More than half of the nation's jail and prison inmates suffer from mental health problems, according to a report released Wednesday that comes as California faces a prison crowding crisis and court orders compelling major changes in mental health care behind bars.
The study, by the research arm of the U.S. Department of Justice, confirms what wardens, convicts and correctional officers already know -- that large numbers of inmates routinely display symptoms of depression, mania or psychotic disorders.
Based on a representative survey of more than 25,000 prisoners nationwide, the report found that mental health problems were associated with an inmate's violence and prior convictions. Those state prisoners with mental problems were more likely to have had at least three prior incarcerations and to have had broken prison rules.
Mentally ill inmates also were twice as likely as other convicts to have been injured in a prison fight, and substantially more likely to have been abused as a child and homeless in the year before their arrest. Three out of four were dependent on drugs and alcohol, with 37% saying that they used drugs at the time of their crime.
Mental health experts called the study disturbing. They said it illustrated a direct relationship between gaps in community mental health care and the large numbers of mentally ill people winding up in the criminal justice system.
"If one out of three people incarcerated in this country are receiving mental health treatment, it shows that there is something very wrong with the way services are delivered in the community," said Bill Emmet of the Washington-based Campaign for Mental Health Reform, a coalition of advocacy groups. "People need services before they do something that might result in their incarceration."
The report comes as California struggles to cope with an overcrowding crisis that has made caring for mentally ill inmates increasingly difficult. More than 172,000 inmates are jammed into the state's 33 prisons, with 16,000 of them in gyms, hallways and other spaces not intended as housing. By next summer, corrections officials said, they will be out of room altogether.
In 1995, the corrections department settled a class-action lawsuit over inmate mental health care, agreeing to improve treatment. But serious problems remain.
"We consider the system in crisis," partly because crowding has reduced space for treatment and has increased tensions among convicts, said Jane Kahn, an attorney representing inmates in the long-running case.
"It's very difficult even to get men out onto the [prison] yard or in any kind of recreational program," Kahn said, "which just adds to the problems facing the mentally ill."
Other problems include a 1,000-bed shortage of space for inmates whom authorities consider so disturbed that they cannot live in the general population, and an upward trend in suicide behind bars. California's prison suicide rate is nearly double the national average -- 27 deaths per 100,000 inmates, compared with a national rate of 14 per 100,000, according to the Bureau of Justice Statistics.
Last month, the federal judge overseeing the mental health case, expressing increasing frustration over the state's lack of progress, ordered the immediate hiring of 550 psychiatrists and other prison mental health staff.
In the meantime, the corrections department has embarked on a plan to add $600 million in beds for mentally ill inmates at several prison sites. Staffing will add considerably more to the cost, expanding a prison system budget that now exceeds $8 billion a year.
U.S. District Judge Lawrence Karlton, who has presided for 11 years over the mental health case, acknowledged that raising care for inmates to constitutional standards would be "horrifically expensive."
That, he added at a court hearing in April, is because "the prisons have become, in effect, mental hospitals."
Referring to the 1960s-era decision by California to close its state mental hospitals, Karlton added: "The state has made that judgment, and now the state has to pay the piper."
The study, by the Bureau of Justice Statistics, can be found at www.ojp.usdoj.gov/bjs/abstract/mhppji.htm.