How the Justice System Fails Those with Mental Illness

Recently, I was having a conversation with a friend, and she brought up a story she heard on the news. A man who was believed to have a mental health condition was recently released from prison; soon after, he was rearrested for a crime similar to his first offense. My friend concluded that he never should have been released in the first place. A few years ago, I might have thought the same thing. Now, unfortunately, I’ve found myself with a front row seat to what it really means to be incarcerated.

Many believe that if someone released from prison is rearrested, they were probably not incarcerated long enough. Accordingly, recidivism is a major concern for Departments of Corrections (DOCs).

In Connecticut, where I live, the DOC describes itself as, “striving to be a leader in progressive and partnered re-entry initiatives to support responsive evidence-based practices geared toward supporting reintegration and reducing recidivism.” The department, however, does not appear to be achieving this goal; the most recent documented recidivism rate is 79%.

This failure is not surprising to me, based on my experience with my son who is incarcerated in the state. He was a senior in high school and experienced an acute episode of psychosis. Despite the fact that he has not been found guilty of a crime, he has spent the last four years languishing, without any productive uses for his time, in a cell the size of a parking space.

Recovery for SMI is possible with timely, meaningful treatment. But we cannot expect to make progress when we keep those in a mental health crisis in dehumanizing environments that exacerbate their symptoms. I believe my home state’s flawed system perpetuates the revolving door of our correctional facilities. If the system is unable to address the unique needs of someone with SMI, how can the DOC ensure successful reintegration back into our communities?

My Son’s Experience with DOC Mental Health Care

Of Connecticut’s incarcerated population, 5.5% (including my son) has been classified as a Mental Health (MH) level of 4 or 5, meaning they have treatment needs at a severe or crisis level. However, the current facilities are not equipped to provide the level of services he needs (they are also poorly equipped to provide care for lower levels).

The DOC employs mental health counselors — many of whom are empathetic, attentive and well meaning, but also have limited training. For example, they are not trained to offer Cognitive Behavioral Therapy (CBT) for someone with psychosis or trained in understanding anosognosia, a lack of awareness of one’s mental health condition.

Additionally, the mental staff they do have is severely overworked and understaffed. There is a high rate of turnover in medication prescribers— my child is on his fourth provider. After years of incarceration, he was finally seen by an Advanced Practice Registered Nurse (APRN), his third prescriber, who put him on an effective medication regimen including an anti-psychotic that has been beneficial. She has since resigned.

Thankfully, my son is still on the medication regimen and responding well. However, working against the medication are the traumatizing aspects of prison and the imposed inability to use his mind or body in a productive way. The facility provides no space to exercise, and he is not permitted to go outdoors in the winter months, so he has no access to daylight. There are occasional vocational courses offered (that come with long wait lists), however, my son is ineligible for a college course solely because he’s in a mental health unit. The food is filled with additives and lacks any nutrition. So, while the medication improves his illness, every other aspect of his environment exacerbates it.

My Son’s Experience, Sadly, is Not Unique

Due to closures of mental health hospitals, prisons are now housing more and more people with mental illness. According to the Connecticut Memo on Mental Health, in May of 2020 in Connecticut, 28% of the prison population was deemed to have an active mental illness requiring treatment. By January 2022, this number climbed to 32%. In the U.S., those living with SMI are 10 times more likely to end up in prison than in a hospital. In fact, America’s three largest mental health facilities are prisons.

Our prison system is an unnerving environment in which people seem to exist in a constant state of fight or flight. This frightening situation is compounded by mental illness symptoms, like psychosis, which causes confusion about what’s real, leaving incarcerated people with mental illness even more vulnerable. This struggle is even more disconcerting when existing in a space about the size of a bathroom where the most basic necessities — like a spork to eat or a pillow to rest your head — can be difficult to access.

Through my experience with my son, I have met dedicated mental health providers in our prison system. However, they are severely under-resourced, and they are forced to focus solely on symptom management rather than recovery. It is not surprising, then, that people with SMI serve longer sentences for the same crimes as those without mental health conditions. For my child in prison, being brought to the “infirmary” has meant demoralizing strip searches and isolation for 23 hours a day. This is how mental illness is “managed” during a crisis.

We Must Make Changes

Prisons need to escalate their mental health services to be aimed at recovery, not maintenance for people who are living in anguish. Corrections officers should have training to appropriately recognize and address people in crisis. Modalities beyond medication and counseling that can aide in healing should be available, like meditation, education, exposure to daylight, exercise and nutritious food.

When it comes to recidivism for those with mental illness, it’s not the person who is the problem; rather, the person has a problem, an illness, that has only been made worse by incarceration. Consider that nationally about 95% of people incarcerated are released back into their communities. If we truly want to make our communities safer, we must do better to ensure people come home healthy and well prepared to reintegrate — not sick or stuck in a state of hopelessness.

My son is now in his fourth year of waiting to have his case adjudicated. He is still unsentenced. He has not been found guilty of a crime, yet his right to wellness has been revoked. He has been living in dehumanizing conditions waiting to move his case through the court system.

This process has only added to the collateral damage of his first episode of psychosis. There is no consideration of what’s at stake to his health as we wait to have his case adjudicated. And every day, we wait for him to receive meaningful treatment is another day that pulls him from the possibility of ever having a healthy, fulfilling life.

Denise Paley is on the Connecticut State Advisory Board for the Department of Mental Health and Addiction Services and is a Board Member of NAMI Shoreline. She is a mental health and prison reform advocate, frequently testifying for laws to improve prison conditions in Connecticut. and have been testifying for laws to improve conditions here in CT.