[Senate Hearing 111-975]
[From the U.S. Government Publishing Office]
S. Hrg. 111-975
HUMAN RIGHTS AT HOME: MENTAL ILLNESS IN U.S. PRISONS AND JAILS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HUMAN RIGHTS AND THE LAW
of the
COMMITTEE ON THE JUDICIARY
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
----------
SEPTEMBER 15, 2009
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Serial No. J-111-45
----------
Printed for the use of the Committee on the Judiciary
HUMAN RIGHTS AT HOME: MENTAL ILLNESS IN U.S. PRISONS AND JAILS
S. Hrg. 111-975
HUMAN RIGHTS AT HOME: MENTAL ILLNESS IN U.S. PRISONS AND JAILS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HUMAN RIGHTS AND THE LAW
of the
COMMITTEE ON THE JUDICIARY
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
SEPTEMBER 15, 2009
__________
Serial No. J-111-45
__________
Printed for the use of the Committee on the Judiciary
U.S. GOVERNMENT PRINTING OFFICE
66-207 WASHINGTON : 2011
-----------------------------------------------------------------------
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COMMITTEE ON THE JUDICIARY
PATRICK J. LEAHY, Vermont, Chairman
HERB KOHL, Wisconsin JEFF SESSIONS, Alabama
DIANNE FEINSTEIN, California ORRIN G. HATCH, Utah
RUSSELL D. FEINGOLD, Wisconsin CHARLES E. GRASSLEY, Iowa
CHARLES E. SCHUMER, New York JON KYL, Arizona
RICHARD J. DURBIN, Illinois LINDSEY GRAHAM, South Carolina
BENJAMIN L. CARDIN, Maryland JOHN CORNYN, Texas
SHELDON WHITEHOUSE, Rhode Island TOM COBURN, Oklahoma
AMY KLOBUCHAR, Minnesota
EDWARD E. KAUFMAN, Delaware
ARLEN SPECTER, Pennsylvania
AL FRANKEN, Minnesota
Bruce A. Cohen, Chief Counsel and Staff Director
Matthew S. Miner, Republican Chief Counsel
Subcommittee on Human Rights and the Law
RICHARD J. DURBIN, Illinois, Chairman
RICHARD J. DURBIN, Illinois TOM COBURN, Oklahoma
RUSSELL D. FEINGOLD, Wisconsin LINDSEY GRAHAM, South Carolina
BENJAMIN L. CARDIN, Maryland JOHN CORNYN, Texas
EDWARD E. KAUFMAN, Delaware
ARLEN SPECTER, Pennsylvania
Joseph Zogby, Chief Counsel
Brooke Bacak, Republican Chief Counsel
C O N T E N T S
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STATEMENTS OF COMMITTEE MEMBERS
Page
Coburn, Hon. Tom, a U.S. Senator from the State of Oklahoma...... 3
prepared statement........................................... 140
Durbin, Hon. Richard J., a U.S. Senator from the State of
Illinois....................................................... 1
prepared statement........................................... 142
Feingold, Hon. Russell D., a U.S. Senator from the State of
Wisconsin, prepared statement.................................. 185
Franken, Hon. Al, a U.S. Senator from the State of Minnesota..... 5
prepared statement........................................... 187
WITNESSES
Bagenstos, Samuel, Deputy Assistant Attorney General, Civil
Rights Division, U.S. Department of Justice, Washington, DC.... 8
Fuller, David L., Outreach and Housing Coordinator, Manhattan
Outreach Consortium, Brooklyn, New York........................ 31
Lappin, Harley G., Director, Federal Bureau of Prisons,
Washington, DC................................................. 5
Leary, Mary Lou, Deputy Assistant Attorney General, Office of
Justice Programs, U.S. Department of Justice, Washington, DC... 10
Maynard, Gary D., Secretary, Maryland Department of Public Safety
and Correctional Services, Towson, Maryland.................... 25
Randle, Michael P., Director, Illinois Department of Corrections,
Springfield, Illinois.......................................... 27
Zenoff, Kathryn E., Presiding Justice, Illinois Appellate Court,
Second District, Rockford, Illinois............................ 29
QUESTIONS AND ANSWERS
Responses of Samuel Bagenstos to questions submitted by Senator
Coburn......................................................... 44
Responses of Harley Lappin to questions submitted by Senator
Coburn......................................................... 46
Responses of Mary Lou Leary to questions submitted by Senator
Coburn......................................................... 54
Responses of Gary D. Maynard to questions submitted by Senator
Coburn......................................................... 58
Responses of Michael P. Randle to questions submitted by Senator
Coburn......................................................... 61
Responses of Kathryn E. Zenoff to questions submitted by Senator
Coburn......................................................... 63
Questions submitted by Senator Coburn to David Fuller (Note:
Responses to questions were not received as of the time of
printing, May 10, 2011)
SUBMISSIONS FOR THE RECORD
American Civil Liberties Union, Michael W. Macleod-Ball, Acting
Director, Joanne Lin, Legislative Counsel, Washington, DC,
statement...................................................... 68
American Psychological Association, Washington, DC, statement.... 79
Amnesty International, New York, New York, statement............. 84
Bagenstos, Samuel, Deputy Assistant Attorney General, Civil
Rights Division, U.S. Department of Justice, Washington, D.C.,
statement...................................................... 87
Burr, Richard, Attorney, Houston, Texas, prepared statement...... 93
Byrne/JAG Appropriations, grant.................................. 98
Campaign for Youth & Justice, Liz Ryan, President and Chief
Executive Office, Washington, DC, statement.................... 100
Council of State Governments, Justice Center, Fred C. Osher,
Director of Health Systems and Services Policy, New York, New
York, statement................................................ 128
Department of Justice, Office of Justice Program, Washington,
DC.:
Bureau of Justice Statistics, Special Report................. 145
Bureau of Justice Statistics, Bulletin....................... 157
Federal Grant Programs Available for Treatment of Mentally Ill
Offenders...................................................... 183
Fuller, David L., Outreach and Housing Coordinator, Manhattan
Outreach Consortium, Brooklyn, New York, statement............. 193
Griffin, Gene, J.D., Mental Health Services and Policy Program,
Northwestern University Feinberg School of Medicine, Chicago,
Illinois, statement............................................ 206
Heartland Alliance's National Immigrant Justice Center, Chicago,
Illinois, statement............................................ 208
Human Rights Watch, New York, New York, statement................ 214
Lappin, Harley G., Director, Federal Bureau of Prisons,
Washington, DC., statement..................................... 228
Leadership Conference on Civil Rights, Wade Henderson, President
& Chief Executive Office, Washington, DC, statement............ 236
Leary, Mary Lou, Deputy Assistant Attorney General, Office of
Justice Programs, U.S. Department of Justice, Washington, DC.,
statement...................................................... 241
Maynard, Gary D., Secretary, Maryland Department of Public Safety
and Correctional Services, Towson, Maryland, statement......... 329
Mental Health America, Alexandria, Virginia, statement........... 334
National Council for Community Behavioral Healthcare, Linda
Rosenberg, President & CEO, Washington, DC, statement.......... 339
National Council on Disability, John R. Vaughn, Chairperson,
Washington, DC, letter and attachment.......................... 344
National Disability Rights Network, Protection & Advocacy for
Individuals with Disabilities, Washington, DC, statement....... 349
New Yorker.com, Atul Gawande, March 30, 2009, article............ 357
Randle, Michael P., Director, Illinois Department of Corrections,
Springfield, Illinois, statement............................... 368
Rebecca Project for Human Rights, Malika Saada Saar, Executive
Director, Kathleen Shakire Washington, Policy Director,
Washington, DC, joint statement................................ 372
Rights Working Group, Washington, DC, statement.................. 382
Rohr, Gretchen, Director, DC Jail Advocacy Project, University
Legal Services, Washington, DC, statement...................... 383
SAVE Coalition, statement........................................ 401
VERA Institute of Justice, Alex Busansky, Director, Washington,
DC, statement.................................................. 403
Witness Justice, Helga Luest, President & CEO, Frederick,
Maryland, statement............................................ 405
Zenoff, Kathryn E., Presiding Justice, Illinois Appellate Court,
Second District, Rockford, Illinois, statement................. 437
HUMAN RIGHTS AT HOME: MENTAL ILLNESS IN U.S. PRISONS AND JAILS
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TUESDAY, SEPTEMBER 15, 2009
U.S. Senate,
Subcommittee on Human Rights and the Law,
Committee on the Judiciary,
Washington, DC.
The Subcommittee met, pursuant to notice, at 9:58 a.m., in
room SD-226, Dirksen Senate Office Building, Hon. Richard J.
Durbin, Chairman of the Subcommittee, presiding.
Present: Senators Durbin, Franken, and Coburn.
OPENING STATEMENT OF HON. RICHARD J. DURBIN, A U.S. SENATOR
FROM THE STATE OF ILLINOIS
Chairman Durbin. This hearing of the Human Rights and the
Law Subcommittee will come to order. The subject at today's
hearing is ``Human Rights at Home: Mental Illness in U.S.
Prisons and Jails.''
At the outset, I want to thank Judiciary Committee Chairman
Pat Leahy for reestablishing this Subcommittee. This is another
measure of his commitment to human rights. I also want to thank
Jeff Sessions, the Committee's Ranking Member, for his support
of the re-creation of this Subcommittee.
I want to express personal appreciation to my colleague
Senator Tom Coburn, who not only is serving again as Ranking
Member of this Subcommittee, but spoke up and said, ``Why would
you not have this Subcommittee? '' That is a nice thing to hear
from your colleague, and I think we proved in the first 2 years
of our existence as a team on this Subcommittee that we could
accomplish some good things.
In the 110th Congress, this Subcommittee focused and
reflected on issues like genocide in Darfur, Internet
censorship in China, and rape as a weapon of war in the
Democratic Republic of Congo. But, in all honesty, we must also
reflect on ourselves.
Today in the United States, more than 2.3 million people
are imprisoned. This is, by far, the most prisoners of any
country in the world and, by far, the highest per capita rate
of prisoners in the world. African Americans are incarcerated
at nearly six times the rate of white citizens. And many of
these prisoners are non-violent drug offenders and individuals
with serious and persistent mental illness.
Now, Senator Jim Webb of Virginia has introduced
legislation creating a commission to examine our criminal
justice system and make recommendations for reform. This
comprehensive review is really needed. But there are critical
reforms needed right now and we should not wait to address
them.
Earlier this year, Senator Lindsey Graham of South Carolina
and I held a hearing on the sentencing disparity between crack
and powder cocaine, which leads to excessive prison sentences
for many non-violent drug offenders. We are working with all
the members of the Committee to try to come up with legislation
to address this problem.
Today, we are going to address another aspect of the
criminal justice system that raises important human rights
issues: the treatment of mental illness in U.S. prisons and
jails.
My late friend and mentor, former Senator Paul Simon,
brought this issue to my attention many years ago. The problem
has only grown worse since then.
In 2006, the Bureau of Justice Statistics found that more
than half of all prison and jail inmates, including 45 percent
of Federal prisoners, 56 percent of State prisoners, and 64
percent of local jail inmates suffer from a mental health
problem.
In fact, the three largest mental health facilities in the
United States of America are the Los Angeles County Jail,
Rikers Island Jail, and the Cook County Jail.
