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What would happen if these prisoners were not cared for properly

We commend the Subcommittee for recognizing the importance of securing respect for human rights here in the United States as well as overseas. The specific focus on the rights of persons who have a mental illness and who are incarcerated in the United States is particularly welcome. Human Rights Watch has worked for many years to improve protection for the rights of US prisoners, including those with mental illnesses, and we stand ready to assist the Subcommittee with its efforts in any way we can.

In this statement we will present a brief overview of the problems faced by mentally ill persons who are incarcerated and the human rights that are implicated. Prisons and Prisoners with Mental Illness: Overview Prisons were never designed as facilities for the mentally ill, yet that is one of their primary roles today. Many of the men and women who cannot get mental health treatment in the community are swept into the criminal justice system after they commit a crime.

According to the Bureau of Justice Statistics, 56 percent of state prisoners and 45 percent of federal prisoners have symptoms or a recent history of mental health problems. Mental health treatment can help some prisoners recover from their illness and for many others it can alleviate its painful symptoms, prevent deterioration, and protect them from suicide.

It can enhance independent functioning and encourage the development of more effective internal controls. By helping individual prisoners regain health and improve coping skills, mental health treatment promotes safety and order within the prison environment and enhances community safety when prisoners are ultimately released.

Unfortunately, prisons are ill-equipped to respond appropriately to the needs of prisoners with mental illness. Prison mental health services are all too frequently woefully deficient, crippled by understaffing, insufficient facilities, and limited programs.

Many seriously ill prisoners receive little or no meaningful treatment. Although there are many conscientious and committed mental health professionals working in corrections, they face daunting if not insurmountable challenges to meeting the needs of their patients: Gains in mental health staffing, programs, and physical resources that were made in recent years have all too frequently since been swamped by the tsunami of prisoners with serious mental health needs.

Overburdened staff are hard pressed to respond even to psychiatric emergencies, much less to promote recovery from serious illness and the enhancement of coping skills. Mindful of budget constraints and scant public support for investments in the treatment as opposed to punishment of prisoners, elected officials have been reluctant to provide the funds and leadership needed to ensure prisons have sufficient mental health resources.

Twenty-two out of forty state correctional systems reported in a recent survey that they did not have an adequate number of mental health staff. They are afflicted with delusions and hallucinations, debilitating fears, or extreme mood swings. They huddle silently in their cells, mumble incoherently, or yell incessantly.

They refuse to obey orders or lash out without apparent provocation. They beat their heads against cell walls, smear themselves with feces, self-mutilate, and commit suicide. Doing time in prison is hard for everyone. Prisoners struggle to maintain their self-respect and emotional equilibrium in facilities that are typically tense, overcrowded, fraught with the potential for violence, cut off from families and communities, and devoid of opportunities for meaningful education, work, or other productive activities.

But life in prison is particularly difficult for prisoners with mental illnesses that impair their thinking, emotional responses, and ability to cope. They are more likely to be exploited and victimized by other prisoners. They are less likely to be able to what would happen if these prisoners were not cared for properly to the countless formal and informal rules of a strictly regimented life and often have higher rates of rule-breaking than other prisoners.

  • With mental illness so prevalent in U;
  • As you can imagine, many people consider mental health treatment among prisoners to be a low funding priority compared to other federal programs, such as college student financial aid;
  • Given the investment that taxpayers make in the criminal justice system, it is reasonable for the public to expect a return on their investment in the form of lower repeat criminal activity;
  • Jacques Baillargeon, Ingrid A.

Supermaximum Security Prisons and Isolation When mentally ill prisoners break the rules, officials punish them as they would any other prisoner, even when their conduct reflects the impact of mental illness. Once isolated, continued misconduct-often connected to mental illness-can keep them there indefinitely. A disproportionate number of the prisoners in segregation are mentally ill. Prisoners are confined 23 to 24 hours a day in small cells that frequently have solid steel doors.

They live with extensive surveillance and security controls, the absence of ordinary social interaction, abnormal environmental stimulus, a few hours a week of "recreation" alone in caged enclosures, and little, if any, educational, vocational, or other purposeful activities.

They are handcuffed and frequently shackled every time they leave their cells. Prolonged confinement under such conditions can be psychologically harmful to any prisoner, with the nature and severity of the impact depending on the individual, the duration, and the specific conditions for example, access to natural light, radio, or books.

It can provoke anxiety, depression, anger, cognitive disturbances, perceptual distortions, obsessive thoughts, paranoia, and psychosis. The stress, lack of meaningful social contact, and unstructured days can exacerbate symptoms of illness or provoke a reoccurrence. Suicides occur proportionately more often in segregation units than elsewhere in prison. All too frequently, mentally ill prisoners decompensate in isolation, requiring crisis care or psychiatric hospitalization.

