Prison Inmates and Mental Illness

Only a small number of severely disturbed inmates are sent to an inpatient hospital unit for treatment, and after their release, they receive drastically inadequate follow-up care. Like sane inmates who have trouble managing their anger, mentally ill inmates have precarious control over their behavior and are often punished with solitary confinement for getting into fights or creating disturbances.

Prison inmates are sent to solitary confinement units or "supermax" facilities for disciplinary purposes when their behavior in the general prison population has been assessed as dangerous, violent or disruptive.

While some inmates do act in ways that make them a serious threat to the safety of the general population, others are sent to solitary confinement for minor offenses such as taking too long in the shower.

Most states (about two-thirds) have segregation units or "supermax" facilities where prison inmates are confined in cells for 23 out of 24 hours each day. They are allowed one hour out of their cells for exercise in a small contained area.

Some inmates use aggressive or disruptive behavior to cope with the traumatic stress of being in prison. These inmates are repeatedly sent to segregation units as punishment.

Each time, they emerge with increasingly more severe aggressive and violent behaviors, including criminal victimization of vulnerable inmates.

They come out looking for a target for their intense rage, and often that target is a mentally ill inmate who is too disoriented, depressed, or distracted by hallucinations to be able to defend himself.

Mentally ill inmates start out with limited resources to defend themselves against physical and sexual violence. If the targeted inmate is taking antipsychotic medication, his capacity to keep himself safe may be compromised even further by delayed reactions to stimuli. This is a common side effect of antipsychotic drugs.

Inmates with bipolar mania or paranoid schizophrenia are the most likely to be sent to solitary confinement as punishment for defiant or bizarre behavior.

Others, particularly inmates with post-traumatic stress disorder, choose to stay in their cells all day in order to avoid being attacked out on the exercise yard.

And for inmates with major depressive disorder or catatonic schizophrenia, isolation and withdrawal is a characteristic symptom of their illness.

Racism is another major dynamic underlying the violence, victimization, and madness in prisons. Kupers makes a direct connection between racism and mental health problems: "Blatant and unopposed racism has devastating effects on the mental health of prisoners," he says. "Quite a few prisoners of color are driven mad by the racism and their lack of recourse."

The racial discrimination that permeates the criminal justice system also infects correctional facilities, and Kupers points out that opportunities for inmates of color to correct racist injustices are extremely limited in the prison environment.

Inmates of color are frequently misidentified by prison staff as gang members and forced to "snitch" on other gang-involved inmates. In order to avoid the inevitably severe and violent consequences of naming real gang members, the informant will give the name of a socially isolated or mentally ill inmate who lacks the resources to launch a retaliatory attack.

As a result, mentally disturbed inmates with limited social skills are falsely identified as gang members and sent to segregation units.

This is best understood as a consequence of racist misconceptions among prison workers, and not as a reflection on the snitch's moral character. The snitch has only two alternatives to making false identifications: he can choose not to provide any names and be punished with solitary confinement, or he can supply names of real gang members and risk his life.

Not much of a choice.