Women and children are especially vulnerable. The Bureau of
Justice Statistics found that 61 percent of females in Federal
prisons have mental health problems, compared to 44 percent of
males.
In a recent survey, two-thirds of boys and three-fourths of
girls detained in juvenile facilities in Cook County, Illinois,
have at least one mental illness. Juvenile offenders with
serious mental illnesses are more likely to be abused by other
juvenile offenders and have their incarceration extended
because of conduct related to their mental illness.
By allowing our prisons and jails to become one of our
Nation's primary providers of mental health services, we have
taken a step backward in time. Two hundred years ago, people
with mental illness were incarcerated in jails and prisons. By
the beginning of the 20th century, we transitioned from that
model to State mental institutions and hospitals. Growing
public revulsion about conditions in mental hospitals led to a
movement for deinstitutionalization around 40 or 50 years ago.
Community mental health services were supposed to step in to
replace State mental hospitals, but that did not happen. It is
stunning to read that 8 years ago the GAO found that 9,000
children were surrendered by their families to the juvenile
justice system so that they could receive basic mental health
services.
As a result of all this, many people with mental illness
cycle in and out of correctional institutions, presenting a
danger to themselves, correctional officers, and the public. We
have returned to the loathsome, indefensible practice of
incarcerating the mentally ill. While in prison, many mentally
ill prisoners have limited or no access to mental health
services, and their conditions frequently deteriorate. They
often have difficulty complying with prison rules and, as a
result, are disproportionately represented in solitary
confinement, which only makes their mental illness worse.
I am deeply troubled by reports about conditions for
persons with mental illness at Tamms Correctional Center, a
super-maximum security facility in my own home State of
Illinois. Governor Pat Quinn recently ordered a review of
Tamms, and I look forward to discussing this issue with one of
our witnesses, Michael Randle, who heads the Illinois
Department of Corrections.
I want to salute Gary Marx of the Chicago Tribune and
especially George Pawlaczyk and Beth Hundsdorfer of the
Belleville News-Democrat for their provocative and thorough
articles on the Tamms Correctional Center.
I look forward to hearing from our witnesses about the best
practices for dealing with people with mental illness in the
criminal justice system, including mental health courts to
divert appropriate individuals into treatment and a continuum
of care for individuals from entry screening to discharge
planning.
Our country was founded on the principle that all people
are created equal and endowed with certain inalienable rights.
This was, and still is, the promise of America. For
generations, this singular idea has inspired freedom fighters,
toppled ruthless dictators, and given hope to the disempowered
and disenfranchised around the world. We must keep faith with
our Founders by working to keep America's promises not only
abroad but at home.
That is true even for, in fact especially for, the least
among us--whether it is a crack addict serving a mandatory
minimum sentence or a person with mental illness who cycles
endlessly through shelters, hospitals, jails, and prisons. This
is the right thing for us to do, but it is also the smart thing
to do because it will keep police and corrections officers and
the public safer and dramatically reduce costs for
incarceration at a time of fiscal crisis.
Senator Coburn.
STATEMENT OF HON. TOM COBURN, A U.S. SENATOR FROM THE STATE OF
OKLAHOMA
Senator Coburn. Well, thank you, Senator Durbin, and I
thank our witnesses for being here. I do apologize to you in
advance. I am conflicted with two other ongoing committees at
the same time, and so I will be leaving in a short period of
time.
As a practicing physician, I have seen over the last 25
years a significant increase in how the stressors in our
country and in our lives have impacted mental health, and there
is no question the greatest factor, I believe, happens to be
addiction to drugs and what that does to us. And the Chairman
and I both have a desire at some point in time to see a
different system of incarceration for those that are addicted.
We think we can do it more economically. We know we can do it
more successfully, and we know that good drug treatment
programs make big differences in people's lives to the tune of
about 60 to 70 percent of them never walk that path again.
In terms of our hearing today, the key is recognition and
prevention. If we have some incarcerated that we have not
recognized a significant illness, we are asking for problems
for us as well as for them. And so intake screening and
thorough evaluation is a must. We understand that. Treatment
also is a must, especially in some of our more significant
psychoses and tougher illnesses.
The point that Senator Durbin made--I almost called you
``doctor,'' ``Dr. Durbin.'' The point that Senator Durbin makes
about developing mental illness in prison, it is easy to see.
Depression, psychotic depression, which oftentimes those who
work in our system are not prepared to understand that a
psychosis is ongoing that is not the individual's normal
behavior, but it is a result of psychotic depression, which I
could imagine very easily anyone could fall into.
Where Senator Durbin and I differ is that, number one, I
look for a constitutional role within the enumerated powers
that we have the authority to fix it at the States. I am not
sure we do, but the one thing I am in agreement with him on is
we ought to model the absolute best practices at the Federal
level, and that if we do that, lots can be learned from that,
and that example can be utilized.
Oklahoma is high in its incarceration rate. We have a
pretty tough justice system, and this is a problem that we
experience as well.
The answer is not just more money. The answer is a great
plan and set an example and let us see if we cannot markedly
improve.
The final point I would make--and I appreciated the
testimony from Mr. Maynard in terms of his three suggestions,
which I thought were very cogent in terms of the things that we
need to do:
Ensure a specific methodology at intake so that we know
what we have got, know what we are doing, and make sure it is
thorough.
Second, technology improvement to identification ongoing
while at intake; and cross-checking data bases with past
history. You know, one of the biggest problems is we do not get
thorough past medical histories.
I will take just a little bit of liberty. I have a
gentleman that is incarcerated today that had true manic-
depressive disease, and all of his convictions are on the basis
of when he was in a manic state, uncontrolled, undiagnosed, and
he is now serving the minimum mandatory 15-year sentence simply
because we failed. We failed to diagnose him. We failed to
treat him, both inpatient and outpatient, in incarceration as
well as outpatient. And so now he finds himself in a long-term
situation, and he is a model prisoner because he is being
controlled. His medicines are being given. He no longer has the
disease. So it is a real problem, and we do not deny that.
Then, finally, appropriate staffing levels in terms of mental
health professionals and counseling that would go along with
that.
So I am very pleased we are having--I think it is a human
right to have your health care diagnosed when we are going to
incarcerate you, and I think we ought to set that example at
the Federal Government, and I look forward to the witnesses'
testimony. I thank you all for being here.
Chairman Durbin. Thank you, Senator Coburn.
Without objection, a statement by Senator Feingold will be
entered in the record.
[The prepared statement of Senator Feingold appears as a
submission for the record.]
Chairman Durbin. I yield to Senator Franken, if you would
like to make an opening comment or statement.
STATEMENT OF HON. AL FRANKEN, A U.S. SENATOR FROM THE STATE OF
MINNESOTA
Senator Franken. Thank you, Mr. Chairman. I would like to
make just a short statement and submit a fuller statement for
the record, if that is okay.
Mr. Chairman, Senator/Dr. Coburn, I appreciate the
opportunity to participate in this hearing which touches on two
issues that are of utmost importance to me: caring for those
with mental illness and working to reform our country's deeply
flawed prison system. The sheer volume of people that we
imprison in this country is a crime in itself, and as a
society, we are most guilty of failing the thousands of young
people who, instead of receiving education, support, and
treatment, are growing into adulthood behind bars, a fate which
virtually dooms these children from ever becoming productive
citizens.
I was very happy to hear Senator Coburn's remarks on
treatment and am very encouraged by that, and I am in complete
agreement with him. So I would like to hear from the witnesses,
and thank you, Mr. Chairman and Senator Coburn.
Chairman Durbin. Thank you, Senator Franken, and your
opening statement will be admitted into the record at this
point, without objection, and Senator Coburn's as well.
[The prepared statement of Senator Franken appears as a
submission for the record.
[The prepared statement of Senator Coburn appears as a
submission for the record.]
Chairman Durbin. Now we turn to the first panel of
witnesses for opening statements. They will each have 5
minutes. Their entire written testimony will be part of the
record. I am going to ask them to stand, and as is the custom
of the Committee, we swear in our witnesses.
Would you please raise your right hand? Do you affirm that
the testimony you are about to give before the Committee is the
truth, the whole truth, and nothing but the truth, so help you
God?
Mr. Lappin. I do.
Mr. Bagenstos. I do.
Ms. Leary. I do.
Chairman Durbin. Let the record indicate that all three
have answered in the affirmative and, therefore, may proceed.
Our first witness is Harley Lappin, the Director of the
Federal Bureau of Prisons. He has served at BOP for 24 years,
and has been the Director since 2003. Mr. Lappin is responsible
for the Bureau's 114 institutions and the safety and security
of over 208,000 Federal inmates. He holds a B.A. in forensic
studies from Indiana University in Bloomington and an M.A. in
criminal justice and correctional administration from Kent
State University.
Thanks for joining us today and please proceed.
STATEMENT OF HARLEY G. LAPPIN, DIRECTOR, FEDERAL BUREAU OF
PRISONS, WASHINGTON, D.C.
Mr. Lappin. Good morning, Chairman Durbin, Ranking Member
Coburn, and members of the Subcommittee. I am pleased to appear
before you today to testify on the very important topic of
mental illness in correctional facilities. Inmates with mental
health problems present a host of challenges. I am well aware
that the challenges we face in the Bureau of Prisons are not
unique to the Federal prison system. State and local
corrections systems have similar issues and often fewer
resources at their disposal. I am committed to ensuring the
Bureau of the Prisons does all it can to attend to this
vulnerable population, but I know there are cases where
individuals leave prisons with their mental illnesses
untreated. We must do more if we want to prevent further
criminal behavior and victimization in our communities.
Since early 2000, the National Institute of Corrections has
provided support to State and local corrections in the area of
mental health, including holding public hearings, sponsoring
Web-based forums, and providing technical assistance both
directly and through a third party. We estimate that 19 percent
of the inmates admitted to the Bureau of Prisons suffer from
some mental illness. As in the community, the vast majority of
these inmates are treated on an outpatient basis at the
institution by Psychology Services staff working in
collaboration with other staff, including therapists,
counselors, social workers, and either a full-time or
consultant psychiatrist, as indicated. Our staff also conduct
an array of forensic evaluations for the courts.
Group counseling is a very effective method for the
delivery of mental health services to inmates in the Bureau of
Prisons. Individual counseling is also provided at every
institution to inmates with a need for more intensive services.
Inpatient psychiatric services are provided for chronic and
acutely mentally ill cases, as well as for court-ordered
placements. These services are provided at the Bureau of
Prisons medical referral centers, each of which is accredited
by the Joint Commission on Accreditation of Health Care
organizations. The chronically mentally ill remain at the
centers for the duration of their sentence, but acute cases are
treated, stabilized, and then returned to our mainstream
institutions.
All inmates coming in to the Federal prison system are
screened for mental illnesses, and subsequent screenings are
done during reviews of inmates in special housing units, as
indicated. Treatment plans are developed for inmates found to
be in need of treatment, and when necessary, inmates are
transferred to different institutions.
We offer a variety of residential or intensive treatment
programs for mentally ill inmates of both genders at all
security levels. My written statement describes these programs
in some detail.
We also operate a dual diagnosis residential drug abuse
treatment program for inmates suffering from both a substance
abuse disorder and a serious mental illness, and we offer this
program to both male and female offenders.
