Fault Lines
The forgotten US patients
Fault Lines' Josh Rushing reports on the fate of the mentally ill in US prisons.
Last Modified: 29 Aug 2010 17:31 GMT

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As the healthcare debate rages in the US, the fate of the hundreds of thousands of mentally ill people in jails and prisons in the US has been absent from the agenda.

In a special report, Fault Lines' Josh Rushing visited detention facilities in Texas to discover how inmates with mental illness are treated.

Homelessness has become a part of the landscape of every major city and town in the US, but it is often more than poverty that is to blame for the plight of the homeless.

While there are no exact figures, advocacy groups estimate that as many as 80 per cent of homeless people suffer from mental illness.

For many, this sad reality eventually leads to confrontations with the law, which explains how the mentally ill have come to make up more than half of the US prison population.

Houston in Texas has one of the nation's largest homeless populations. Incidents across the country in which police officers have shot and killed mentally ill individuals have forced law enforcement officials here to re-think their approach.

"As the years passed, we decided to take advantage of the resources of the mental health community," Chief Harold Hurrt of the Houston police says.

"And now, we are much more professional in our response in that we realise that jail is not the answer."
Houston is home to the nation's largest Crisis Intervention Team (CIT) unit. The programme partners police officers with mental health clinicians who attempt to allow distressed mentally ill individuals to recover in hospitals rather than detention facilities.

However, public hospitals are under-funded and over-crowded, meaning that if they offer any psychiatric services at all, it is only for the short term.

'New asylum'

Psychiatrists say jail is not an ideal environment to treat inmates

Meanwhile, long-term stay facilities have all but disappeared throughout the US.

Fewer than 40,000 Americans currently reside in psychiatric hospitals, while according to the Department of Justice, 30 times that number - 1.25 million mentally ill people - are serving time in US prisons.

"There's no question jails are the new asylums," says Dr E Fuller Torrey, the author of The Insanity Offence.

"I have tried to find a single county in the United States - we have over 3,000 counties in the United States - where the hospital still has more mentally ill people than the jails. In every country that I can find, the jail has more mentally ill people than the hospital."

Harris County jail in Houston is no exception. Each year 130,000 inmates pass through the facilty and the jail's authorities recently made significant changes to improve conditions for the mentally ill. 

At any given time it doses 2,500 inmates with psychotropic drugs, making it the largest mental health facility in Texas.

Andre Bonier is illiterate and has been living on the streets for 15 years.

He is in Harris County jail for the 31st time and has been diagnosed as schizophrenic.

"When he got here a week ago, he was a completely different person from what you were able to see today," says Dr Jackie Bickham.

"He was extremely aggressive, so aggressive that he had to be brought over directly from processing, had been on office meds, was combative, threatening, hostile, throwing faeces."

Andre has been charged with assaulting a family member, although he claims to have no recollection of it or understanding of the legal process he faces.

Treatment trouble

Charlie Brink says his
treatment in prison 'sucks'

The problems for Harris staff go beyond treating Andre's wellbeing - they have to prepare him for a trial, after which, if found guilty, he could be transferred into the Texas prison system.

"This is intended to be a jail, not a treatment centre, as much as we try, we create an environment that's as therapeutic as possible, it's staffed with professionals ... But it's still not a hospital setting," says Dr Patrick Seale.

The Texas prison system has more than 150,000 inmates and 112 units across the state. Fault Lines visited one facility, the Luther Unit, where two psychiatric staff are responsible for more than 1,300 inmates. 

Charlie Brink is serving a seven year sentence for drug charges. He says his treatment "sucks" and that he only sees a doctor once every six months.

"You go into a room and you look at the big screen TV and he's there on the TV and he can see you, but it's just not the same as talking to someone in person.

"To me prison is for people like child-molesters and rapists and murderers and stuff like that. It seems like we're not even treated like people here."

While direct contact with a doctor may be rare, prescription medications seem to flow through the corrections system without a problem.

The Texas Department of Criminal Justice refused numerous requests to speak with Fault Lines about its mentally ill population behind bars. 

At the heart of the issue is the crucial question of whether, if mentally ill people break the law in the US, jails should help or punish them.


The origins of the problem can be traced to insitutions such as the Rosewood Centre, near Baltimore in Maryland.

Founded in 1888 as an "Asylum and Training School for the Feeble Minded", such places were later criticised for often holding and medicating people against their will.

Starting in the 1960s, these institutions fell victim to political pressure from both the left and right.

Conservatives such as Ronald Reagan, the then governor of California, pressed for state budget cuts to reduce the size of what they called the welfare state, while civil liberties groups began an aggressive campaign against involuntary commitment, calling it a violation of patients' civil rights.

Lawyers and politicians argued that the mentally ill would do better in society and treated as out-patients by community mental health centres, but the idea never got off the ground.

"The whole idea behind de-institutionalisation turned out to be very well-meaning, but a disaster because there was not a plan for what was going to happen to people when they left the hospitals," says Dr Torrey.

"It's a major black mark. And I think the whole de-institutionalisation movement will go down in history as one of the great social disasters of the 20th century."

Mental gap

Torrey says the treatment of the mentally ill in prison is a 'black mark'

Healthcare has dominated the domestic agenda in the US recently, with fierce debate sparked by Barack Obama's proposed reforms of the system but advocates say mental illness has been conspicuously absent from the conversation.
Instead the administration has been touting so called "parity" legislation, which will require private insurance companies to cover mental illness.
But critics point out that people who are homeless or in prison often do not have access to insurance, and the legislation does not address the real problem.
Kathryn Power is the director of the Center for Mental Health Services and the highest-ranking federal official responsible for protecting the interests of the mentally ill.

"I have a very small programme," she says. "My jail diversion programme is a $10 million programme - that's not a very big programme. And [with a] $10 million programme we can perhaps fund five or six communities in the United States.

"I don't think anybody's proud that people with mental illnesses aren't getting that kind of care."

Two hours north of Houston, the Huntsville Unit, the oldest prison in Texas, releases dozens of prisoners every day

Bill Kleiber, a former inmate with bipolar disorder, greets them and trains volunteers to be the first point of contact for newly-released prisoners as they prepare to step out into the world.

'Human garbage'

He is assisted by Eric Strawhacker who was released from prison in April. In addition to coping with his mental illness, Eric now faces the additional stigma of being a convicted felon.

"It is really a travesty that we would take mentally ill people and cycle them through incarcerations," Kleiber says. "They're just cycled through there as big human warehouses.

"Come spend a day with me at the bus station. And see the human garbage we have created. A lot of those men were not like that when they went in there. And I'll take you in to some of these prisons and they walk around like zombies."

The healthcare discussion has become as ugly of a partisan debate as any in recent US history. Yet when it comes to treatment for the mentally ill, it is clear that the status quo is both potentially dangerous and inhumane.

"I think our era will be regarded with a great deal of wonderment as to why they allowed all those mentally ill people to be on the streets," Torrey says.

"You need leadership, you need professional leadership within the psychiatric profession and you also need political leadership. You need governors or someone in the White House or someone in the Department of Health and Human Services who says this is a problem that we can solve and we're going to solve it."

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