The HRW Report says 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.
HRW adds: Individual therapy, group therapy, structured educational, recreational, or life-skill enhancing activities, and other therapeutic interventions are usually not available because of insufficient resources and clashes with prison rules-for example, insufficient numbers of custodial staff to take prisoners to and from their cells to private meetings with clinicians, and rules requiring prisoners to remain in their cells and prohibiting contact with other prisoners.
As Duncan Campbell of The Guardian wrote in the Los Angeles Times, "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."
In fact, they commit crimes specifically to get swept back into the system. For example, they act out, get themselves arrested, and know at least that they'll have a meal and a roof over their heads for a day or two -- or longer.
Twin Towers jail in central Los Angeles is known by the Los Angeles county sheriff's department as the biggest known jail in the world. In 2003 there were more than 2,000 mentally ill prisoners, recognizable by yellow shirts and the letter M on their name tags, make up almost half its intended occupants.
There are multiple reasons. "De-institutionalization," the emptying of state mental hospitals, has been one of the most well-meaning but poorly planned social changes ever carried out in the United States. According to a 2010 study by the Treatment Advocacy Center and the National Sheriffs Association, it was a product of the overcrowding and deterioration of hospitals; new medications that significantly improved the symptoms of about half of patients; and a failure to understand that many of the sickest patients were not able to make informed decisions about their own need for medication.
Ronald Reagan, as governor of California, is often blamed for the failures of this policy, but the emptying of the state's mental hospitals began in the mid-1950s under Republican governor Goodwin Knight and continued in the 1960s under Democratic governor Edmund "Pat" Brown. When Reagan took office as governor, the hospitals had already been half-emptied. Reagan distinguished himself, however, by vowing to close the hospitals completely.
As this failing social policy was mincing its way across the nation, next to nothing was being done to prepare our prisons for the new intake of now dispossessed mentally ill patients. Similar patterns began to emerge cross country.
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