The Bureau of Prisons currently has more than 450 full-time
psychology treatment staff, the majority of whom are
psychologists, with some psychology technicians and treatment
specialists. This figure does not include the drug treatment
staff.
We also have 30 full-time psychiatrists within the system.
These psychiatrists are able to treat inmates at all of our
institutions through the use of video technology, which is much
less costly than relying on contract psychiatrist and also
ensures continuity of care.
Many individuals who suffer from mental illnesses are at
the risk of committing suicide. All Bureau of Prisons staff are
trained to recognize signs indicative of potential suicide, to
prevent suicides, and to understand and make appropriate use of
the referral process. The Bureau of Prisons uses well-trained
staff, skilled clinicians, frequent referrals, prevention
techniques, and extended follow-up services to manage the
suicide risk by Federal inmates. While any suicide is tragic,
over the past 10 years, the Bureau's suicide rate has been less
than the rate for the general U.S. population.
The Bureau of Prisons works hard to ensure the smooth
transition of mentally ill inmates from prison to the community
through the close communication with other authorities--the
United States Probation Services, the Court Services and
Offender Supervision Agency, as well as treatment providers in
the community, through our network of residential reentry
centers.
The majority of the inmates transition through residential
reentry centers--also known as community corrections centers or
halfway houses--to help them to adjust to life in the
community, to acquire post-release employment, and in many
cases find suitable housing. The BOP's Transitional Services
staff coordinate and oversee treatment of inmates housed in
residential reentry centers.
Thank you for holding this hearing and bringing attention
to this important topic. The mentally ill in prison are a
unique population that poses real challenges for our agency. We
are doing a lot, particularly given the budget restrictions we
have experienced. But more can be done, particularly through
collaborating with our partners around the country, State,
local, and other Federal law enforcement agencies, mental
health agencies, and community organizations. I think it is
critically important, as Senator Coburn mentioned, that we work
together to identify the presence of mental illness in
offenders as early as possible in the criminal justice system,
such as at arrest, and that there be a mechanism in place for
that information to be passed on to those who will incarcerate
that person or hold that person in the future. This will often
avert harm to the offender and to others.
We should provide the resources to meet the needs of
mentally ill offenders during incarceration and support them
upon release as they face the challenges of reentering
communities.
Finally, we should encourage jails, prisons, lock-ups,
community corrections centers to seek accreditation from
outside entities, thereby establishing a set of standards and
expectations for staff to follow.
Chairman Durbin, this concludes my formal statement. I am
pleased to answer any questions at the appropriate time. Thank
you.
[The prepared statement of Mr. Lappin appears as a
submission for the record.]
Chairman Durbin. Thank you, Mr. Lappin.
Our next witness, Samuel Bagenstos, is Deputy Assistant
Attorney General in the Civil Rights Division of the U.S.
Department of Justice, an expert in disability law, taught at
the University of Michigan Law School, the UCLA School of Law,
Washington University School of Law, and Harvard. He has a B.A.
from the University of North Carolina and a J.D. from Harvard
Law School.
Mr. Bagenstos, thank you for joining us, and the floor is
yours.
STATEMENT OF SAMUEL BAGENSTOS, DEPUTY ASSISTANT ATTORNEY
GENERAL, CIVIL RIGHTS DIVISION, U.S. DEPARTMENT OF JUSTICE,
WASHINGTON, D.C.
Mr. Bagenstos. Thank you, Chairman Durbin and Ranking
Member Coburn and members of the Committee. I am honored and
pleased to be here today to testify about the enforcement of
the Civil Rights of Institutionalized Persons Act and its
application to protect the rights of individuals who have
mental illness in prisons and jails. My name is Samuel
Bagenstos, as the Chairman said, and as Deputy Assistant
Attorney General for the Civil Rights Division, among my duties
is supervising the Special Litigation Section, which has the
responsibility for enforcing the CRIPA statute.
In the nearly three decades since the enactment of the
statute, the Division has investigated more than 430 facilities
across the country and has been able to improve conditions for
tens of thousands of individuals in those facilities. We
currently has 24 ongoing CRIPA investigations involving jails
and prisons, and we are enforcing compliance with consent
decrees and other agreements covering 21 correctional
facilities nationwide. And I should point out that those
numbers do not include our investigations of juvenile justice
facilities, of which we have 17 ongoing, about three-quarters
of which raise issues of mental illness and treatment of people
with mental illness. And those figures also don't include our
enforcement, which is a significant part of our duties, of the
Supreme Court's landmark Olmstead case, which we are applying
to ensure that people with mental disabilities are served in
appropriate settings in the community.
Inadequate mental health care in the Nation's jails and
prisons, which is the subject of this hearing, poses a critical
problem for inmate safety and can stand in the way of real
rehabilitation for those who are incarcerated and do not have
access to treatment. In our CRIPA enforcement, we have
uncovered systematic deficiencies in mental health care in
jails and prisons across the Nation, and we have aggressively
pursued reforms to ensure that inmates are afforded their
constitutional rights.
I will just talk about a couple of examples, a couple of
the key areas in my oral testimony, and maybe we can have
questions about others.
Probably the most urgent issue that we encounter in our
investigations is the lack of adequate procedures for the
detection of suicide risk and the lack of measures for suicide
prevention. So in our investigations, we often find that jails
and prisons process and house inmates without regard to their
suicidal history or their mental health history. One example
was a jail that failed to take precautions even when warned by
a family that an inmate was suicidal, and the inmate committed
suicide within hours of his arrest.
We have found problems including the failure to remove
features in jail cells that have proven conducive to suicide,
like protuberances that people can hang themselves from and
other situations where individuals who are suicidal have not
been adequately supervised.
Another example of our enforcement, we detected in a
facility where an inmate attempted to commit suicide by cutting
himself had hoarded 30 razors in his cell. Yet 4 months later,
another inmate committed suicide by cutting himself with a
razor. In other facilities we have found a lack of adequate
safety equipment, such as cut-down tools, to quickly respond to
suicide attempts. Suicide is a major part of the problems we
find in the treatment of people with mental illness in prison,
as Director Lappin testified.
We also frequently find that jail and prison staff use
harmful methods of isolation, seclusion, or restraint as a
substitute for mental health treatment, often in response to
behaviors that inmates cannot control because of their mental
disabilities.
In one facility we investigated, because of a lack of staff
detainees were regularly placed on suicide watch, which meant
they were isolated for 23 hours a day, sometimes for days or
weeks at a time. They did not receive adequate assessment or
treatment. They sometimes waited days for an initial
evaluation, initial psychiatric evaluation, and several times
detainees placed in isolation injured themselves due to
psychosis-related behavior. In one instance, an individual was
slamming himself against the wall of his cell while wrapped in
a blanket, which protected his body somewhat. Correctional
staff removed the blanket. That was their response.
We have also found that inmates with mental disabilities
are subject to attack by other inmates, and jail and prison
officials fail to provide proper protection. We have some
examples of that in the written testimony.
And we find generally that the deficiencies that we uncover
stem from two basic problems: first of all, the failure to
commit sufficient resources to provide adequate care to people
who are put in prison and kept away from their own opportunity
to get medical care; and, second, the failure to provide
adequate training to jail and prison staff.
We found one facility that had 217 detainees who received
psychotropic medications, and yet there were only two part-time
psychiatrists at that facility.
In other instances, when we find that staff are not trained
to deal with people with mental disabilities in the prisons,
they respond by using force appropriately. We have examples of
people who were beat up by prison guards for engaging in
conduct that was a result of their mental illness.
We have been successful in resolving the vast majority of
the violations we discover through voluntary agreements,
without contested litigation. We have some examples in the
testimony of working cooperatively with, for example, the State
of Wisconsin, with their only women's correction facility where
we found significant issues relating to the constitutional
rights of inmates with mental illness, but we have worked
cooperatively to lay out a set of specific remedies, a detailed
action plan that the State of Wisconsin has followed and that
has at this point been successful. That agreement, as with all
of our agreements under CRIPA, is one that we closely monitor
to ensure compliance. And we find that access to mental health
care is a critical need in jails and prisons across the Nation,
so we are committed to ensuring inmates with mental illness
receive adequate treatment in safe conditions.
Thank you again for the opportunity to testify before this
Committee, and I look forward to your questions.
[The prepared statement of Mr. Bagenstos appears as a
submission for the record.]
Chairman Durbin. Thank you very much.
Our next witness, Mary Lou Leary, is the Deputy Assistant
Attorney General for the Justice Department's Office of Justice
Programs. Previously, she served as the Executive Director of
the National Center for Victims of Crime, Acting Assistant
Attorney General of OJP, and U.S. Attorney for the District of
Columbia. She has a bachelor's degree from Syracuse University,
a master's degree in education from Ohio State University, and
a law degree from Northeastern University School of Law.
Ms. Leary, thank you for being here. Please proceed.
STATEMENT OF MARY LOU LEARY, DEPUTY ASSISTANT ATTORNEY GENERAL,
OFFICE OF JUSTICE PROGRAMS, U.S. DEPARTMENT OF JUSTICE,
WASHINGTON, D.C.
Ms. Leary. Thank you very much, Mr. Chairman, Ranking
Member Coburn, and Senator Franken. I am very happy to be here
to discuss the Department of Justice's efforts to improve the
response of State and local criminal justice systems to people
with mental illnesses. We are very pleased that the
Subcommittee is interested in this issue.
As you all are very well aware, many people entering the
criminal justice system in this country have problems with
mental illness. According to a report from the Council of State
Governments that was funded in part by the Office of Justice
Programs, 16.9 percent of the adults in a sample of local jails
had mental illness, a serious mental illness. That is three to
six times the rate for the general population. And also
troubling is that while the rate was 14 percent for men, it was
31 percent for women. If you applied these rates to the 13
million jail admissions in 2007, the study suggests that more
than 2 million bookings of persons with serious mental illness
take place every year.
So to help address this issue, OJP's Bureau of Justice
Assistance administers a program called the Justice and Mental
Health Collaboration Program, bringing together the mental
health system and the criminal justice system to work
collaboratively to address these needs. And the program helps
State and local governments and tribes design and implement
collaborative efforts between the criminal justice system and
the mental health systems. The goal is to improve access to
effective treatment for people with mental illness. That
improves public safety, prevents recidivism, and provides
effective treatment for those who need it.
From fiscal year 2006 through 2008, BJA awarded 76 of these
grants--that is a total of about $12 million--to 32 States,
D.C., and Guam. Many of these programs support--many of the
grants support programs for adults, but some also go to
juveniles, and there are a number of grantees who are
addressing both of those populations.
Also, projects have been targeted, through the Bureau of
Justice Assistance, to the National Institute of Corrections,
and Council of State Governments to jointly to provide training
and technical assistance to communities across this country
regardless of whether they have received funding. Training and
technical assistance is really critical when we talk about
replicating good practices.
In just a very short period of time, we have already seen
significant progress. We know that the majority of women inside
prisons have mental health problems, and yet only a very few of
them receive treatment while they are incarcerated.
In New Jersey, their Department of Corrections received a
grant in 2008 to provide trauma-informed care and reentry life
skills to women in the New Jersey State prison. This program
teaches basic life skills--health, nutrition, job applications,
things of that nature--but they also take part in something
called ``Seeking Safety,'' and that is a trauma-informed
therapeutic program that gets at the roots of trauma and
provides treatment and an outlet for women who are in this
program.
