STUDY: PRISONS SERVE AS MENTAL HOSPITALS

The first comprehensive study of the rapidly growing number of emotionally
disturbed people in the nation's jails and prisons has found that there are
283,800 inmates with severe mental illness, about 16 percent of the total
jail population. The report confirms the belief of many state, local and
federal experts that jails and prisons have become the nation's new mental
hospitals.

The study, released by the Justice Department yesterday, paints a grim
statistical portrait, detailing how emotionally disturbed inmates tend to
follow a revolving door from homelessness to incarceration and then back to
the streets with little treatment, many of them arrested for crimes that
grow out of their illnesses.

According to the report, mentally ill inmates in state prisons were more
than twice as likely to have been homeless before their arrest than other
inmates, twice as likely to have been physically and sexually abused in
childhood and far more likely to have been on drugs or alcohol.

In another reflection of their chaotic lives, the study found that
emotionally disturbed inmates had many more previous incarcerations than
other prisoners. More than three quarters of them had been sentenced to
jail or prison before, and half had served three or more prior sentences.

Many of them were arrested for bizarre public behavior or petty crimes like
loitering or public intoxication. But the report, by the Justice
Department's Bureau of Justice Statistics, also found that mentally ill
inmates in state prisons were more likely than other prisoners to have been
convicted of a violent crime.

Moreover, once incarcerated, emotionally disturbed inmates in state prisons
spend an average of 15 months longer behind bars than other prisoners,
often because their delusions, hallucinations or paranoia make them more
likely to get in fights or receive disciplinary reports.

"This study provides data to show that the incarceration of the mentally
ill is a disastrous, horrible social issue," said Kay Redfield Jamison, a
professor of psychiatry at the Johns Hopkins School of Medicine. "There is
something fundamentally broken in the system that covers both hospitals and
jails," said Jamison, the author of "Night Falls Fast: Understanding
Suicide," to be published later this year by Knopf.

With the wholesale closings of public mental hospitals in the 1960s, and
the prison boom of the past two decades, jails and prisons are often the
only institutions open 24 hours a day and required to take the emotionally
disturbed.

The hospitals were closed at a time when new antipsychotic drugs made
medicating patients in the community seem a humane alternative to long-term
hospitalization. From a high of 559,000 in 1955, the number of patients in
state hospitals dropped to 69,000 in 1995.

But drugs work only when taken, and many states failed to build a promised
network of clinics to monitor patients. To compound the problem, for-profit
hospitals began turning away the psychotic.

At the same time, the number of jail and prison beds has quadrupled in the
last 25 years, with 1.8 million Americans now behind bars.

"Jails have become the poor person's mental hospitals," said Linda A.
Teplin, a professor of psychiatry and director of the psycho-legal studies
program at Northwestern University.

All previous estimates of the number of emotionally disturbed inmates have
been based on research by Teplin in the Cook County Jail in Chicago. She
found that 9.5 percent of male inmates there had experienced a severe
mental disorder like schizophrenia, manic depression or major depression,
four times the rate in the general population.

Teplin said that while she welcomed the Justice Department count, it was
open to question because the study relied on reports by the inmates
themselves, who were asked whether they had a mental condition or had ever
received treatment for a mental problem. People with emotional disorders
often are not aware of them, or do not want to report them, she said, so
the Justice Department estimate of more than a quarter million inmates with
mental illness may actually be too low, Teplin said.

In addition, Teplin said, the study was not conducted by mental health
professionals using diagnostic tests, so it was impossible to tell what
mental disorders the inmates suffered from, and whether they were severe
illnesses, like schizophrenia, or generally less severe problems, like
anxiety disorders.

One of the most striking findings in the study, and the one most likely to
be disputed, is that mentally ill inmates were more likely to have been
incarcerated for a violent offense than other prisoners, with 53 percent of
emotionally disturbed inmates in state prisons sentenced for a violent
crime, compared with 46 percent of other prisoners.

Specifically, the report found that 13.2 percent of mentally ill inmates in
prisons had been convicted of murder, compared with 11.4 percent of other
prisoners, and 12.4 percent of mentally ill inmates had been convicted of
sexual assault, compared with 7.9 percent of other prisoners. Emotionally
disturbed inmates in state prisons had also been convicted of more property
crimes, but were only half as likely to have been sentenced for drug crimes.

Advocates for the mentally ill have worked hard to show that emotionally
disturbed people are no more violent than others, to try to lessen the
stigma surrounding mental illness. But recent research, while confirming
that mentally ill people may not be more violent than others, suggests that
they can become violent in a number of conditions, including when they are
off their medications, are actively psychotic or are taking drugs or alcohol.

In another important finding, also subject to differing interpretations,
the study found that reported rates of mental illness varied by race and
gender, with white and female inmates reporting higher rates than black and
male inmates. The highest rates of mental illness were among white female
state prisoners, with an estimated 29 percent of them reporting emotional
disorders, compared with 20 percent of black female prisoners. Overall,
22.6 percent of white state prisoners were identified as mentally ill,
compared with 13.5 percent of black prisoners.

Dr. Dorothy Otnow-Lewis, a psychiatrist, said the differences were a result
of white psychiatrists "being very bad at recognizing mental illness in
minority individuals." Psychiatrists are more likely to dismiss aggressive
behavior in men, particularly black men, as a result of their being bad,
rather than being mad, said Otnow-Lewis, who is a senior criminal justice
fellow at the Center on Crime, Communities and Culture of the Soros
Foundation.

Michael Faenza, president of the National Mental Health Association, said
the finding that mentally ill inmates tend to have more previous
incarcerations than other prisoners "shows that the criminal justice system
is just a revolving door for a person with mental illness, from the street
to jail and back without treatment."

Jamison noted that jails and prisons are not conducive to treatment, even
when it is available. "Inmates get deprived of sleep," she said, "and
isolation can exacerbate their hallucinations or delusions."