by Ed Lyon

Since the 1962 publication of One Flew Over the Cuckoo’s Nest, a mirror image of the best-selling novel’s plot has played out in U.S. prisons. Author Ken Kasey wrote a work of fiction about a prisoner who was sent to a mental hospital. In fact, mentally ill Americans are often denied the treatment they need and instead end up in prisons and jails. It happens so often that correctional facilities have become the de facto source for mental health services.

From the 1960s to the present the U.S. incarceration rate more than tripled, and around 2.2 million people are currently incarcerated nationwide. During that same period of time, the population of institutionalized mental patients shrank by 90 percent to under 60,000. Alisa Roth, author of Insane: America’s Criminal Treatment of Mental Illness, estimates that half of U.S. prisoners suffer from a mental illness, since the lack of other treatment options means they are more likely to end up behind bars.

“It’s unpleasant, it’s loud, it’s claustrophobic,” she said of units that house mentally ill prisoners.

As a result, large urban jail systems in Chicago, Los Angeles and New York City are now the largest psychiatric care providers in the nation. In Chicago’s Cook County jail system, the proportion of its 6,000 prisoners with mental illness has increased to 33 percent. Sheriff Tom Dart has instituted staff training on mental health issues; the jail also offers individual and group therapy in its Mental Health Transition Center, and its Supportive Release Center provides food, clothing, access to showers and referrals for longer-term care needs.

In 2018, the Bureau of Justice Statistics (BJS) reported that 14 percent of prisoners in state and federal facilities met the criteria for having serious mental health conditions. In local jails the number was 26 percent. Only five percent of the general population meets those criteria, according to the BJS. Mental illness also affects a higher percentage of female prisoners than males.

According to federal data, 40 percent of prisoners were diagnosed with a mental health disorder between 2011 and 2014. Every year two million people with psychological problems are jailed, based on estimates by the National Alliance on Mental Illness. A 2016 report by the Treatment Advocacy Center found that mentally ill prisoners stay locked up longer, cost more to house and are more likely to commit suicide and be placed in solitary confinement.

The costs of incarcerating the mentally ill are significant. In Michigan, where mental illness afflicts a quarter of the state’s 41,000 prisoners, it costs $95,000 a year to house each one, compared to $35,000 for prisoners without mental health problems. For the mentally ill who are not incarcerated, the state spends just $6,000 each per year, on average.

In Wisconsin, state prison officials estimated in their budget request for 2019-21 that 41 percent of the state’s prisoners have mental health issues, including 55 percent of men at the Green Bay Correctional Institution. At the Taycheedah Correctional Institution for women, the number reached 90 percent – over one-third of whom have “serious mental health illnesses.”

Data compiled and published by The Marshall Project in November 2018 indicated that 30 percent of California state prisoners suffer from a psychiatric condition serious enough to require regular treatment. The number in New York is 20 percent, while in Texas it’s 21 percent. But when the same data was obtained through a Freedom of Information Act request, the number for the federal Bureau of Prisons (BOP) was just three percent.

Some critics contend the BOP does not properly evaluate prisoners for mental illness, or downgrades their condition. A lawsuit filed by prisoners at the federal ADX supermax facility in Florence, Colorado contended that mentally ill prisoners received grossly inadequate care. That case settled in December 2016. [See: PLN, Sept. 2017, p.30].

The BOP confirmed that it needs additional mental health staff, but said it is “developing a strategy” to deal with the needs of its mentally ill population. Former BOP psychologist Russ Ward characterized this as a “catchphrase in the bureau [that] was ‘Do more with less,’ including the use of mental health counselors as prison guards – a practice BOP defended by rationalizing that ‘all staff are professional law enforcement officers first.’”

Congress first addressed mental health treatment at the national level with an 1854 bill that designated 10 million acres of public lands for mental health facilities, but it was vetoed by President Franklin Pierce. The next national legislation did not follow until 1946. President John F. Kennedy championed passage of the Community Mental Health Act just prior to his 1963 assassination, though it was never funded by Congress.

When Medicaid was created in 1965 it did not cover people in “institutions of mental diseases,” but did allow federal funds to finally reach community mental health centers. President Jimmy Carter signed the Mental Health Systems Act of 1980, providing more federal money directly to community mental health care facilities, but the next president, Ronald Reagan, spearheaded a repeal of the law and slashed mental health spending by 33 percent.

