may be at particularly high risk.

Death of Gleb Alfyorov

In Ontario, a 16-year-old who broke his sister’s nose, was arrested and brought before a court. His name was Gleb Alfyorov. Judge Susan MacLean told the troubled youth, “I want you to be with a team of specialists — nurses and doctors who can meet with you and talk with you about things.” The judge ordered a 30-day psychiatric evaluation of the Pickering teen.

That night, a police cruiser dropped Gleb at Syl Apps Youth Centre in Oakville, a young offender’s facility. Gleb was strip-searched, interviewed and directed to cell 12. A stunning series of miscommunications kept him from receiving help.

Twenty-nine days later, he hanged himself from a ceiling grate in his cell with his black shoelaces. It was five days after his 17th birthday. His story reveals a justice system that is failing our mentally ill youth.

Gleb’s mother, Marina, said in an interview at her Pickering home that she thought the justice system would put him in a safe and secure place where he could be “made normal” again. “Nobody cared,” said his mother. “They just locked him up.”

The inquest has heard contrasting descriptions of Gleb from the social workers, doctors, nurses, lawyers and jail staff who had contact with him during his four months in custody.

Some say he was cooperative, others uncooperative. One worker said he was polite; a psychologist said he was psychotic. He was a victim, said a youth service manager, while a social worker called him a bully. Academically gifted, one report said; challenged was the description in another. His mental illness was clear to most.

Four months earlier, Gleb told a youth counsellor at Durham Family Court Clinic that he was “chosen to save the planet from the universe” because machines were masquerading as men. The teen said he could tell them apart and talk telepathically.

A few months later, in January 2008, he was arrested and charged with beating up his older sister. He broke her nose. In court, Gleb insisted on pleading guilty and waived his right to a lawyer.

Judge Kofi Barnes in Oshawa accepted the plea but ordered a report to assess Gleb’s mental state and aid the court in sentencing.

Gleb was sent to Brookside Youth Centre, a jail in Cobourg, that January to await the assessment and sentencing. The assessment, which can be performed relatively quickly, is not the intensive 30-day psychiatric evaluation a judge would later order to see if Gleb was criminally responsible for his actions.

At Brookside, Gleb was escorted to Martin House, reputed to hold the most troublesome youth. “It was designated like a jail,” Ralph Hull, a psychiatrist, told the inquest. It was not uncommon for youth to be “handcuffed to the bed or have two staff with them.”

Following complaints from other youth, the provincial advocate for children and youth toured Brookside and its solitary confinement unit five months after Gleb’s death. In a report, the conditions were described as “depressing, dark and inhumane.” Bugs, bodily excretions and generally filthy conditions were noted throughout the cells.

At Brookside, jail staff immediately began referring to Gleb’s behaviour as “bizarre.”

A psychologist at Brookside met Gleb twice. The second time Gleb kicked the table, lifting it off the ground. In a memo, the psychologist, John Satterberg, advised staff that at the “slightest deviation from acceptable behaviour,” Gleb should be taken to solitary confinement. As far as I am concerned, the psychologist’s actions were that of a quack. Didn’t this twit know that solitary confinement actually increases the anxiety the prisoner is experiencing and increases the risk of suicide?

Records and testimony at the inquest show that Gleb was put in solitary for making “strange noises” at night (another youth said it was like “a spirit comes out of him”), for fighting another youth who had jumped him in court and for not eating breakfast. Why would any prison official with anything resembling a sound mind order that a prisoner is to be put in solitary confinement because he would eat his breakfast?

The snapshot assessment of Gleb was coordinated by a social worker who, at the inquest, said she was not sure if she was qualified to do such a report. With input from a psychiatrist and a psychologist, the social worker wrote that the court should consider Gleb’s “significant mental health issues when sentencing.” She also recommended that the court consider sending Gleb to a secure treatment facility to evaluate and treat his “very serious mental health and very serious substance abuse issues.”

On April 2, Gleb appeared before Judge Barnes, who had ordered the snapshot assessment. The judge said he had “very serious concerns” about Gleb’s mental state and in a later hearing noted Gleb was saying things that “make me wonder how he is going to survive in a correctional institution.” The Crown (prosecutor) agreed another, more in-depth assessment was in order. This assessment would determine if Gleb was criminally responsible for assaulting his sister.

The idea of another month in jail weighed on Gleb. He would miss his 17th birthday, and his mother’s birthday. He tried to find a lawyer to help him simply serve his sentence but became frustrated and gave up.

He arrived again in court on April 14, 2008, his face stained with tears. Judge Barnes was busy on another case. Judge Susan MacLean was in court and asked how he was feeling. “I was crying about my mom,” he said.