In Cass County, North Dakota, in 2005 only 191 detainees
were even referred for a psychological assessment, and out of
these, only 92 of them actually got treatment because there
just were not enough resources to provide that treatment. They
received grant funding in 2008 to address these issues, and in
just the first 5 months of 2009, 550 detainees received an
assessment; 373 of them were referred for treatment and
services, and 10 of them were actually taken for
hospitalization or inpatient evaluation.
Encounters with law enforcement we know often play a very
critical role in whether or not people with mental illness end
up recycling in and out of the criminal justice system. In
order to address this, there are many law enforcement
departments that are partnering with mental health specialists
around this country to make it easier from the get-go, from the
first encounter with law enforcement, to refer the appropriate
people for mental health services. These programs are often
called ``co-responder teams'' or ``crisis intervention teams,''
and these kinds of models are eligible to receive funding under
the program at BJA.
Seven jurisdictions in the country have used BJA funds to
start or enhance law enforcement response programs that link
people with mental illness to treatment and services, and this
is the best kind of diversion from the criminal justice system
for people with these problems.
BJA has also partnered with the Council of State
Governments and the National Association of Counties on a
number of publications to help other communities learn about
best practices and how to implement these models. Those
publications address things like law enforcement response,
mental health courts, effective reentry practices for people
with mental illness, and I have included copies of these
publications with my testimony, so I hope you will have a
chance to look at those.
Please be assured that the Department of Justice will
continue with its work and its commitment to addressing this
issue. In fiscal year 2009, we will be awarding 43 grants, a
total of nearly $8 million. These grants include projects in
Illinois, Minnesota, Oklahoma, Pennsylvania, South Carolina,
Texas, and Wisconsin. Additional funding will support training
and technical assistance efforts. Also, there are many grants
under the Second Chance Prisoner Reentry Act that will
specifically address mental illness and pre-release services
and treatment as part of a comprehensive reentry effort.
This concludes my statement, and I am really grateful for
the opportunity to testify today. I will take any questions
that you have.
[The prepared statement of Ms. Leary appears as a
submission for the record.]
Chairman Durbin. Thanks, Ms. Leary.
Mr. Lappin, you testified that 19 percent of incoming
offenders into the Federal correctional system in 2002 and 2003
suffered from mental illness. That translates to well over
30,000, maybe 40,000 in your total population with mental
illness. You testified that Bureau of Prisons psychologists
conducted 37,263 individual counseling sessions in fiscal year
2008, which sounds like a large number until you consider that
somewhere between 30,000 and 40,000 inmates are mentally ill.
How many inmates received individual counseling sessions
during fiscal year 2008? And how frequently did these sessions
take place?
Mr. Lappin. I am not sure that I have the actual number of
individual counseling sessions that took place. I can try to
gather that and provide it for the record, but it is all
determined on a case-by-case basis. Obviously, as well staffed
as we are--and I have to state we are probably much better
staffed in the area of mental health needs than many States and
locals--it is still a huge challenge to address the needs of
that many individuals.
And just so you know, our definition of ``mental health''
is meeting the criteria of the Axis I Disorder and the
Diagnostic and Statistical Manual of Mental Disorders. It does
not include--as part of that Axis I, it does not include folks
diagnosed with antisocial behavior or drug abuse disorders. So
we have not included those in that category even though they
fall within the Axis I. If we add those folks in, it would be a
much higher number.
Chairman Durbin. How many Bureau of Prisons inmates receive
psychotropic medication?
Mr. Lappin. In excess of 16,000, and we are working on--it
is a little confusing because psychotropic medication is
actually provided for some disorders other than mental health
issues, so we are sorting through that. We will be able to
provide a more accurate number in the not too distant future.
But we spent $61 million last year on medications, and $11.5
million was spent on psychotropic medication. So you can see it
is a large portion of that medication that we do provide.
Chairman Durbin. $11.5 million?
Mr. Lappin. $11.5 million. We only provide medications for
those that have a clinical need for medication. So not all
folks who suffer from mental illness get medication.
Chairman Durbin. With 30 full-time psychiatrists at the
Bureau of Prisons located primarily at your medical referral
centers and other BOP facilities receiving psychiatric services
via video or contract psychiatrist, this translates to roughly
one psychiatrist for every 1,000 inmates with mental illness,
and apparently one psychiatrist for every 530 inmates who are
currently on psychotropic medication. That is an incredible
caseload.
Mr. Lappin. There are also a number of contract
psychiatrists--I can get that number--that support those 30
psychiatrists. But you are right, it is a large number. We are
able to do it more efficiently because of the use of
telepsychiatry in lieu of people having to travel to assess and
determine appropriate medications and utilization of
psychotropic medication.
But it is, it is a large number. We struggle in some
locations recruiting and retaining not only psychiatrists but
psychologists as well, in part because of the rural nature of
some of our facilities on the one side, and, two, high cost-of-
living areas. Those are our two most challenging areas.
To our benefit, which unlike States, we have the
flexibility of moving those inmates to locations that have more
of those staff and services available. And so I sympathize with
some States that are very rural and struggle across the board,
whereas we do have the ability to move the inmates who have the
needs to other locations where those services can be provided.
Chairman Durbin. The Seventh Circuit Court of Appeals at
the Federal level is not known as a liberal court of appeals.
They characterize the lack of an onsite psychiatrist in the
Indiana State prison system as ``a serious system deficiency,
contributing to a finding of deliberate indifference to a
serious medical need.'' That is a standard established by our
court system, which Mr. Bagenstos has spoken to.
I would like to ask, of the inmates who are currently in
the Federal Bureau of Prisons system, how many are being held
in segregation or isolation?
Mr. Lappin. Well, that varies. There are two types of
segregation: disciplinary segregation and administrative
detention. And we can get an actual--it varies from day to day
to day. But I know at our highest-level institution,
administrative maximum security facility in Florence, of the
208,000 there are about 450 inmates there who are in controlled
housing. We do not call it ``solitary confinement,'' but they
are in controlled housing. Then every facility has a
segregation unit for inmates who are either misbehaving or are
fearful to be on a compound or just need to be removed from the
general population.
So the number varies, but we can get an actual number on a
given day and provide it for the record.
Chairman Durbin. What do you think is the impact of
segregation and isolation on a mentally ill prisoner?
Mr. Lappin. We have not seen as a consequence of conditions
of confinement of that nature a result being an increase in
mental illness. So at, for example, ADX Florence, we have not
seen an increase in mental illness, we believe, driven by the
fact they are confined in that nature.
Now, realize although isolated or controlled, they are seen
by staff daily. They interact daily. They are removed for
recreation. So it is not like they are locked in a cell and
there is no external contact.
We have a pretty heavy presence of medical and mental
health professionals there who do ongoing assessments. There
are no unstable mentally ill inmates. If they become unstable,
we remove them from there. We put them in a hospital until we
gain their stability, at which time they would be returned to
those conditions.
So there are inmates there who have mental illnesses, who
came there with mental illnesses, but they are controlled and
they are stable during the period of time they are there, and
they are monitored very closely.
Chairman Durbin. I am not an expert in this field. I am
trying to learn.
Mr. Lappin. Yes.
Chairman Durbin. In June of 2006, a bipartisan national
task force, the Commission on Safety and Abuse in America's
Prisons, released its recommendations after a year-long
investigation. It called for ending long-term isolation of
prisoners.
``Beyond about 10 days, the report noted, practically no
benefits can be found and the harm is clear--not just for
inmates but for the public as well. Most prisoners in long-term
isolation are returned to society, after all. And evidence from
a number of studies has shown that supermax conditions--in
which prisoners have virtually no social interaction and are
given no programmatic support--make it highly likely they will
commit more crimes when they are released. Instead, the report
said, we should follow preventive approaches used in [other]
countries.''
What I just quoted was an article entitled ``Hellhole'' by
Dr. Atul Gawande. I do not know if you have seen it. It was
published in The New Yorker on March 30, 2009. Without
objection, I will enter it into the record.
[The article appears as a submission for the record.]
Chairman Durbin. Do you disagree with the conclusion of
that task force?
Mr. Lappin. I am going to speak to the supermax issue, and
I disagree with that there is no benefit there. Let's realize
there has got to be a balance here. Without question, the
inmates that are housed at that supermax--and I cannot speak to
the States, but my guess is they are similar. These are very
violent, aggressive, challenging, difficult inmates who have
decided they are not going to listen to the rules in prisons,
they are not going to adhere to the direction of staff.
You cannot run safe prisons with folks like that out in the
general population.
Chairman Durbin. Is there a middle ground between
isolation--23 hours in a cell, for example--and general
population?
Mr. Lappin. I think there is, and that is when it comes to
how those supermaxes are run. Is there contact with staff? Are
there assessments that are done? Are there ongoing reviews? Is
there a way for those folks to work their way out of those
conditions of confinement? And, in fact, there are, as long as
they agree to participate and abide by those rules.
So our supermaxes, I am sure like many others, have a
phased program that people can work their way through and
eventually work their way out. But they have got to follow the
rules. And the dilemma we have is if you look at this array of
inmates that happen to be housed currently, the majority of
them at ADX Florence--and I am sure other supermaxes
similarly--are folks that have routinely and frequently
assaulted staff and inmates in our institutions, killed
inmates, sometimes killed staff.
And, again, although it is tragic and unfortunate, you
cannot protect the other inmates, nor can you protect the other
staff, without managing these inmates in a more controlled,
more structured environment.
If people have other suggestions as to how that can be done
and we still protect the other inmates and the staff who work
in those facilities, I assure you that myself and the other
directors of corrections around this country will be listening.
Chairman Durbin. I will return to this, but, in fairness,
Senator Franken has waited patiently. I have gone over my time.
Senator Franken.
Senator Franken. Thank you, Mr. Chairman.
Mr. Lappin, how many Federal prisons are there under the
Federal Bureau?
Mr. Lappin. We own and operate 115 Federal prisons. We
contract privately with 14 large private contract facilities.
They house primarily low-security criminal aliens. And then
there are about 8,000 to 9,000 inmates on any given day in 250
to 300 contract residential reentry centers. These are inmates
who are transitioning from prison to the community. So we
contract those services with companies and organizations in
local communities--for a total of 208,000 inmates.
Senator Franken. Thank you. You mentioned the dual
diagnosis residential drug abuse treatment program, which seems
like a very worthwhile investment for prisoners who have a dual
diagnosis of mental illness and chemical dependency. At how
many sites does the Bureau have this program?
Mr. Lappin. We have this at three locations, and it is all
driven on the number of inmates we see who have that dual
diagnosis. If there are more inmates than we have room for, we
would add more programs of that nature.
But to give you an idea, 40 percent of our inmates have a
diagnosis of drug or alcohol abuse in the Federal prison
system; 92 percent of those inmates are volunteering for
treatment. A portion of them have been diagnosed with a dual
diagnosis condition, and we place them in these three programs
to deal with both their addiction to drug or alcohol as well as
their mental health issues.
Senator Franken. It just seems like out of all the prisons
that you have, to have only three prisons with that program
seems inadequate.
Mr. Lappin. Well, I will check and return for the record, I
will tell you how many folks are in that program, how many have
been diagnosed--they have to volunteer for treatment--and how
long the waiting lists are, because what we do is monitor that
waiting list. And if we saw the waiting list was such that we
could not treat the number of folks who have that need, we
would add programs. But we will provide that information for
the record. We will tell you how many folks are on the waiting
list and whether or not we are able to get to everybody that we
diagnose with that need who volunteer for treatment.
