Punishment or Rehabilitation? Care for Inmates with Mental Illness
by April Mancino-Rosete, DRT Investigator
The debate between punishment and rehabilitation has been a persistent theme in the corrections world. It is well known that recidivism rates are high among those being released from jails and prisons. While there is consensus in the desire to see those rates decrease, there continues to be controversy about which intervention to use – especially for inmates with behavioral health diagnoses.
In 2016, the Tennessee Department of Corrections (TDOC) was responsible for over 20,000 inmates. Of those inmates, over 5,500 received treatment of a diagnosed behavioral health issue, or approximately 20% of the inmate population in Tennessee.
Disability Rights Tennessee (DRT) conducts numerous investigations regarding the care and rights of people with disabilities who are incarcerated in our state prisons. In most cases, prisons are not set up to be treatment facilities for persons with mental illness and the environmental conditions of a prison often exacerbate symptoms present from an inmate’s behavioral health diagnosis. It is also notable that the majority of Tennessee’s inmates are serving time for non-violent charges, such as drug related offenses, which carry an average sentence of 7-10 years.
So what happens to an inmate who has a behavioral health crisis in prison?
Picture this: An inmate who has a behavioral health diagnosis is assaulted by another inmate. The inmate reports pain from his injuries because the pain medication he was given is wearing off. As his pain increases, he asks a guard to see the medical care team. He is told to fill out a sick call form because his pain is “not an emergency.” This inmate knows that it could be the next day before he can talk to medical staff. He begs and pleads the guards to no avail. So, he resorts to a behavior that is not new to him. Even before he came to the prison he often cut himself to deal with the stressors of life. He finds a razor and begins to slice his arms and stomach. In response, five members of the Certified Emergency Response Team (CERT) forcibly remove him from his cell. He is taken to a single cell on the medical unit, his superficial injuries are treated, and he is placed under suicide watch.
Suicide watch generally consists of an inmate being placed in a single cell with no clothes, blankets, reading material or personal items. The inmates are often limited to finger foods only and have reported that water in the cell is turned off. They are checked on every 15 minutes. These conditions often cause inmates to become increasingly agitated and, in some cases, they continue to self-harm. If behavior continues, many inmates in these restrictive environments are then placed in 6-point restraints (pictured below).
Image: 6 Point Restraint
A Real DRT Case
In one recent case, DRT served an inmate with a behavioral health diagnosis who was placed in 6-point restraints while on suicide watch. The inmate’s upper arms, wrists, thighs and ankles were strapped down to a flat metal bed with a thin mattress pad. Unclothed, a weighted blanket covered his body. He wore cotton mittens over the palms of his hands. He was restrained in the middle of an empty room – white cinderblock walls, no TV, no reading materials, no radio, no visits. The lights remained on at all times. The allowable time frame for inmates to be in restraints varies and can range from a day to months depending on the reason for the restraints. Regardless of time, the experience is utterly restrictive and isolating.
Once inmates are removed from the restraints they are often kept in segregated housing, with restrictions similar to the suicide watch protocol. When time has passed without incident and they are determined by the behavioral health provider to be stable, they are moved back into their general population assignment.
These inmates may or may not be offered mental health treatment or the opportunity to learn alternative behavior resolutions. Instead, many inmates report nightmares and PTSD symptoms directly related to their experiences in restraint and segregated housing. It should be considered that these individuals will complete their sentence and be released back into the community, often with more psychological trauma then before they went in.
Given these factors, are inmates in mental health crisis receiving adequate care? What do you think? Punishment or rehabilitation?