Many simply will not get better as long as they are isolated. According to one federal judge, putting mentally ill prisoners in isolated confinement "is the mental equivalent of putting an asthmatic in a place with little air.

  • Prisoners are confined 23 to 24 hours a day in small cells that frequently have solid steel doors;
  • To make mental health care in state and federal prisons a national priority, a transformation in how we view the role of prisons is needed;
  • While prisoners have access to basic health care, treatment for mental health conditions is less broadly provided;
  • Some may debate the connection between disorder and usefulness, but it is beyond contention that the rise in the number of persons incarcerated has been yoked to the rise of disordered persons incarcerated.

The psychological harm of supermaximum security confinement is exacerbated because mental health professionals are not permitted to provide a full range of mental health treatment services to the prisoners. Mental health services are typically limited to psychotropic medication, a health care clinician stopping at the cell front to ask how the prisoner is doing that is, "mental health rounds"and occasional meetings in private with a clinician.

Mental Illness, Human Rights, and US Prisons

Improved clinical responses of prisoners with mental illness in these prisons have been achieved without compromising safety or security. Unfortunately, except in the small number of prisons covered by this litigation, mentally ill prisoners continue to be sent to segregation; indeed, they are often disproportionately represented in segregation units.

Re-entry There is increasing awareness among public officials of the importance of providing re-entry services to prisoners leaving prison as an effective means of increasing the likelihood they will successfully make the transition back to the community.

Men and women with mental illness have unique needs for discharge planning and re-entry services. In addition to support for housing, employment, and income, they also need links to appropriate mental health treatment and access to public assistance.

According to the Council of State Governments: All too many mentally ill prisoners leave prison without arrangements to ensure they will continue to receive an appropriate level of mental health treatment, without ready access to public assistance, and without assistance to navigate the difficult waters of life after prison, in which the stigma of being a felon now accompanies all the problems that existed before incarceration.

Mental Health and American Prisons: A Human Rights Framework Human rights standards acknowledge the unique vulnerability of prisoners to abuse and afford special protections to them.

The UN Human Rights Committee has affirmed the "positive obligation" of states to protect the rights of those whose vulnerability arises from their status as persons deprived of their liberty. A prison operated within a human rights framework would provide a full range of mental health services with the staffing, resources, and facilities needed to serve the prison's population.

Custodial policies and practices would be adjusted to ensure security and safety needs do not compromise mental health treatment. Staff would no longer constantly find themselves forced to choose between what they know they "should" be doing in terms of standards of care and sound principles of treatment, and what is feasible in the circumstances.

Respect for human rights of prisoners not only underpins and protects the fundamental values agreed on by the international community, it promotes safe and effective prison management. Unfortunately, human rights standards are all too often honored in the breach in US prisons. They are little known and almost never directly applied. Right to Humane Treatment and Rehabilitation All human rights are grounded in the inherent dignity of all persons, as affirmed in 1948 by the Universal Declaration of Human Rights.

Recognizing the temptation to ignore the human dignity of persons who are confined in prisons, article 10 1 of the International Covenant on Civil and Political Rights ICCPRto which the United States is a party, expressly requires all prisoners to be treated, by all officials and anyone else, "with humanity and with respect for the inherent dignity of the human person.

The failure to provide adequate mental health services in prison cannot be excused by the cost of ensuring adequate numbers of qualified staff or sufficient facilities for responding to mental health needs. The Human Rights Committee has affirmed that the application of article 10, promoting the right to humane treatment, "cannot be dependent on the material resources available. Article 10 of the ICCPR requires the "essential aim" of imprisonment to be "reformation what would happen if these prisoners were not cared for properly social rehabilitation.

As stated in the UN-approved Standard Minimum Rules for the Treatment of Prisoners "SMR"imprisonment should be "used to ensure, so far as possible, that upon his return to society the offender is not only willing but able to lead a law-abiding and self-supporting life.

As the SMR states: The medical services of the institution shall seek to detect and shall treat any physical or mental illnesses or defects which may hamper a prisoner's rehabilitation. All necessary medical, surgical and psychiatric services shall be provided to that end.

According to the SMR, persons found to be "insane" should what would happen if these prisoners were not cared for properly be kept in prisons but should instead be transferred to appropriate medical institutions; prisoners who are "mentally abnormal" should be "observed and treated in specialized institutions under medical management.

The SMR notes that correctional facilities should work with the appropriate agencies to determine what after-care services are necessary and can be arranged so that individuals will have necessary treatment, care, and support when they return to the community. Neglecting to provide needed treatment to alleviate mental suffering may violate article 7 as may deliberately withholding such treatment.