Senator Franken. Thank you.
Mr. Bagenstos, in your testimony you describe the methods
of isolation that Chairman Durbin referred to that are used to
control prisoners with mental illnesses. Are these tactics used
with juvenile prisoners?
Mr. Bagenstos. Yes, they are. So we have found in some of
our juvenile investigations isolation and seclusion used as a
replacement for mental health treatment in some of our
investigations, even more shockingly than in some of our jail
and prison investigations. So in an investigation of one set of
juvenile facilities, there were individuals who violated prison
rules or facility rules, were locked in a darkened room for 23
hours a day, was our finding. And so we have definitely found
those sorts of problems in many juvenile facilities across the
country.
Senator Franken. Are there other tools that are better than
putting a juvenile in isolation in a darkened room for 23
hours?
Mr. Bagenstos. We certainly think so. Our experts who we
take on our tours certainly think so and who suggest minimum
remedial measures to come into compliance with the
Constitution. Often the problem in juvenile facilities is you
are dealing with a population that has often undiagnosed mental
illness problems, and for a variety of reasons, institutions do
not provide the sorts of treatment or appropriate behavioral
responses. And instead we have found in many cases seclusion
restraint abuse as responses instead.
Senator Franken. Let me ask you, what percentage, in your
opinion or your research, are dual diagnosis, people with
mental illness and substance abuse problems?
Mr. Bagenstos. In what class of facilities? In the juvenile
facilities?
Senator Franken. Just in our Federal prison system.
Mr. Bagenstos. Well, you know, our CRIPA enforcement
authority does not extend to the Federal prison system, so I do
not know that I am the best person to answer that question.
Senator Franken. Okay. Let me ask you this: What type of
training do prison officials receive to help them identify
mental illness and defuse conflicts with mentally ill
prisoners? And do you think there should be a Federal
requirement for this kind of training?
Mr. Bagenstos. Well, it is an interesting question whether
there ought to be a Federal requirement for this kind of
training. We enforce the constitutional rights of inmates at
facilities or residents at juvenile facilities, and what we
have found contributing to violations of the Eighth Amendment
and 14th Amendment is a lack of training.
So the example that I give in the written testimony of the
Wisconsin State prison for women, the Taycheedah Correctional
Institution, is an example where systemic deficiencies in the
treatment of inmates with mental illness was related directly
to a lack of training, and the remedy that we negotiated with
and adopted and worked cooperatively with the State to
implement includes requirements for training of the people who
work at that facility, both when they come into service and
then in-service training.
The lack of training is one of the essential problems that
we have found contributing to constitutional violations around
the country.
Senator Franken. Ms. Leary, just a general question. Do you
think there are just too many people in prison in this country?
Ms. Leary. I think there are too many people in prison in
this country, Senator Franken, and part of the reason is that
we are not addressing appropriately the needs of many people
who do end up in prison--for instance, those with mental
illness. Oftentimes, they are creating a disturbance, police
are called to the scene, and they just lock them up. Then they
end up in prison, and it starts a cycle, and they recidivate
and they never get the treatment that they need. It just
becomes a lifelong process in and out. That is just one example
of the type of person who is in prison who should not be there.
Senator Franken. You know, I liked your testimony about the
Bureau of Justice grantee program in New York City that
combines mental health treatment with community service as an
alternative to traditional incarceration. How much does it cost
to run a program like that? And do you think that alternative
programs to incarceration for the mentally ill save taxpayers
money in the long run?
Ms. Leary. I can get you the figures on the costs for
actually running a program like that. I do not have them with
me. But we have seen an evaluation of several of these kinds of
programs; we have seen that it does save the taxpayer money
because you prevent recidivism and you can reduce the costs of
incarceration.
It is simply really beyond the capacity of the States to
incarcerate all our problems. There are better and more cost-
effective investments that we can and should be making in such
things as diversion programs, mental health courts, drug
courts, better reentry so that once you leave you will not be
coming back. There are many ways to save taxpayer dollars and
actually improve public safety outcomes. That is a lot of what
we do at the Office of Justice Programs.
Senator Franken. Thank you.
Thank you, Mr. Chairman.
Chairman Durbin. Thank you, Senator Franken.
Mr. Lappin, returning to the one example you cited, when I
asked you about isolation, you used the example of Florence,
where you thought there were perhaps 450 inmates in isolation.
Is there a resident psychiatrist at Florence?
Mr. Lappin. Yes.
Chairman Durbin. One or two?
Mr. Lappin. There is one psychiatrist at Florence. There
are about 3,000 inmates there, but he spends a great deal of
his time at the administrative maximum security facility. There
are also seven or eight psychologists.
Chairman Durbin. And you indicated that if an inmate is put
in isolation and there is a detection of a deteriorating mental
condition, they are removed from isolation.
Mr. Lappin. Well, we remove them to a hospital.
Chairman Durbin. To a hospital.
Mr. Lappin. To return them to a stable condition.
Chairman Durbin. And who would make that observation of a
deteriorating condition?
Mr. Lappin. Well, yearly we train all of our staff as to
what to look for. Now, granted, our experts--our psychiatrists,
our psychologists, our treatment staff--are the ones that do
the diagnosis and the assessment. But an alert can come from a
correctional officer, from a unit staff, from an education
person, because as part of our training we train our staff what
to look for and who to inform if they see an inmate acting in a
certain manner. And so that report can come from anyone, and
then a mental health professional would intervene and make an
assessment.
Chairman Durbin. And what is the range of isolation, in
terms of days, months, years, in the Federal Bureau of Prisons?
Mr. Lappin. Typically very short. If you look at all the
people who are in segregation as a whole, and on average, the
amount of time they are there, typically their stays are short.
That is our objective, to make that stay as short as possible
and return them to a general population facility. So these
supermaxes are the extreme only because these folks resist and
they are not going to comply. And as a consequence, they end up
in segregation or isolation for longer periods of time than
what most inmates find themselves in those conditions that
confine them.
Chairman Durbin. There was an editorial in the Washington
Post this morning about sexual violence in American prisons and
sexual exploitation. What is your experience or your knowledge
of the connection between mental illness and sexual
exploitation in our Federal Bureau of Prisons?
Mr. Lappin. In general, that is a more vulnerable
population, those that have mental illnesses--not only those
that have mental illnesses, but the folks who come in who are
young, inexperienced, do not have the wherewithal to manage in
that social environment. So without a doubt, there are higher-
risk groups who fall into the category of being manipulated or
being taken advantage of. The mentally ill fall into that
group. And it is unfortunate when, in this case, an employee
violates the public trust in their capacity as a law
enforcement officer and takes advantage of someone. It is
unfortunate. Our policy is zero tolerance of that, and we try
to aggressively identify that, investigate those incidents, and
remove those folks if we have the evidence to do so.
But, without a doubt, the mentally ill are more
susceptible, more risky, and more vulnerable, as are some other
unique groups of inmates within our population.
Chairman Durbin. Also, with the Bureau of Prisons, do you
have a juvenile population?
Mr. Lappin. Very small, 141, and we contract out with local
communities typically to house those offenders, unless they are
of a very violent nature, and then we have a few special
locations around the country where we house them. But on that
issue, our challenge is finding locations that have the
adequate services and support for the juveniles because, I do
not disagree, a higher incidence of mental illness and
emotional concerns with the juveniles. We have limited
locations because when we go--we just do not dump these folks
in there. We go out and we visit them. We have a contract with
them. We set expectations. And it is very difficult sometimes
for us to find appropriate facilities to house even as small a
number as 141.
Chairman Durbin. So, Mr. Bagenstos, now that you have heard
this discussion here and have told us that you are trying to
put this in the context of the constitutional rights and legal
rights of prisoners in these circumstances, what is your view
of segregation and isolation, the treatment of the mentally ill
in our prison system, the treatment of juveniles? Do you have a
view as to whether or not there is work to be done here?
Mr. Bagenstos. I think there is a great deal of work to be
done in the treatment of inmates with mental disabilities,
psychiatric disabilities, in State jails, State prisons,
juvenile facilities. You know, we do a lot of that work, and I
have to----
Chairman Durbin. Can you speak to the Federal system?
Mr. Bagenstos. Well, it is difficult for me to speak to the
Federal system because that is not within our CRIPA enforcement
responsibilities, so we have not done investigations of that.
You know, when I speak to this Committee----
Chairman Durbin. Who does?
Mr. Bagenstos. Well, I think Mr. Lappin could talk about
that.
Mr. Lappin. First of all, let me just say we believe that
isolation should be used very seldom for folks who are mentally
ill. And so if you look at our inpatient cohort, you are going
to find that we use isolation as seldom as possible for that
group who have been diagnosed with that mental illness and who
are exhibiting behavior that needs to be managed and
controlled. So there is a combination of things, if you talk to
our treatment specialists, besides isolation. There is
medication in appropriate cases. There is more counseling,
there are more, other ways of controlling that. So isolation is
the one that we try to use the least. However, there are some
cases where it is necessary.
If there are complaints about treatment of inmates in the
Federal Bureau of Prisons--and those complaints can come from
staff, from inmates, from the public, from whomever--all of
those complaints work their way to the Office of the Inspector
General, who would make a determination as to whether or not
they would investigate, and they may reach out to Civil in some
cases and ask them to jointly investigate a concern or a
complaint that has been made. But the Office of the Inspector
General takes the lead on how and where and in what fashion a
complaint will be investigated and dealt with.
Chairman Durbin. So, in addition to the court system, which
is, of course, going to have the last word here, the internal
mechanism is through the Inspector General's office?
Mr. Lappin. Yes.
Chairman Durbin. Which we probably should have invited to
this hearing, but thank you very much.
Mr. Bagenstos, we are going to hear later about the Tamms
Correctional Facility in my State, a supermax facility. Have
you received any complaints about Tamms?
Mr. Bagenstos. I cannot tell you the answer to that. I do
not know whether we have received complaints about Tamms. I
will certainly look into that, and, you know, we can provide
that information to the Committee.
Chairman Durbin. Ms. Leary, one of the things that you said
struck me as interesting. The first intake officer for someone
mentally ill about to enter our system is usually a policeman,
and the obvious question is what skills do they have to
recognize mental illness and its manifestations in contrast to
simple criminal misconduct.
Ms. Leary. I think that is a very difficult situation, and
I would say probably most police officers really do not have
the kind of training that they would need to recognize that
this is a person with a mental disability, not just someone who
is committing a criminal act.
That is where these teams come into play where you pair law
enforcement officers with mental health professionals. They
train as a team, and they respond as a team so that each has
knowledge of the other's role at the scene, and they can assess
the situation appropriately, and then if the right thing to do
is to get that person some mental health treatment, instead of
throwing them in jail, that should be the outcome.
When I was a prosecutor here with the U.S. Attorney's
Office in D.C. in the 1980's, police officers who would
encounter people with mental disabilities would just lock them
up and drop them off at St. Elizabeths, and that was the end of
it, or else in the D.C. Jail. And that situation is the wrong
thing for everybody, and, frankly, it is dangerous. It is
dangerous to the offender, and it is dangerous to the police.
