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The Criminalization of Mental Illness in Missouri

In response to the 1999 U.S. Supreme Court ruling that prohibits states from forcing people with mental health disabilities to live in state mental institutions when they are capable of living in community settings, state governments turned to using jails and prisons instead. Although this trend continues today, there is very little evidence that prisoners with mental disabilities receive necessary treatment and services while incarcerated.

Sol Wachtler, former chief judge of the New York Court of Appeals, once wrote that “Few judges can fully sense or relate to determinations concerning sentencing, or the inhumanity or cruelty of punishment.” Wachtler was arrested in November 1992 on extortion, racketeering and blackmail charges; he resigned and served time in prison, which is when he discovered he had mental health problems. [See: PLN, Nov. 1995, p.6].

Judges do not fully consider the long-term ramifications for both society and defendants with mental disabilities who are sentenced to serve time in jails and prisons, particularly given the lack of necessary mental health programs and services provided to prisoners. It is naïve to believe that people are not sentenced to jail or prison because they have mental disabilities, which is a reality that has perpetuated our criminal justice system’s revolving door.

Theoretically, when a person is sent to prison or jail it provides them an opportunity to contemplate on their life and the direction it is heading. But for people with severe mental disabilities this opportunity is clouded by the fact that they have mental health problems which impede or preclude their ability to do so, which is further obstructed by the reality that they do not receive adequate mental health care while incarcerated.

In Missouri, MHM Services, Inc. is the current mental health contract provider for the state’s prison system. MHM began its contract in 2007 and, according to news media reports, the Missouri Department of Corrections reported a 14.6% recidivism rate in 2006 among parolees with severe mental disabilities. In 2010, the Missouri Department of Corrections reported a 14.8% recidivism rate among parolees with severe mental disabilities.

According to these reports, Missouri has not experienced a decrease in recidivism in the four years that MHM has provided mental health services to state prisoners. One possible contributing reason for this is that, as local media reports also noted, MHM prison mental health employees do not provide offenders with access to individual counseling services. MHM staff have argued that they are not required to provide such services because monthly chronic care evaluation meetings constitute individual counseling. That argument is clearly contradicted by the company’s contractual obligations, however.

Section 4.1.11b of MHM’s contract requires that “at a minimum” prison mental health staff are to conduct “routine, face to face, follow up visits to all offenders identified as having severe mental impairments” in order to determine if the offender “requires psychiatric assessments and medication evaluation....” If the offender is not provided individual counseling, mental health staff is still required, at a minimum, to conduct the monthly chronic care evaluation meetings.

Further, section 4.1.15 of the contract specifically states that “[T]he contractor shall offer gender relevant individual and group psychotherapy or counseling for offenders with the following ... whether or not the offenders have a severe mental impairment.” The five areas covered in that section include a history of sexual or physical abuse, chronic thoughts of suicide or attempted suicide, low frustration with anger management issues, issues with adjustment to prison life, and grieving the loss of another. This clearly demonstrates that individual counseling is a distinctly different service independent of monthly chronic care evaluations.

Despite the clarity of these contractual mandates, the news media reported in March 2011 that “[A] former mental health provider who worked in the Missouri prison system, and asked not to be identified, said the prison system didn’t really offer counseling,” and that “[T]he counseling sessions that took place were mostly responses to requests for services from the prisoners....” When mental health staff meet with offenders, “[A] typical ‘session’ lasts less than five minutes, and they are scheduled four to 10 per hour.”

Individual counseling is a fundamentally important aspect of delivering effective mental health services, and can greatly assist in decreasing prison violence and the extent that offenders violate prison rules and regulations. Additionally, it can have a significant impact in reducing the extent that prisoners with mental disabilities are denied or delayed in receiving parole. Moreover, individual counseling can assist offenders in successfully reintegrating back into society after their release from prison.

When individual counseling is denied, prison mental health staff are failing to provide meaningful access to mental health services, programs and activities. This is particularly detrimental to offenders with mental disabilities because, as Congress pointed out in the Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act of 2008, “[I]n addition, mentally ill offenders can be affected psychologically by incarceration differently than general population offenders.”

Further, as the Commission on Safety and Abuse in America’s Prisons wrote in 2006, “What happens inside jails and prisons does not stay inside jails and prisons. It comes home with prisoners after they are released.” This is especially true for offenders with mental disabilities because they are affected differently by prison life and conditions than their non-disabled counterparts.

Unfortunately, based on news reports in March 2011, it appears that MHM and its employees apply a very narrow interpretation of section 4.1.11b of the contract, as they believe they are only required to provide the absolute bare minimum treatment to offenders with mental disabilities while being paid over $101 million since 2007 to deliver mental health services to state prisoners. This mindset does not serve any genuine penological interest, nor does it serve the best interests of offenders or the public.

Even if we assume for the sake of argument that section 4.1.11b allows prison mental health staff to substitute a monthly chronic care evaluation meeting in lieu of individual counseling services, it is highly improbable that an offender is going to receive effective therapeutic help if all they get is a once-a-month chronic care evaluation. Many would argue that this amounts to a temporary and ineffective band-aid solution that provides the appearance of delivering effectual mental health services without having to actually produce results.

When prisoners with mental disabilities are denied effective opportunities to access the mental health services and programs they need, they face incredible odds in terms of whether they can and will successfully reintegrate back into society. This perpetuates the vicious cycle of our criminal justice system’s revolving door, whereby prisoners with mental health problems end up being recycled through the system over and over again.

It is not that judges, legislators, prison administrators and mental health personnel are oblivious to the fact that offenders with mental disabilities are not being provided necessary mental health services and programs while incarcerated; indeed, many openly admit this is the case. Rather, it is indifference to this situation that continues the trend of using jails and prisons as de facto mental institutions, to the detriment of prisoners with mental health problems.

Christopher Cross, M.A., R.D.S.P. is a court-appointed legal guardian of an adult prisoner incarcerated in Missouri’s prison system. He provided this article exclusively for Prison Legal News.

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