A friendly duty counsel, Jeffrey Ludlow, volunteered to help find a hospital that could perform the fuller psychiatric assessment. Ludlow found a facility that could provide a psychiatrist but not a bed. He also spoke with Richard Meen, the psychiatrist who reviewed Gleb for the snapshot assessment. Meen was the clinical director at Syl Apps, a privately run but government-funded youth jail that also had a small, secure, hospital-like setting where it treated mentally ill kids. “At least he’ll be in a hospital setting and not in a jail,” MacLean said. Gleb was out of options but he agreed a hospital sounded better than staying at Brookside.

Gleb awoke on April 15th at Syl Apps, not in the hospital-like wing but in the larger secure-custody detention side, sharing a unit with youth who were serving time after being convicted of various crimes. Ludlow, the lawyer who coordinated the transfer, later told the inquest that at the time he did not realize the facility even had a jail.

When the cell door opened, Gleb saw a group of women (jail guards, as it turned out) in the main office. With a goofy grin he asked if they wanted to have an orgy. The guards pushed panic buttons and male staff came running.

Gleb was put on a “sexual aggression plan” and escorted at all times by two male guards. A daily tracking log was to be created to monitor his behaviour. It was rarely used. Gleb seldom left his cell and staff infrequently went in.

Though the staff at Syl Apps included a psychiatrist, a psychologist, a doctor, a nurse, an art therapist, recreation workers, social workers and youth service officers, few interacted with him, the inquest heard.

One who did, Dr. Jennifer Felsher, later told the inquest she had no idea why Gleb was at Syl Apps. Her supervisor, Richard Meen, who had earlier worked on the sentencing assessment, also told the inquest he was in the dark, thinking Gleb was at Syl Apps for a second snapshot assessment. It wasn’t until after Gleb’s death that Meen, in preparation for the inquest, learned he was there for an assessment of criminal responsibility.

Inside cell 12, Gleb ate every meal alone. He wrote disjointed messages on his wall in pencil about hate and suffering. At night he screamed out, “Rescue me!”

Jurors at the inquest asked Meen why he did not complete the assessment. Meen said he was travelling across Ontario giving speeches on preventing youth suicides and working with a native community in northern Ontario to reduce its suicide rate among young people. Meen said he did not believe Gleb to be at risk of suicide.

The inquest heard that Syl Apps staff blamed the boy for being “uncooperative” and the province for taking too long to send over additional funds to pay for the evaluation. The inquest was told the $3,500 for the assessment was approved April 24.

With time running out on the 30 days allotted to complete the assessment, Syl Apps asked for an extension. A social worker wrote a letter on May 13, the day Gleb was sent back to court. With no evaluation done, MacLean told Gleb he would have to go back to Syl Apps for another month.

“If I have mental issues, why am I in jail?” he asked. That was a reasonable question. The judge said she could not deal with the matter and told the teen to return the next day.

The police returned Gleb to Syl Apps sometime after 8:30 p.m. He was last seen on a video monitor entering cell 12 with a plate of microwaved spaghetti.

Jail staff were supposed to make sure Gleb’s laced sneakers were placed outside his door before he was locked in his cell at 9 p.m. — a standard suicide prevention measure. Guards were supposed to look in on him every 15 minutes. In fact, it was fifty-six minutes that had passed before a guard checked and found him dangling from shoelaces fed through a metal cage that covered the ceiling smoke detector.

On May 14, 2008, Gleb Alfyorov finally arrived at a hospital. He was rolled into the autopsy room in the basement of Hamilton General. Zipped inside a white body bag.

Now obviously, the guards who were supposed to watch this young man failed in their duties. In my opinion, there is no excuse for their failures and they should be fired. But the system also failed this young man.

Death of Ashley Smith

Ashley Smith born January 29, 1988 New Brunswick, Canada) is a prisoner who was detained at the Grand Valley Institution for Women in Kitchener, Ontario, Canada. She died at her cell on October, 2007 at a Federal Prison in East Kitchener at the age of 19. Smith, who spent 23 hours a day in isolation wearing little more than an asbestos gown, tied a cloth ligature around her neck on Oct. 19, 2007 after telling a guard she had the urge to "tie up" again. Ordered by managers to not intervene so long as Smith appeared to be breathing, seven correctional officers watched as she strangled herself. Sapers issued a report last year, concluding her death was "preventable."

Smith was originally jailed at age 15 after throwing crab apples at a postman in her hometown of Moncton, N.B. Her four-month sentence grew to four years after she racked up a series of minor offences while in custody. This tells you something about justice in the prison system.

On March 9, 2003, Ashley was admitted to the Pierre Caissie Centre. The centre has an intensive support program that works with adolescents that display challenging behaviors. The centre works with Ashley’s mom, support program staff, a probation officer and the school to try and keep Ashley in the community. While there, Ashley has psychological and psychiatric assessments done.

A doctor at the centre wrote in his diagnostic assessment that Ashley had a learning disorder, ADHD, and borderline personality disorder and narcissistic personality traits. The assessment recommends Ashley receives counseling from her local mental health center, monitoring and assessment for a personality disorder and that she receive a follow-up on the medication regime prescribed.