The prohibition should be interpreted to extend the widest possible protection against abuses, whether physical or mental. The UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment points out that persons with disabilities "are often segregated from society in institutions, including prisons.

Article 7 may also be violated if prisoners are confined under conditions that put them at high risk of psychological harm, such as solitary confinement. Principle 9 of the UN Basic Principles for the Treatment of Prisoners states, "Prisoners shall have access to the health services available in the country without discrimination on the grounds of their legal situation. Introducing this decision, President Obama stated, "Disability rights aren't just civil rights to be enforced here at home; they're universal rights to be recognized and promoted around the world.

Many of the provisions of the Convention have unique relevance for prisoners with mental disabilities. The Convention in article 5, for example, prohibits discrimination on the basis of disability, and requires states to provide "reasonable accommodation" to persons with disabilities.

The Special Rapporteur on Torture has pointed out that the lack of reasonable accommodation in detention facilities may increase the risk of exposure to neglect, violence, abuse, torture, and ill-treatment. In addition to violating other rights, placing prisoners with mental disabilities in solitary confinement may constitute a violation of the Convention on the Rights of Persons with Disabilities.

Human Rights and Supermax Prisons Human rights experts have long criticized prolonged solitary confinement, understood as physical isolation in a cell for 22 to 24 hours a day, such as exists in US supermax prisons.

Criminals Need Mental Health Care

In 2008, the Special Rapporteur on Torture concluded that "the prolonged isolation of detainees may amount to cruel, inhuman or degrading treatment or punishment, and, in certain instances, may amount to torture. Noting that solitary confinement "harms prisoners who were not previously mentally ill and tends to worsen the mental health of those who are," the Istanbul Statement concludes that "solitary confinement should only be used in very exceptional cases, for as short a time as possible and only as a last resort.

It is particularly concerned by the practice in some such institutions to hold detainees in prolonged cellular confinement, and to allow them out-of-cell recreation for only five hours per week, in general conditions of strict regimentation in a depersonalized environment.

  • Prisoners are confined 23 to 24 hours a day in small cells that frequently have solid steel doors;
  • The Committee is concerned about the prolonged isolation periods detainees are subjected to, the effect such treatment has on their mental health, and that its purpose may be retribution, in which case it would constitute cruel, inhuman or degrading treatment or punishment;
  • We do not call them defective and make of them a pariah class;
  • Still, solutions are within reach;
  • The Committee Against Torture called for repeal of the "physical injury" requirement when it last reviewed US compliance with the Convention Against Torture in 2006.

It is also concerned that such treatment cannot be reconciled with the requirement in article 10 3 that the penitentiary system shall comprise treatment the essential aim of which shall be the reformation and social rehabilitation of prisoners. It also expresses concern about the reported high numbers of severely mentally ill persons in these prisons, as well as in regular in U.

The Committee is concerned about the prolonged isolation periods detainees are subjected to, the effect such treatment has on their mental health, and that its purpose may be retribution, in which case it would constitute what would happen if these prisoners were not cared for properly, inhuman or degrading treatment or punishment.

They are found in the standards and guidelines of the American Correctional Association and the National Commission on Correctional Health Care, in court rulings, expert reports, and in a voluminous professional literature. What is lacking in prison mental health services is not knowledge about what to do, but the resources and commitment to do it.

We hope the work of the Subcommittee will help marshal those resources and that commitment. Compassion, common sense, fiscal prudence, and respect for human rights dictate a better approach to the treatment of persons with mental illness in US prisons than is evident today.

The recommendations that follow focus on several key steps we believe Congress should take. Amend the Prison Litigation Reform Act PLRA The Prison Litigation Reform Act of 1996 has placed serious obstacles in the path of prisoners seeking to protect their rights while incarcerated, including their rights to mental health treatment and services. Prisoners with mental illness can find it impossible to comply with all the deadlines and technical rules in a grievance system, and may then find themselves forever barred from vindicating their rights in court.

On the other hand, correctional agencies legitimately want a reasonable opportunity to respond to prisoners' complaints before having to defend themselves in court. Congress should amend the PLRA to remove the current exhaustion requirement and substitute a provision allowing courts to stay lawsuits temporarily to allow prisoners to take their complaints through the grievance system.

Congress should also repeal the PLRA provision that denies compensation for "mental or emotional injury" absent a prior showing of physical injury. Although isolated confinement and deficient mental health care can cause serious suffering and catastrophic injury to a prisoner's psychiatric condition, the PLRA's "physical injury" requirement bars a remedy for such injuries if the prisoner has not been physically injured as well.

The Committee Against Torture called for repeal of the "physical injury" requirement when it last reviewed US compliance with the Convention Against Torture in 2006.