Chairman Durbin. The second intake officer, the second
level of intake, is likely to be our profession: lawyers,
criminal defense lawyers who interview these patients. I cannot
recall a moment in law school when anyone took the time to talk
to me about what you should look for to recognize mental
illness.
What do you think about that?
Ms. Leary. I do not think it is taught at law schools,
although I think it certainly should be taught in places like
law schools, especially if you are working in a clinic. Say you
are doing a prosecution clinic or a defense clinic, or any kind
of clinical work, you really should have that training, and
that should be encouraged.
I think attitudes about mental illness have improved in
general, in the general public in the last few years, but we
still have a long, long way to go.
Chairman Durbin. What is your opinion of the impact of
segregation and isolation on the mentally ill?
Ms. Leary. I do not have any knowledge of that. I have not,
you know, researched that. Common sense would tell you that if
that isolation and segregation means that the person truly is
isolated from human contact, that is an aggravating
circumstance that I would think has great potential to
aggravate a mental illness.
Chairman Durbin. I have many more questions, but I know we
have another panel and will not be able to go much longer. It
is possible that some of these will be touched on in follow-up
written questions, if it would be convenient for you, if you
could respond.
I would like to turn now to Senator Franken.
Senator Franken. Thank you, Mr. Chairman. I just am going
to do a few questions.
First of all, it seems to me, Mr. Lappin, that you are
saying that when mentally ill patients are put in isolation, it
is really because they have acted out in a way that really
affects the safety of other prisoners and of the guards at the
prison, right?
Mr. Lappin. Or themselves.
Senator Franken. Or themselves, okay. And you are talking
about--I hear about a ratio of psychiatrists to prisoners of
one to a thousand. Is it fair to say that psychiatrists at the
prisons sometimes feel a little overwhelmed?
Mr. Lappin. Well, let me clarify a little bit. For those
that would end up in isolation, they are at medical centers. So
our ratio of mental health professionals to staff is much
smaller. There is going to be an abundance of----
Senator Franken. You are saying that there are not mentally
ill prisoners who end up in isolation in prison?
Mr. Lappin. In our general population facilities, it can
happen. If someone becomes unstable during their period of
incarceration at a general population facility, we are going to
move them----
Senator Franken. Are you confident that everyone----
Mr. Lappin.--to a location where----
Senator Franken.--with a mental illness has been diagnosed?
Mr. Lappin. I am sorry?
Senator Franken. Are you confident that everyone with
mental illness has been properly diagnosed?
Mr. Lappin. Well, I think there is always--with that many
inmates, there is always a chance there would be a missed
diagnosis. I go back to the key, and that is, early diagnosis.
In our intake screening, it is not only a case manager who
interviews the inmate. Within 24 hours there is a psychological
assessment as well as a medical assessment, and then a follow-
up within 7 days.
We also have a history, the pre-sentence report if there
are indications there. So our psychology staff are alerted to
that. So they can begin tracking whether or not a person has a
mental health condition sometimes in advance of the inmate even
arriving at the institution, because in advance of the inmate,
we get all the court documents. And if those court documents
reflect that, they are aware of that before the offender even
arrives. But once they arrive, within 24 hours there is an
assessment. And if the person is displaying that behavior upon
intake, there is an alert made to our psychology staff who will
then respond to them immediately--their highest priority is to
respond to those who are displaying behavior consistent with a
mental illness.
So although it is not impossible for us to miss it, with
thorough screening and competent staff and trained staff at all
levels, we have a better chance of identifying those folks in
advance. So if they become unstable and they end up in
segregation at an institution and the psychologist there
determines that I do not think this is the appropriate place
for us to treat this person--sometimes they can, sometimes they
cannot--they would refer them to a medical referral center. We
would move that person to a location where there are more
psychiatrists, more psychologists, more treatment staff. And
typically that is where isolation occurs. And, again, isolation
is the last resort, and we try to do it for the minimal amount
of time to restore that person to the point that they are no
longer a danger to themselves or somebody else. So that is how
it works in our system.
Senator Franken. I understand. There was one phrase you
used, which was ``with that many prisoners.'' And I had asked
Ms. Leary before, Do we have too many prisoners in prison in
this country? And I believe we do. And I believe that it puts a
burden on everyone, including the psychiatrists in these
prisons.
Mr. Lappin. Well, here is an example. We are going to add--
just to give you an idea how it works in this system, which is
probably similar to your systems. Not only are there 208,000
inmates, but we release 60,000 inmates a year. But we are going
to admit this year 67,000 inmates. So we are going to add a
7,000 increment to the base, and you can assume that within
that 7,000 there are 1,500 who have a mental illness. So the
number continues to grow, which puts an increased burden on
those in institutions.
So I go back to my original comment that early diagnosis,
adequate resources in the institutions, and, as importantly, an
issue we have not touched on is our inability--you are correct,
most of these folks are going to release into our communities--
is the inability to find contract support facilities for
reentry that provide the level of services for this unique
group.
So there are three groups of folks, to give you a idea:
42,000 inmates in our system released back into the streets of
the United States every year; 85 percent of those released
through a halfway house. We believe the most appropriate manner
in which to move someone from prison to the community is
through a halfway house. The three most difficult groups to
place, the 15 percent we are not getting, the vast majority of
them are mentally ill inmates, sex offenders, and inmates who
are very violent and disruptive even toward the end of their
sentence.
Let us just focus on the mentally ill. Why is it difficult?
Again, because many of them are going to rural locations, where
there may be a halfway house, but they do not have the
wherewithal, they do not have the resources available in that
halfway house to care for that individual who has unique mental
health concerns, as well as the challenges we face in our more
urban areas where it is very expensive. They struggle getting
the resources necessary, because our contracts require that.
So here we are, we have this mentally ill inmate who is
going to release, and we prefer to put them into a halfway
house to transition out, acquire the services they need,
whether it is for medication, whether it is for treatment or
ongoing therapy, before they go to the street. But we lack the
services in many of those locations. And, consequently, the
inmate goes to the community.
One last issue: too many communities that continue to
resist the fact that their citizens who happen to be offenders
are going to return home. In some cases, we actually have to
litigate to convince them to put a residential reentry center
in their communities. And a consequence is these folks go
directly to the street.
Now, again, I think that common sense would tell you that
it is much wiser of us to transition especially these more
challenging folks out through halfway houses than for us to
give them $100 and a new suit and throw them on the street
corner.
I can tell you, in my community I prefer to have more
supervision than that. But, again, we have many communities out
there that continue to resist and say not here, not in my back
yard, and it is kind of like out of sight, out of mind, I do
not want them here. And that is reality. That is tragic, but it
is the truth. And it is even more complicated when you have the
mentally ill, the sex offenders, and the more violent offenders
who are going to go directly into our communities.
I did not mean to get off track, but that is an area we
really have not touched on. But I think it is critically
important, because as we have all said, most of these folks in
local, State, and Federal prisons, they are going to go home at
some point in the future.
Senator Franken. They almost all go home.
Now, just one last thing to wrap up. Ms. Leary, the Office
of Justice Programs' mission is to provide leadership and
services and grant administration and criminal justice policy
development to support local, State, and tribal justice
strategies to achieve safer communities. That is in your
testimony.
Ms. Leary. Yes, sir.
Senator Franken. So you have an overview of the whole
prison system, right?
Ms. Leary. We work with the State and the local prison
systems, that is right. And we also work with the National
Institute of Corrections.
Senator Franken. Okay. So I am going back to this deal
where we are talking--Mr. Lappin says eventually most of them
get out, right?
Ms. Leary. Right.
Senator Franken. So we have got people we are putting in
the system, and then they come out. In your opinion, do they
come out better than they went in? And this goes, again, to my
opinion that we have too many people in prison in this country.
And I was struck with your talking about drug courts and mental
health courts, which I was not aware of. So I guess it is--can
you just respond to what you think I am getting at?
[Laughter.]
Ms. Leary. Sure, I would be happy to. I think that there
are many far better alternatives than incarceration for those
who should not be incarcerated, so we are not talking about the
most serious, violent offenders and those who really are big
risks to public safety.
One of the things that the Office of Justice Programs works
on is helping communities figure out what these alternatives
are and how can we improve public safety in our communities
without locking everybody up. And it runs the gamut, and you
have to look at the whole spectrum from prevention to
alternatives which include all the problem-solving courts that
we work on, like drug courts and veterans' courts and mental
health courts and so on, to provide people with the resources
and the treatment they need so that they will not end up in
prison, because the chances of them getting what they need
while they are in prison are much slimmer than they are if you
have a really effective community-based program to deal with
people's issues.
Then, again, as I said, you have to look at the whole
spectrum, and that is where I think reentry is so important for
those who do end up incarcerated. Reentry planning has to start
right from the time of sentencing and follow all the way
through your term of incarceration and back out into the
community.
Senator Franken. Thank you.
Thank you, Mr. Chairman.
Mr. Lappin. May I add to that? There are some people that
belong in prison.
Senator Franken. Absolutely.
Mr. Lappin. And we will send you some research for the
record that reflects the availability of programs to focus on
skills they lack result in fewer of them coming back to prison.
So for those that need to be in prison, the availability of
programs and opportunities to improve on the skills they lack,
it is shown, results in fewer of them returning to prison--
better educated, have a vocational skill, learn work skills,
learn to manage this mental illness that they sometimes come to
prison with, because that is probably, in part, part of the
problem for this unique group. We try to put programs in place
that teach them how to manage their mental illness, and there
is an array of other skills they lack. And we will send the
research for the record that reflects that the availability of
those programs and the willingness of those to volunteer and
participate typically results in fewer of them returning to
prison. And that is why we have a little bit lower recidivism
rate than what you are seeing on the average.
Thank you.
Chairman Durbin. Mr. Lappin, let me thank you for that last
comment and add what probably does not need to be said but will
be said. The safety and security of the people who are working
in our prisons is the highest priority, and I do not think
anything we have said today should diminish from that
commitment, which we all have, to that end. And for those
correctional officers who literally risk their lives in this
business, that is the first thing: to make certain that they
are safe. And the safety of America at large, of course, is an
equally important priority. I think we have raised some
interesting and challenging questions about those who are
released from prison and the likelihood that they will commit
another crime, find another victim. We certainly want to
diminish that as much as possible.
You mentioned during the course of your testimony that you
are open to ideas. The Gawande article talks about things that
are being done in Britain today as an alternative to our
incarceration model. I do not know if you have had a chance to
look into that, but it is at least worth a discussion, probably
at another time in another setting. But I want to thank this
panel, an excellent panel, for the testimony given. I am told
it is extraordinary for the Department of Justice to make this
kind of commitment, for several people to come forward for this
kind of a hearing, and I appreciate it very much. You will
receive some written questions, which I hope you can respond to
in a timely fashion. Thank you all.
Chairman Durbin. We are now going to welcome our second
panel, four distinguished witnesses, who will now come to the
table. If you would just remain standing for a moment, I will
not have to ask you to stand up again.
If you would please raise your right hand, do you affirm
that the testimony you are about to give before the Committee
will be the truth, the whole truth, and nothing but the truth,
so help you God?
Mr. Maynard. I do.
Mr. Randle. I do.
Justice Zenoff. I do.
Mr. Fuller. I do.
Chairman Durbin. Thank you. Let the record reflect that all
four witnesses answered in the affirmative.