The deinstitutionalization of the mentally ill, who were moved from in-patient facilities to poorly-funded community-based programs, resulted in more people with mental health problems ending up in jails and prisons.

From 2009 and 2012, the number of mental health patient intakes rose 10 percent. Yet at the same time almost $4.35 billion was cut from state mental health care budgets following the financial crisis of 2008. As a result, the Stepping Up Initiative was launched in 2015 by the CSG Justice Center in conjunction with the National Association of Counties and the American Psychiatric Association Foundation. Intended to help local jails lower their population of mentally ill prisoners, the program has been joined by over 400 counties.

In March 2018, Congress appropriated $30 million for the Mentally Ill Offender Treatment and Crime Reduction Act, more than doubling 2017’s funding level for the program, which is run by the U.S. Department of Justice. As described by Richard Cho with the CSG Justice Center, jails are “the front end of the criminal justice system” and thus are the logical place to begin reducing the number of mentally ill people entering the corrections system.

Undertreated mentally ill prisoners can increase levels of violence within prisons, especially in facilities where there is an insufficient number of mental health care providers.

For example, a mentally ill prisoner identified only as H.R. was housed at the Hughes Unit of the Texas Department of Criminal Justice (TDCJ) in the 1990s and 2000s. Serving a 99-year sentence for assaulting a police officer, he had accrued two more five-year sentences for assaulting guards before being released from administrative segregation in 2004.

H.R. was placed in a cell with E.B., a prisoner who had a federal court injunction against the TDCJ in which U.S. District Court Judge Lynn N. Hughes came close to a contempt finding against the Hughes Unit’s warden, major and law librarian.

Encouraged by prison staff, H.R. assaulted E.B., leaving him with serious bodily injuries. Texas Department of Mental Health and Mental Retardation staff at the unit downgraded H.R.’s disciplinary case to a minor level. He was then housed in a succession of cells with other prisoners, assaulting each in turn until he was finally returned to administrative segregation, where he ultimately committed suicide.

In April 2015, New York state prison guard Bruce Tucker, a former Marine, was completing 27 years on the job, 20 of which he had spent working E Block at the Sullivan Correctional Facility, a housing area reserved for mentally ill prisoners. As a union member with seniority, Tucker could work wherever he wanted as long as he was not found guilty of misbehavior.

Former Sullivan warden James Walsh described Tucker as a “black-and-white the rule is the rule” type of guard. Walsh admitted that Tucker’s name appeared “in a fair amount” of use-of-force reports involving prisoners, which accused Tucker of being “volatile and menacing” and “a mental bully” who called prisoners “stupid” and “asshole.”

Fellow Sullivan guard Jeffrey Hunt said Tucker’s negative interactions with prisoners were “common knowledge.”

“Officers would talk about it,” he said. “It was ‘Oh, Tuck got into another one, huh?’ I don’t think he was cut out for corrections, that’s all.”

Former E Block prisoner Raymond Bird described how other prisoners were treated by guards. “The slower guys, those are the ones they’d pick on,” he stated.

When new warden William Keyser took charge of the Sullivan prison in 2014, he was warned by officials in the state capital about Tucker and another guard.

“They just said, ‘Watch, these are people we are concerned about. They’re involved in a lot of use of forces,’” Keyser testified in a later deposition, though he maintained he never had any reason to discipline Tucker.

Karl Taylor was a mentally ill 51-year-old prisoner convicted of rape who showed no indication of psychological problems until after his arrest in the early 1990s, with his condition steadily worsening since that time. His disciplinary history reflected scores of incidents, many of which are commonly exhibited by prisoners who endure long periods in administrative segregation.

In March 2015, Taylor was returned to his E Block cell, which had been searched by guards in his absence. Tucker later admitted in one of many deposition responses that he had “to go through everything,” so a cell search was never a neat, orderly process.

Bird, who witnessed the search, said Taylor’s “stuff was all torn up” and guards “trashed his books, his legal work, [and left] his clothes all thrown on the floor.” After Taylor returned and saw the condition of his cell he was heard saying, “They did it, so they gonna clean it up.”

Bird said Tucker would begin his shift every morning by beating on Taylor’s cell door with his baton, ordering him to clean up the mess, sometimes calling Taylor a racial epithet and a “piece of shit.” Prisoner Malik Thomas witnessed Taylor and Tucker vehemently arguing with each other during those episodes. But Taylor steadfastly refused to clean his cell.

