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Whatever the cause of increased imprisonment rates, the already-overburdened criminal justice system cannot cope with the current volume of mentally ill offenders. While the National Commission on Correctional Health Care (NCCHC) has set standards for identifying and treating mentally unstable criminals and providing them with appropriate care, these guidelines are seldom met. Over its two-year study of the US penitentiary system, HRW found that only 237 prisons meet the NCCHC accreditation standard. In its 2003 report, HRW also identified numerous specific problems with mental healthcare in prisons: understaffing, failure to identify inmates in need of care, failure to provide treatment and access to medication, and a lack of crisis care and suicide prevention programs. Additionally, HRW reported that many problems derive from a lack of education of prison staff. Prison guards, trained as they are to ensure discipline, often accuse mentally ill offenders of malingering, rather than empathizing and ensuring that they receive adequate medical attention.
Prison conditions may augment the frequency of mental illness. HRW writes that prison is “not only serving as a warehouse for the mentally ill, but, by relying on extremely restrictive housing for mentally ill prisoners, it is acting as an incubator for worse illness and psychiatric breakdowns.” HRW argues that the conditions in overcrowded prisons, in conjunction with abusive fellow prisoners and unsympathetic prison guards who are not trained to deal with mental illness, often worsen inmates’ mental problems.
Many mental health advocacy groups, including HRW, also maintain that the lack of follow-up care is largely responsible for the high recidivism rates in criminality amongst mentally ill offenders. The Bureau of Justice Statistics reports that 81.2 percent of the mentally ill in state prisons have prior criminal histories, 26.3 percent have three to five prior sentences of probation or incarceration, 15.6 percent have six to ten, and 10 percent have eleven or more. While the Bureau of Justice Statistics also reports that 64 percent of prison systems provide some follow-up care, HRW comments that “the percentage of mentally ill ex-prisoners who actually receive transitional care is unknown as is the quality of that care.” HRW and others posit that a lack of post-incarceration planning, failure to secure financial assistance for treatment, and shortage of ex-offender programs all contribute to high recidivism rates.
Despite mounting evidence of a mental health crisis in the American prison system, politicians continue to support the imprisonment of the mentally ill, rather than sending them to treatment centers and hospitals. For politicians seeking to cut costs, incarceration of the mentally ill is appealing: prison costs less than half of alternative treatment. Dr. Fred Maue, of the Pennsylvanian Department of Corrections, comments: “State hospitals cost $90-$100,000 per year per patient. In prison, a seriously mentally ill individual is imprisoned and treated for around $35,000.” Nevertheless, many mental health advocates have argued that fixing the system would save costs in the long-term by decreasing rates of repeat incarceration.
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