National Alliance on Mental Illness
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Cruel and Unusual Punishment: The Continuing Criminalization of Mental Illness

By Ron Honberg, NAMI Director of Policy and Legal Affairs

If documentation is needed that the overuse of criminal justice facilities to house people with serious mental illnesses has gone from bad to worse, two recent events provide ample evidence. 

The Cook County (Greater Chicago) Illinois jail has long been characterized as one of the nation’s largest “mental health treatment” facilities.  Recently, Sheriff Tom Dart of Cook County threatened to file a lawsuit against the state for allowing his jail to become a “dumping ground” for people with mental illnesses. Since 2008, Illinois has cut $113.7 million, or 15 percent, from its state mental health budget, and even larger cuts have been proposed for this year.

Speaking to a reporter of the ABC News affiliate in Chicago, Dart expressed his frustration with growing burdens on corrections resulting from these budget cuts.  “The elaborate game where we just squeeze off all of the services so there aren’t any, so these folks just end up going into jails frequently and then we act as it that’s not the reason.  We need to call it like it is.”

The second example concerns a decision issued by the U.S. Supreme Court in late May.  Over the course of 30 years or more, increasing  use of “get tough on crime” policies, coupled with reductions in services for people with severe mental illnesses and addictions disorders, have led to massive over-crowding in California’s prisons.  As of 2010, some of these prisons were filled to more than 200 percent of capacity. 

More than 20 years ago, a lawsuit was filed on behalf of California’s inmates with severe mental illnesses, alleging constitutional deficiencies in the provision of mental health treatment.  Later, a similar lawsuit was filed on behalf of inmates with HIV and other health problems. 

The lawsuit focused on mental health, known as the Coleman case has resulted in numerous judicial findings of constitutionally deficient mental health care, and a number of agreements between the state and the Plaintiffs on how to improve mental health care in the state’s prisons. Unfortunately, none of these agreements have led to actual improvements.  Instead, the state’s response to inmates manifesting the symptoms of severe mental disorders was frequently to place these individuals in solitary confinement or other forms of administrative segregation, a step that is almost guaranteed to worsen the symptoms of severe mental illness.    

It should be noted that the excessive use of solitary confinement, super-max facilities and other forms of administrative segregation is by no means unique to California.  It is a problem in most other states as well and will be the subject of a symposium at the forthcoming NAMI convention in Chicago.

Several years ago, the special expert assigned to oversee mental health treatment in California’s prisons concluded that the constitutional infirmities could not be solved until the problem of over-crowding in California’s prisons was addressed.  A three judge federal panel agreed and ordered the state to reduce its prison population to no more than 137 percent of capacity.  The state appealed and the case reached the U.S. Supreme Court. 

In an unprecedented decision, the Supreme Court affirmed the three judge panel’s decision, finding that the overcrowding in California’s prisons to be so severe that it violated the U.S. Constitution’s ban on “cruel and unusual punishment.”  Unless it reduced overcrowding, the Supreme Court held, California would be unable to improve mental health and healthcare in the prisons to achieve minimally acceptable constitutional standards. 

The Court thus ordered the state to reduce its prison populations to no more than 137 percent of capacity, meaning that more than 30,000 prisoners are likely to be released.  There are no assurances that all or even some of these will be individuals with serious mental illness.  But, the Court’s decision sends a clear message to California: discharge individuals into the community who don’t need to be in prison and improve treatment for those who remain in prison.

While the decision is gratifying, it does not address the underlying problems that have contributed so significantly to the overrepresentation of people with severe mental illnesses in jails and prisons.  As documented in NAMI’s recent report, State Mental Health Cuts: A National Crisis, states have cut nearly $2 billion dollars from general mental health funding alone in the last two years, and more cuts are expected in 2011 and 2012.  Impending federal reductions in Medicaid funding for states will likely exacerbate these problems.  Sadly, law enforcement and corrections will continue to bear the burdens of responding to people with severe mental illness in crisis until the public mental health system is fixed. 

To learn more, read the Supreme Court’s decision or visit the NAMI Blog For an extensive report on the overuse of prisons to house individuals with severe mental illnesses, including the overuse of solitary confinement, visit the Human Rights Watch website.  For more information about the NAMI Convention and the symposium “Solitary Confinement and Mental Illness”, see download the convention program. The symposium will take place on Friday, July 8th at 10:45 am to 12:30 pm.