The Criminalization of People with Mental Illness
NAMI’s Position (Summarized from the NAMI Policy Platform)
Treatment, not punishment:
NAMI believes that persons who have committed offenses due to states of mind or behavior caused by a brain disorder require treatment, not punishment. NAMI believes that a prison or jail is never an optimal therapeutic setting. NAMI believes that mental health systems have an obligation to develop and implement systems of appropriate care for individuals whose untreated brain disorders may cause them to engage in inappropriate or criminal behaviors.
Treatment while in correctional settings:
NAMI believes that states and communities have legal and ethical obligations to provide people with brain disorders humane and effective treatment while in correctional settings.
Training and education:
NAMI believes that education about brain disorders at all levels of judicial and legal systems is crucial to the appropriate disposition of cases involving offenders with brain disorders. Judges, lawyers, police officers, correctional officers, parole and probation officers, law enforcement personnel, court officers, and emergency medical transport and service personnel should be required to complete at least 20 hours of training about these disorders. Consumers and family members should be a part of this educational process.
NAMI believes that, in the overwhelming majority of cases, dangerous or violent acts committed by persons with brain disorders are the result of neglect or inappropriate or inadequate treatment of their illness.
NAMI supports the retention of the "insanity defense" and favors the two-prong test that includes the volitional as well as the cognitive standard. NAMI opposes the adoption of "guilty but mentally ill" statutes. NAMI supports systems that provide comprehensive, long-term care and supervision in hospitals and in the community to individuals found "not guilty by reason of insanity," "guilty except for insanity, or any other similar terminology used in state statutes pertaining to the insanity defense.
Parole and probation, transitional services:
NAMI believes that states must adopt systems for assisting individuals with serious brain disorders who have served sentences and are eligible for release on parole with appropriate treatment and services to aid their transition back into the community.
NAMI opposes the death penalty for persons with brain disorders.
The "Criminalization" Trend Is Today Worse Than Ever
In 1992, NAMI and Public Citizen’s Health Research Group released a report, entitled Criminalizing the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals, which revealed alarmingly high numbers of people with schizophrenia, bipolar disorder, and other severe mental illnesses incarcerated in jails across the country. Most of these people had not committed major crimes, but either had been charged with misdemeanors or minor felonies directly related to the symptoms of their untreated mental illnesses, or had been charged with no crimes at all. Unfortunately, the problems described in that report have worsened in the ensuing years.
A report issued by the United States Department of Justice in 1999 revealed that 16 percent of all inmates in state and federal jails and prisons have schizophrenia, manic depressive illness (bipolar disorder), major depression, or another severe mental illness. This means that on any given day, there are roughly 283,000 persons with severe mental illnesses incarcerated in federal and state jails and prisons. In contrast, there are approximately 70,000 persons with severe mental illnesses in public psychiatric hospitals, and 30 percent of them are forensic patients. Additionally, police are increasingly becoming front-line respondents to people with severe mental illnesses experiencing crises in the community.
Conditions in jails and prisons are often terrifying for people with severe mental illnesses. These settings are not conducive to effectively treating people with these brain disorders. Many correctional facilities do not have qualified mental health professionals on staff to recognize and respond to the needs of inmates experiencing severe psychiatric symptoms. Correctional facilities frequently respond to psychotic inmates by punishing them or placing them in physical restraints or administrative segregation (isolation), responses that may exacerbate rather than alleviate their symptoms. Inmates with severe mental illnesses usually do not have access to newer, state-of-the-art, atypical antipsychotic drugs because of the costs of these medications. Federal and state prisons generally do not have adequate rehabilitative services available for inmates with severe mental illnesses to aid them in their transition back into communities.
These alarming trends are directly related to the inadequacies of community mental health systems and services. The widespread adoption of systems with proven effectiveness in addressing the needs of people with the most severe mental illnesses, such as assertive community treatment programs, would sharply decrease the numbers of people with severe mental illnesses involved in criminal justice systems.
However, since these programs are available only sporadically throughout the country, NAMI’s strategies for reducing criminalization focuses both on improving community mental health services and on addressing the treatment and support needs of people with severe mental illnesses in criminal justice systems.
Strategies for Reducing the Criminalization of People with Severe Mental Illnesses:
NAMI is pursuing the following strategies for reducing the criminalization of people with severe mental illnesses:
- Adopting programs such as the Memphis Police Crisis Intervention Team (CIT) program to train police officers who come into contact with people with severe mental illnesses in the community to recognize the signs and symptoms of these illnesses and to respond effectively and appropriately to people who are experiencing psychiatric crises.
- Supporting mechanisms to divert people with severe mental illnesses from arrest and incarceration into treatment before they are arrested and come into contact with correctional and court systems. In FY 2002, Congress appropriated $4 million for the federal Jail Diversion program at the Center for Mental Health Services (CMHS) authorized under P.L. 106-310 (Section 520g). NAMI urges full funding of $10 million for this program in FY 2003.
- Creating authority in state criminal codes for judges to divert non-violent offenders with severe mental illnesses away from incarceration into appropriate treatment. This includes authority for judges to defer entries of judgment pending completion of treatment programs and to dismiss charges and expunge the records of individuals who successfully complete treatment programs.
- Establishing specialty "mental health courts" to hear all cases involving individuals with severe mental illnesses charged with misdemeanors or non-violent felonies, with the purpose of diverting as many of these cases as possible away from criminal incarceration into appropriate mental health treatment and services. In 2000, Congress enacted and former President Clinton signed into law a bill (P.L.106-515) authorizing grants to communities to establish demonstration mental health courts. In fiscal year (FY) 2002, Congress appropriated $4 million for these Courts. One of NAMI’s priorities is to ensure that Congress appropriates full funding of $10 million for these Courts as part of the FY 2003 Commerce-Justice-State Appropriations bill.
- Training probate, civil, and criminal court judges and other Court personnel about severe mental illnesses and legal issues affecting people with these illnesses.
- Creating specialized divisions or units within departments of parole and probation with specific responsibility for coordinating and administering services for people with severe mental illnesses who are on probation.
- Providing specialized training to parole officers about severe mental illnesses, the needs of people with these illnesses on probation, and treatment resources and benefits available to these individuals.