Our first witness Gary Maynard, Secretary of the Maryland
Department of Public Safety and Correctional Services, has over
30 years of experience in the field, having served as Director
of Corrections in three other States--Iowa, South Carolina, and
Oklahoma. He was also the President of the American
Correctional Association and a member for 32 years of the Army
National Guard, having served as the Adjutant General to the
Oklahoma Army and Air National Guard. Mr. Maynard is a native
of Oklahoma, holds a master's degree from Oklahoma State, a
bachelor's degree from East Central University in Ada.
Mr. Maynard, thanks for being here. Please proceed.
STATEMENT OF GARY D. MAYNARD, SECRETARY, MARYLAND DEPARTMENT OF
PUBLIC SAFETY AND CORRECTIONAL SERVICES, TOWSON, MARYLAND
Mr. Maynard. Thank you, Mr. Chairman, Senator Franken. My
name is Gary Maynard. I serve as Secretary of the Maryland
Department of Public Safety and Correctional Services. I have
been involved in corrections for 39 years, working in five
States and the Federal Bureau of Prisons. Early in my career, I
served as a prison psychologist. I rose through the ranks of
management, serving as warden on two occasions, and eventually
serving as the head of corrections in four States. I am the
Immediate Past President of the American Correctional
Association, an active member of the Association of State
Correctional Administrators, and have worked closely with the
American Jail Association over the past several years. All
three of these national recognized organizations have provided
data for the testimony I will offer today.
Correctional administrators across the country have an
obligation to provide effective programming for all offenders.
Over the past three decades, we have witnessed an increase in
the number of inmates possessing mental health issues entering
the criminal justice system. Many researchers point to the
depopulation of the State-operated mental hospitals in the late
1960's as one of the contributing factors to this trend.
In 1959, there were over 550,000 mentally ill patients
residing in State-operated mental hospitals. This number is now
less than 80,000. During this same period of time, we have seen
the number of incarcerated individuals quadruple to close to
2.5 million annually.
Corrections certainly does not dispute the concept of
offering comprehensive community-based services to individuals
with mental health needs. However, insufficient resources have
led to an increase in the incarceration of these individuals,
and the resources available to us are lacking.
The American Jail Association estimates that there were
over 650,000 bookings of persons with some type of mental
illness in 2008. A study by the Bureau of Justice Statistics
estimates that more than half of the prison population has
mental health issues. This population is at higher risk of
incarceration due to a number of factors, including substance
abuse. Law enforcement and correctional staff lack the training
and education necessary to work with this population
effectively.
A study of Washington State prisons found that while only
18 percent of their inmate population was classified as
mentally ill, they accounted for 41 percent of the reported
infractions. Lack of training and sufficient staff to work with
the population leads many correctional agencies to use
disciplinary segregation as a tool to manage the population.
This type of isolation sometimes proves destructive to certain
members of this population.
Please understand that corrections professionals do not
believe in abandoning this population and do not feel that
segregation by itself is a useful practice. Though we believe
strongly that the mental health system should hold the primary
responsibility for this group, we understand that many of these
become sentenced to our prisons and jails. We must make solid
investments in working with this population.
Leadership has come from our national associations who have
developed policies and standards to guide correctional
administrators in the treatment of mentally ill offenders.
State and local corrections have adopted a number of methods to
identify and provide appropriate treatment for this population.
In Maryland, the Montgomery County Department of
Corrections and Rehabilitation has served as a model in the use
of a comprehensive screening and referral process that is
overseen by public mental health professionals. In our
department in Maryland at the State level, we have improved our
methods to identify these inmates at intake. We have developed
a system to share information with the Baltimore Mental Health
System in order to protect our staff and prescribe appropriate
treatment.
Corrections agencies across the country have invested in
services to carry the inmates from incarceration to reentry
back into the community. In Cook County, Illinois, the Adult
Probation Department's Mental Health Unit employs officers with
a mental health background to assist clients in accessing
disability benefits upon release.
The Wisconsin Department of Corrections works with
community advocates to assist inmates in filing applications
for Medicaid benefits before release.
In Pennsylvania and Minnesota, reentry staff work with
their psychologists and community providers to ensure that
there is support available to returning offenders.
In Maryland, our department partnered with the Mental
Health Association to pass legislation at the State level to
provide 30 days' worth of medication for offenders being
released in the community. Local health departments across the
country have joined in release planning, staking a claim in the
future of these individuals.
Each of us in the corrections profession does what we can
given our respective resources, but we know that more is
needed. Work has been done at the Federal level to assist us.
In 2004, the Mentally Ill Offender Act was signed into law to
provide agencies with the necessary resources to care for this
population. However, due to limited funding, many corrections
applications have been denied. In the period of 2006-08, only
11 percent of all applicants received funding.
Corrections agencies need funding and technical assistance
to continue building collaborative relationships to properly
care for this population. The corrections field needs the
Federal Government to define a clear role on behalf of this
population.
Specifically, we would benefit from supplemental funding
for medication in prison, enhanced protocols, and proper
training for our staff. We know these things exist, but working
to provide a coordinated approach would greatly strengthen to
serve this population.
We would encourage the Substance Abuse and Mental Health
Services Administration to take the lead in working with
corrections and public health agencies. We understand the
complexity of this population, but we know that funding,
coordination, and Federal support will be a great step forward.
I know corrections leaders across the country are ready to
continue to identify effective practices to support the needs
of this population.
Thank you for inviting me to testify today. I would be
happy to answer questions at the appropriate time.
[The prepared statement of Mr. Maynard appears as a
submission for the record.]
Chairman Durbin. Thanks, Mr. Maynard.
The next witness is Michael Randle, Director of the
Illinois Department of Corrections, operates 28 adult
correctional centers, responsible for 46,000 adult inmates;
previously served for 19 years in the Ohio Corrections System,
most recently as Assistant Director of the Ohio Department of
Rehabilitation and Corrections; a bachelor's degree from The
Ohio State University and a master's degree from Ashland
University.
Mr. Randle, thanks for coming from Illinois to be with us
today, and please proceed.
STATEMENT OF MICHAEL P. RANDLE, DIRECTOR, ILLINOIS DEPARTMENT
OF CORRECTIONS, SPRINGFIELD, ILLINOIS
Mr. Randle. Thank you, Mr. Chairman, for this opportunity
to speak with you. Thank you, Senator Franken.
Prior to my appointment in Illinois, I served as Assistant
Director in the Ohio Department of Rehabilitation and
Corrections. In conjunction with the Ohio Department of Mental
Health, I had oversight responsibility over a Community Linkage
Program, which was charged with providing continuity of mental
health care to mentally ill persons entering and leaving the
prison system.
The issue of mental illness in our prisons and jails is
both complex and pervasive. In fact, a recent study conducted
by the Bureau of Justice reported that up to 16 percent of the
prison and jail populations are afflicted with mental illness,
which is approximately four times higher for men and eight
times higher for women than in the population at large. This
disproportionate representation is primarily a result of
policies that have shifted the emphasis from community-based
treatment of the at-risk populations and priorities that have
diverted resources away from treatment providers.
In recognition of these problems, Congress enacted the
Mentally Ill Offender Treatment and Crime Reduction Act in
2004. The act required collaboration between justice and mental
health program providers to help States and counties to design
and implement collaborative programs within their communities
regarding mental health treatment. While the Act authorized $50
million to be granted toward these efforts, only $21.5 million
has been appropriated between fiscal years 2006 and 2009. Due
in part to this lack of funding, coupled with record deficits,
States and counties have found themselves in dire circumstances
with respect to treatment and management of the mentally ill.
In 1995, the State of Ohio created the Community Linkage
Program, which was designed to facilitate mental health care
for persons entering or leaving the prison system by assisting
in policy development, providing information sharing,
monitoring outcomes, and providing assistance. In essence, this
program was created as a result of recognized and demonstrated
need and out of legal necessity.
At its core, the program is designed to bridge the gap
between State and local criminal justice and mental health
services; it provides a consistent, sustained link between
these entities from the moment offenders enter the criminal
justice system to the time that they are released into the
community.
Like other States, Illinois prisons and jails are facing
crisis levels with regards to mentally ill offenders. Recent
figures indicate that between 20 to 25 percent of the inmate
population in Illinois are carried on the mental health
caseload, with 12 percent requiring psychotropic medication.
This large caseload, along with fiscal challenges and
inadequate community resources, has created difficulties with
managing these offenders while incarcerated, as well as
difficulty in providing reentry services.
The Illinois Department of Corrections has historically
issued a 14-day supply of psychotropic drugs to offenders upon
release. Unfortunately, it usually takes a few months for such
offenders to acquire access to the mental health services that
they need; this gap from access to services can and does lead
to decompensation and often recidivism. In light of this, the
department has begun to initiate a linkage program similar to
that of the Ohio Linkage Program.
As director, I recognize that the challenges of providing
proper care for mentally ill offenders while protecting them
from themselves and the community will be ongoing. At both the
national and State levels, we have made significant progress in
recognizing and dealing with this issue. However, more needs to
be done.
With the passage of the Mentally Ill Offender Treatment and
Crime Reduction Act, we have a vehicle to help provide these
resources. I respectfully ask that you fuel this vehicle and
fully fund the program.
Thank you very much for allowing me to come before the
Committee, and I will be obliged to answer any questions that
the Committee may have.
[The prepared statement of Mr. Randle appears as a
submission for the record.]
Chairman Durbin. Thank you, Director Randle.
Kathryn Zenoff is a Second District Appellate Court Judge
in Illinois. She served as presiding judge of the Criminal
Division and Mental Health Court in the 17th Circuit. She is
the national co-chair of the Judges Leadership Initiative for
Criminal Justice and Mental Health Issues. Justice Zenoff has a
bachelor's degree from Stanford University and a law degree
from Columbia University Law School.
Thanks for coming from Illinois. Please proceed.
STATEMENT OF KATHRYN E. ZENOFF, PRESIDING JUSTICE, ILLINOIS
APPELLATE COURT, SECOND DISTRICT, ROCKFORD, ILLINOIS
Justice Zenoff. Chairman Durbin, Senator Franken, I am
grateful for opportunity to share my perspective. I hope that
my experience is valuable to you. It may be somewhat unique as
I can speak from the vantage points of having organized a 70-
person community task force in Rockford, Illinois, to address
the revolving-door syndrome of persons with mental illness
being incarcerated in our jail in disproportionate numbers; of
having presided for 2-plus years over a mental health court,
which Senator Durbin visited a couple of years ago; of having
collaborated with the Illinois Department of Human Services
Division of Mental Health on a statewide mapping project to
identify gaps in services for criminal justice-involved persons
with mental illnesses; and of having the privilege of serving
as the national co-chair of JLI.
Mental health courts--that is, specialized dockets based on
therapeutic justice or approaches that address an offender's
behavior and root causes--are relatively new. Long-term data on
the effects of these courts on recidivism and public safety are
not yet available, but the short-term reports reinforce their
value and I think warrant continued, even increased, funding.
Participants seem to be positively motivated to take
responsibility for their own recovery. Jail and hospital days
are greatly reduced, resulting in cost savings. I recall one
50-year-old man released from jail to our therapeutic
intervention program, or TIP court, who was diagnosed as
schizophrenic. He believed himself to be a retired army general
and barked orders at me when he came into court. In a regular
courtroom, he would have been held in contempt. But in this
therapeutic setting, our team of legal and mental health
professionals worked with him until he steadily took his
prescribed medication, participated in therapy, and was able to
assume more responsibility for his own life and recovery. He is
now living semi-independently and is no longer delusional. He
has not had any contact with the criminal justice system in
2\1/2\ years.