Tucker referred Taylor for more intensive treatment while continuing to insist that he clean the cell. Mental health staff recommended Taylor’s transfer to a hospital, but prison psychiatrist Seung Ho Lee denied the request, stating in a later deposition, “I always believe the officers protect the patient.”

For Tucker and Taylor, April 13, 2015 began the same way as a succession of prior days, with Tucker beating on Taylor’s cell door, calling him names and ordering him to clean his cell or he was “gonna have some serious fucking problems,” according to Thomas. The guard then ordered Hunt to open Taylor’s door. Hunt later stated, “I just had a feeling, maybe things ain’t gonna work out too good.

As Taylor exited his cell and began walking away, Tucker hit him in the back of the head at least twice with his baton. Hunt initially said Taylor hit Tucker first, but changed his story under oath at a later deposition, saying Tucker wielded his baton first. Other prisoners who witnessed the incident agreed.

Bird said: “I seen Tucker hit him, and I seen him hit him again.”

“You heard two loud bangs, like you would hit a hard ball in baseball,” Thomas added.

Taylor turned, took Tucker’s baton from him, hit him with it and broke his arm, then began chasing him. Guard Steve Witte, rushing to aid Tucker, was struck by the baton, causing his head to hit a wall and knocking him unconscious. More guards arrived, and Taylor was overpowered and subdued. Witnesses heard him saying he could not breathe.

It took guards 20 minutes to carry Taylor to the prison infirmary even though it was just a five-minute walk, according to a prison nurse. Prisoners Kurtis Lamar Williams and Gregory Judge gave statements about the beating Taylor suffered from the guards all the way to the infirmary, where he was pronounced dead.

His cause of death was determined to be cardiac arrhythmia complicating hypertensive cardiovascular disease.

The guards claimed the incident began when Taylor punched Tucker in the face. An autopsy showed no damage consistent with a punch like that on either of Taylor’s hands. It did find Taylor had neck fractures consistent with constant pressure on his throat, petechial hemorrhages on his eyelids caused by an inadequate flow of blood to the brain due to an obstructed jugular vein, and eight blunt impacts to his head and others on his body.

Guards Tucker and Witte retired after Taylor’s death. Tucker now claims to have a mental health condition himself, saying at his deposition, “I suffer from post-traumatic stress disorder, and it is very difficult. I don’t want to discuss the incident with anybody.”

No charges were filed in connection with Taylor’s death; in December 2015, a Sullivan County grand jury cleared the guards and their supervisors for their involvement in the fatal incident.

In Alabama, after the Southern Poverty Law Center and Alabama Disabilities Advocacy Program filed a class-action lawsuit, U.S. District Court Judge Myron Thompson agreed that mental health care in the state’s prison system was “horrendously inadequate.” One of the prisoners who testified at the trial, Jamie Lee Wallace, committed suicide days later. The Alabama Department of Corrections blamed its private mental health care contractor and insufficient staffing. A partial settlement was reached in the case on mental health and ADA-related claims in March 2016. [See: PLN, Nov. 2017, p.28].

Later in the litigation, Alabama prison officials avoided a contempt hearing in January 2019 only by agreement between the parties to measure compliance with the settlement based on the number of hours that mental health staff worked, not the number of positions filled.

And under a 2013 consent decree, New Orleans was required to improve mental health care for the city’s prisoners, as that care was found inadequate by U.S. District Court Judge Lance M. Africk. Orleans Parish Sheriff Marlin Gusman announced plans to build a new 89-bed mental health care facility. In the interim, the city contracted with the Louisiana Department of Public Safety and Corrections (DPSC) to ship its mentally ill prisoners to the Elayn Hunt Correctional Center.

While the city council approved a new facility in 2017, construction will “take years,” according to jail director Darnley Hodge, Sr. After five years of annual renewals, DPSC director Jimmy LeBlanc notified Hodge in October 2018 that the city would have to make other arrangements for housing its mentally ill prisoners.

Until government officials find a solution to locking up the mentally ill rather than providing the treatment they need to address the behavior caused by their mental illness, there will continue to be tragic incidents such as the death of Kent Taylor, and more lawsuits against prison and jail officials. 

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Sources: The Atlantic, The Guardian, Mother Jones, The Advocate, The Marshall Project, NPR, Benton/St, Joseph Herald-Palladium, Tuscaloosa News, www.urbanmilwaukee.com, personal interviews