Nothing seemed to work. She was simply getting worse. She was then sent to the New Brunswick Youth Centre. She was in and out of it five times. Ashley had more than 800 documented incidents in NBYC over three years. Ashley would act up or refuse to listen to staff. She would refuse to hand over a hairbrush, a pencil, or an eating utensil. This would land her in solitary confinement.

There are over 150 incident reports of Ashley trying to hurt herself within a span of three years. One incident report details her daily struggle: "staff members found bruises on Ashley's neck. She had constructed a noose and tied it to a ceiling vent in her cell. She told staff members that she was scared of receiving more charges that would prolong her sentence and therefore wanted to die. It was then that it was decided to move Ashley to a solitary cell. It was there on October 19, 2007 that she hung herself.

Death of William J. Hanlin

William J. Hanlin, 21, was buried on his 22nd birthday, July 15, 2010 after hanging himself in his cell at the Frederick County Adult Detention Center on July 9th. He was incarcerated on a traffic charge while addicted to prescription drugs and marijuana.

Hanlin-Cooney said she warned detention center staff that her son had threatened to kill himself, but he was not placed on suicide watch. Instead, he was put in the medical unit of the jail. Employees are responsible for checking on inmates in the medical unit every 20 minutes, but Cooney said that did not happen for her son. Police reports indicate that staff checked on Hanlin at 10 a.m. on the day of his death, but did not check him again until lunchtime. Hanlin hanged himself with a sheet, and was found dead at 11:50 a.m., according to a police incident report.

Approximately 40 percent of inmates who come through that detention center have addiction and/or mental health issues. Of those who committed suicide in jail nationally, 47 percent had a history of substance abuse, and 38 percent had a history of mental illness.

At least 17 inmates in the Tulsa Jail in Tulsa Oklahoma have died since Corrections Corporation of America took over operations, four times the number who died in the jail the previous five years, a review by the Tulsa World has found. The deaths include three suicides in the jail's medical unit. Another inmate who died from a brain aneurysm displayed signs of a head injury for weeks following assaults in the jail, but prison medical staff claimed his problems were "all in his head," records show.

Death of a man called Morris

A man called Morris, 20, was found hanging in a cell from a sheet tied to his bed at 4:50 p.m. on Jan. 15, 2000. The company's initial statement said Morris was seen "acting normally" during a routine check at 4:25 p.m. According to an investigation by the Jail Inspection Division, Morris had apparently been dead for awhile before anyone noticed.

"The time that Morris was found, according to the medical examiner's report was
much later than the actual death given the fact that extreme rigor was in place when found.”

Hourly prisoner checks were not conducted or documented and shift change counts were not conducted or documented according to the state standards. The report notes that an inmate was "allowed to conduct security checks for the officer on duty and was allowed to have supervision over other inmates. The written policy of the facility didn’t not comply with state jail standards and with Oklahoma statutory authority."

Death of Mark Cunningham

Placed in solitary confinement in a Massachusetts prison, Mark Cunningham tried to kill himself in 2010, advocates for inmates say.

Mr. Cunningham cut his legs and arms. He tried to hang himself with a tube from a breathing machine he used for sleep apnea. He smashed the machine to get a sharp fragment to slice his neck and ate pieces of it, hoping to cause internal bleeding. In June, 2011, after being placed in solitary confinement again, Mr. Cunningham, 37, hanged himself.

With that, Mr. Cunningham, who lawyers said had a long history of mental illness, including depression.

This is evidence that prisoners placed in solitary confinement should be watched all the time via closed circuit video.

I personally know of a situation where an inmate in the Guelph Reformatory who hanged himself in 1962 but was cut down before he died, was carried out of his cell, revived, stripped and thrown naked into solitary confinement. The superintendent of that facility was later fired because of the death of another inmate that was under his facility’s care.

In Summary

Prisoners are human beings even though some don’t act like human beings. Mentally ill prisoners are extremely vulnerable to what goes on in prisons and jails. It is for this reason that steps would be undertaken by prison authorities to make sure that such prisoners are properly treated for their illnesses.

Further, they should not be thrown into solitary confinement for simple and harmless infractions. Those who are susceptible to committing suicide should be carefully watched. It would be preferable that closed circuit video cameras be paced in suicide cells.

However I have to admit that even that won’t always prevent someone from committing suicide. When I was in the Toronto Detention Centre doing counselling, on occasion, I found guards asleep at their desks instead of constantly watching what was going on in the ranges. On one occasion, I found all three guards in one office asleep. As far as I am concerned, prison and jail guards who are asleep instead of watching their prisoners in the range are no different than bus drivers falling asleep while carrying a busload of passengers down a highway.

All prisons and jails should have psychologists, psychiatrists and social workers on staff so that mentally ill prisoners can get proper treatment. To release a mentally ill prisoner without making sure that he or she receives some form of treatment and a follow-up regimen that is created for each of the mentally ill prisoners is akin to releasing them into society while they are still infected by the plague.