The Real Cost of Prisons Weblog

According to the federal Justice Department, roughly 16 percent of the inmates in American prisons have serious psychiatric illnesses. They are not in prison because they are mentally ill, but rather because they violated the law. If their crime is the result of their mental illness, efforts should be made through mental health courts to divert them from prison. But for the mentally ill who are sentenced to prison, there must be a recognition of their desperate need for help.

This recognition was absent when it came to the incarceration of thousands of mentally ill veterans returning from Vietnam who, because of drug and related crimes, ended up in prison. We cannot let it happen to those veterans returning from Afghanistan and Iraq who, because of the high incidence of mental disorders, may become involved with the criminal justice system.

As we treat prisoners who suffer physical disabilities, so too should we concern ourselves with the treatment of prisoners who suffer from mental illness. Winston Churchill once observed that one of the most unfailing tests of a civilization is how a country treats its criminals. How much more telling is the way a country treats its mentally ill prisoners.

Five years ago, Disabilities Advocates Inc. brought a lawsuit against the state Office of Mental Health and Department of Correctional Services. It sought to eliminate the destructive practice of placing mentally ill prisoners in punitive segregation known as The Box, a 6-by-8-foot cell where the prisoner is locked down for 23 hours a day.

The suit also addressed another aspect of New York's shame: The Loaf. If a mentally ill prisoner becomes disruptive or acts out in response to voices only he can hear, he is put in The Box. If, while in The Box, he continues to be obstreperous or demonstrate other manifestations of mental illness, he is punished by being fed The Loaf. It's a dense, binding one- pound loaf of bread consisting of potatoes and flour with a side portion of raw cabbage.

That lawsuit was settled, and although the settlement will lead to some improvements, it doesn't come close to resolving the problems presented by our abuse of the imprisoned mentally ill.

For example, as part of the lawsuit settlement, The Loaf may no longer be fed to the inmate for more than seven consecutive days, but it still may be used as a punishment. And the 23 hours a day of lockdown will be reduced to 21 hours a day. This has been heralded as a meaningful concession, but it is far from that.

For most inmates, the extra hour a day, if he is returned to The Box, is useless. When you are caged like an animal in a cell not much larger than a bathroom, losing all sense of time, beset by noises and smells that defy description, being told that you can spend an extra hour or two in an isolated outdoor cage subject to cat calls from other inmates is not beneficial. Being returned to the hole in isolation makes the drill counterproductive and the prisoner even more dysfunctional.

My observations in this regard are not premised on academic theory. I spent more than a month in solitary confinement in a mental health prison unit. I can tell you from that tortured and mind-bending experience that psychiatrists or medical professionals, not prison guards, should oversee mentally ill inmates, and that no severely mentally ill prisoner should ever be put in The Box.

As The Correctional Association of New York recently reported: "On nearly every site visit, we encountered at least one or two individuals in disciplinary lockdown who were active psychotic, delusional or immobilized by depression ... who mutilated their own flesh, who hadn't left their cell in months and repeatedly attempted suicide." One such diagnosed schizophrenic, covered with scars from attempted suicides, "has spent 13 of his 15 years of incarceration in solitary confinement."

Earlier this month, the state Senate unanimously passed legislation that would eliminate solitary confinement for prisoners who are seriously mentally ill. The Assembly is in the process of passing the same legislation. This legislation will allow New York to join the many states, including New Jersey, Connecticut, California, Texas and Florida in keeping the seriously mentally ill out of solitary confinement. Similar legislation was passed last year but vetoed by Gov. George Pataki.

Gov. Eliot Spitzer has already shown his concern for this problem by committing substantial funding for psychiatric services for prisoners. Those who have studied the proposed legislation, which will keep seriously mentally ill prisoners out of solitary confinement, are in agreement that the funds the governor has already committed for the care of mentally ill prisoners would cover the costs of this necessary reform. It is the earnest prayer of those who abhor the mistreatment of the mentally ill that Spitzer sign the legislation.

We have seen the return of the "cold mercy of custodial isolation" in our criminalizing of mental illness. You don't have to be a trained penologist or psychiatrist to know that a mentally ill person should not be put in solitary confinement.

Not only is such internment uncivilized, it is also counterproductive. Most of the inmates will one day return to the streets in a worse state than they were when arrested.

Sol Wachtler is the former chief judge of New York. http://www.timesunion.com/AspStories/storyprint.asp?StoryID=597825