A Prison Suicide Forces a Rethinking of Services for Mentally Ill

John Salvi, who in life turned the spotlight on the volatile issue of abortion when he murdered two clinic workers in Massachusetts, has in death unwittingly brought to the fore another vexing problem.

When he killed himself in his prison cell last week, Salvi focused attention on an issue of rising concern: how to treat the growing number of mentally ill among the nation's 1.6 million prisoners.

"There are too many mentally ill in prison," says Eric Lotke, research director at the National Center on Institutions and Alternatives. "And they're not getting the treatment they need. It's just a warehouse."

By some estimates, as many as 20 percent of America's jail and prison populations can be diagnosed as mentally ill - and that number is expected grow. Since mental hospitals were deinstitutionalized a decade ago, the number of people with mental-health problems in the criminal justice system has soared, psychiatrists and corrections officials say.

In the '90s, the mentally ill have been locked away at a faster pace as communities crack down on "quality of life" crimes such as aggressive panhandling, vagrancy, and prostitution. In addition, mandatory sentences prevent judges from opting for alternatives to prison, and individuals arrested for drug crimes do more time.

The mentally ill have also been hit by a swing in the national mood, which increasingly favors punishment over treatment. As a result, states have cut funds for mental-health programs but increased their jail- and prison-building budgets. In the courtroom, meanwhile, juries are now less willing to issue verdicts of not guilty by reason of insanity.

"What the prisons are housing are people that need mental-health care, not habitual criminals," says Edward Harrison, president of the National Commission on Correctional Health Care.

Mr. Harrison says that putting away the mentally ill without addressing their needs should concern everyone in a community. "Each year, we release 11 million people from our jails and prisons. If someone has gone into an institution with a mental disorder, there's a real chance they will go untreated, be released, and that [disorder] will still be there - or worse, they will have developed a mental illness in prison."

In the wake of the Salvi suicide, the Massachusetts statehouse is introducing a slate of bills and calling for an investigation into the handling of the incarcerated mentally ill. Salvi had a history of mental illness, but the state Department of Corrections insists it treated him appropriately.

In the lawmakers' proposals, all offenders would be screened for mental illness by a mental-health professional as they enter the criminal-justice system. The initial exam would start a continuing evaluation process, which would include drafting a treatment plan that follows the prisoner from facility to facility - from jail to state mental hospital, for instance. Another bill would provide for a "guilty by reason of insanity" plea in the courts, a measure designed to quell juries' reluctance to sentence criminals to treatment rather than prison.

"The reason this is so important is because 80 percent of our prison population is returned to society," says state Rep. Kay Kahn (D), sponsor of one of the bills.

The mentally ill are often victimized by other prisoners when they are placed within the general prison population, says Harrison. In prisons without proper staff and facilities, the mental-health units that do exist may concentrate more on controlling the mentally ill than counseling them. The National Commission on Correctional Health Care issues guidelines on dealing with with the mentally ill in prison, but Harrison estimates that only half of the country's state prisons use them.

Corrections officials nationwide say they don't have the staff or the money to provide additional help for the mentally ill. Prisons daily have to balance the needs of a variety of dangerous populations, says James Turpin of the American Correctional Association. "On the one hand, you've got younger and more aggressive prisoners; on the other, because of truth-in-sentencing laws, you've got older inmates. The question is how do you balance all those needs and maintain a peaceful situation?"