This story can be repeated numbers of times in the now over
175 mental health courts in the country. Yet recent statistics
still show disproportionate numbers of persons with mental
illnesses in our jails. Stigma is still attached to mental
illness.
We all know more needs to be done. How do we move forward?
What should be our focus for study and action?
We must continue to look for new ways to reverse the
criminalization of mental illness and to improve public safety.
Aware of that challenge, we have just established the Mental
Health Court Association in Illinois to improve our
coordination of statewide efforts. This is the first
organization of its kind in the country.
We know that our jails and prisons have become the so-
called ``safety nets'' of our unfunded and underfunded system
of community mental health care in this country. Now is the
time to focus our attention and our resources on continuity of
care, establishing key linkages, and in funding the gaps in
services. A few of my recommendations are:
First, in expanding funding for mental health courts and
diversion programs, which do provide the structure for
integrated treatment outside of our jails and prisons, we
should focus on wrapping our returning veterans into these
programs as their mental illnesses and substance abuse problems
put them at risk for entering the revolving door in and out of
our jails.
Second, we must improve the screening and mental health
services in our jails. We know how expensive it is to house
prisoners, especially those who are mentally ill. Using
screening tools at booking may more readily identify those
inmates. Needed medication and treatment can then be provided,
resulting in earlier releases. What often happens, as we have
heard today, is that inmates with mental illnesses act out due
to their symptomatology and threaten guards and other inmates.
Any good time they may have accumulated is taken away.
Additional training for staff and separate pods may help.
Sharing information between departments of human services and
corrections, such as the Illinois Data Link Project, can help
identify those prisoners who have a mental illness.
Best practices, SAMHSA's best practices--that is, a blend
of the best research and clinical experience in the area--
suggest an integrated approach to treatment of persons with
mental illnesses in the criminal justice system. That includes
not only medication and therapy but supported employment,
supported housing, and trauma-informed services. To my
knowledge, Medicaid does not cover these costs or covers them
in a very fragmented way. A fresh look at this situation would
be in order, along with allowing reimbursement for the case
management linkage piece of release planning and diversion from
our jails.
Also, funding for Centers of Excellence on a statewide or
even a regional basis would be important. These centers could
facilitate necessary research and examination of best
practices, help coordinate efforts at cross-disciplinary
training for professionals, including police officers working
in the field. They could involve consumers and NAMI.
My other recommendations have been submitted to the
Subcommittee in my full statement and include funding for
technical staff assistance to JLI, our judges organization that
has made significant contributions all across the country.
Resources may be more limited than we would like, but we must
persevere.
In closing, I would like to share with you some sage advice
by retired Illinois Chief Justice Mary Ann McMorrow to a group
of new judges. These words describe very well why I as a judge
feel compelled to be involved and committed. Justice McMorrow
offered this:
``As judges, we look beyond the legal formalities of a
particular dispute, to remain aware of the human dilemma that
underlies almost every case brought before us, and always
within the bounds of our authority try to resolve the problems
presented to us in a manner that satisfies both the legal and
the human aspects of the case. Let us not forget that the law
is first and foremost about human beings and their problems.''
Thank you, Mr. Chairman and Senator Franken, for the honor
and the privilege of being here today and assisting in this
important work.
[The prepared statement of Justice Zenoff appears as a
submission for the record.]
Chairman Durbin. Justice Zenoff, thank you for being with
us.
Our last witness, David Fuller, is an outreach and housing
coordinator for the Manhattan Outreach Consortium. Previously,
he worked as the Director of the Supportive Housing Program for
Community Access and a peer specialist for Bellevue Hospital's
psychiatric inpatient service.
Mr. Fuller is a consumer in recovery from psychiatric
disability and substance abuse who spent about 20 years cycling
in and out of jail. Mr. Fuller now works to improve access to
services for people with mental illness. He is a member of the
National Leadership Forum on Behavioral Health and Criminal
Justice.
Mr. Fuller, the topic of today's hearing has affected your
life like it has no other witness. Thank you for being here
today and having the courage to tell your story. Please
proceed.
STATEMENT OF DAVID L. FULLER, OUTREACH AND HOUSING COORDINATOR,
MANHATTAN OUTREACH CONSORTIUM, BROOKLYN, NEW YORK
Mr. Fuller. Mr. Chairman, Senator Franken, I want to thank
you for allowing me to testify today, and other distinguished
members of the Committee that are not here today. I submitted
written testimony, but there are some things I would like to
talk about that are not in the written testimony.
In my trip down here, I was thinking about an occasion when
I was in the Suffolk County Jail in the early 1990's, and I
suffer with major depression, or I used to suffer with major
depression. Today I manage it and live a very full life. But
back then, things were not going so well, and I was homeless. I
got arrested for petty larceny. I had stolen something to eat
and some baby formula for my child at the time. I was arrested,
put in Yaphank Jail, been up 3 or 4 days. I was also abusing
substances at the time, wasn't very clean, depressed,
preoccupied with my own death, most of the time. I viewed it as
not having enough courage to actually take it out at that time.
When I got to Yaphank Jail, all through this time no one
asked me did I have a mental illness or a substance abuse
problem. I saw no opportunity to reach out for help to a
medical professional. While I was in the holding cell going
through the intake process, an officer yelled out something at
me, and I was hearing voices, too. Isolation back then used to
create psychotic episodes for me, especially when I was sent to
the box. And I think he had told a group of us to get up, stand
up from the bench, and I didn't stand up fast enough. And one
of them punched me in the head, threw me to the ground. I was
handcuffed behind my back, and then one of the officers saw fit
to jump off the bench into my rib cage and broke two of my
ribs.
I was put in the box after this and left there. In my mind,
not to be too dramatic, but I felt I was left there to die. I
had no visitors. The medical personnel were not allowed to see
me. I could hear them talking at the door. The officers would
not let them in. I later found out when my family was looking
for me, I was told, they were told I was not in the jail.
What saved me was I had a warrant for petty larceny in New
York City at the time. The officers came to get me because my
name was in the system. I come to find out later those New York
City police officers had a hard time getting me out of Yaphank
Jail. When I was finally produced, they basically looked at me
and asked the Suffolk County officers, ``What is this? What
happened to him? '' And I really do not remember what they
said. All I know is they laid me down in the back seat of their
car, took me to the next county, Nassau County, and I stayed in
Nassau County Medical Center for another 10 days.
The first 3 days, the doctors were going back and forth of
whether they would have to put a tube in my chest because my
lung was collapsing at the time. Luckily, that did not happen.
The sad thing is this was not a unique experience in my
time in jail. I spent 6 to 8 years cumulatively in city jails
in New York City. The sad thing is that there are a lot of my
peers that are not able to testify before you because they are
no longer with us. They either committed suicide in jail or
after they got discharged out of jail.
It is difficult to talk about this topic without thinking
about the other more complicated, overlapping issues of racism,
social and economic disability, cultural incompetence when it
comes to getting services within the jail system. And I think
that is like a sarcastic statement when I say ``getting
services within the jail system,'' because you really do not.
There is no HIPAA inside a jail. There is no privacy in
your care. I put in my written testimony, I remember the first
time that I got the courage up, you know, to tell people about
what was going on with me, my suicidal thoughts, my complete
engulfment in hopelessness, that I would put in a pen with 30
other guys, you know, officers would yell out, ``Fuller, are
you here to see the psychiatrist or the medical doctor? '' If I
wanted to see the psychiatrist, I would have to acknowledge in
front of 30 or 40 people that I did not know that that is what
I was doing.
When I met with the psychiatrist, it was in a little
cubicle, you know, like in an office pool or something, no
solid walls, no door, expected to talk about the most personal
aspects of my life. I could hear other so-called medical
professionals talking about previous patients and their
personal information, and it scared me. I said, ``Well, when I
leave, are they going to be talking about my information the
same way they are talking about others? '' So I would kindly
shut my mouth and not really discuss the issues that were going
on with me.
A few times I took medication in jail. It is a very
embarrassing situation. In Rikers Island, when you go to
medication, you are standing on a line with--I do not know--50
to 100 other inmates, other inmates going on the other side of
the hall. You are taking your medication right there in front
of everybody at a window. Everybody knows what you get. There
are other illicit activities that go on in the medication line,
you know, the selling of illicit drugs, selling of medication,
things like that.
I really, you know, have to reiterate my experiences are
not the worst experiences. I have been in the box three or four
times. I became psychotic in the box twice. My diagnosis does
not carry psychosis with it. I have not been psychotic since I
have been in jail. But the isolation, combined with the
depression, did create a couple of episodes for me.
I did attempt suicide in jail one time. An inmate found me
and untied my neck. He did not tell the officers because just
like I knew, to tell them what happened would just exacerbate
the problem. I would have been put on suicide watch, which was
basically the box, and isolated and probably would have felt
worse, if possible, than I already did. I do not know him name
today, but I always thank him for that.
What helped me was the last time I was in jail I was asked
by someone did I consider treatment, and I told the person
directly that if I couldn't go to some place that would address
my psychiatric disability and my substance abuse, it was really
a waste of time. I had graduated three long-term drug treatment
programs at this time, countless rehabs and detoxes. I really
can't remember how many-20, 30, 40.
It is painful. Every failed treatment episode is very
painful for a person, and at this point I just could not endure
another failed treatment episode. I knew what I needed. The
services just were not out there for me.
This person actually said, well, we have something called a
MICA program--and a MICA program stands for Mentally Ill
Chemically Addicted residential program--would I be interested
in that. I said yes. I sat in jail for another 2 months on a
misdemeanor waiting for the service. But the good thing is when
I got out, got engaged, I was able to get around people like me
with similar experiences, got support, saw a doctor, got
medication, got stable, decided I wanted a job, decided I
wanted a family, became a father, a husband, a citizen, a man
again, regained my role in the community.
For many years, the State, city, and Federal Government
have been wasting their money incarcerating and paying for
inadequate services for me. Through my lifetime I easily have
spent a million dollars of the Government's money that did
absolutely no good for me. I think it is a travesty, you know.
Today, you know, I pay taxes instead of taking out of the tax
coffers. I try to help people with similar experiences that I
do.
But I think what is needed is, like I heard some of the
other panelists talking about it, it is really about supportive
housing, employment, adequate community services. Yes, there
are too many people in jail. There are too many people in jail,
and I do agree that there are a small number of people that
thank God there are jails. You know, I met these people. Some
people really need to be in jail. But 80 percent do not.
Seventy to 80 percent of the people in prisons today are either
there for drug offenses or committed the offenses while under
the influence of drug and alcohol. A majority of these people
have underlying childhood trauma, physical and/or sexual abuse.
I think one of the things that allowed me to recover to the
extent I did is that my trauma was not experienced in the home.
I had great parents, loving parents. I have three siblings. All
of them have post-graduate degrees, live very successful lives.
I did not respond to the violence and the racism in the
1960's as well as my siblings did. You know, I watched people
beaten and killed when I was 6 and 7 years old because of the
color of their skin. I went to all-white schools through
elementary and high school because my parents wanted a better
public education for me. I did not have the courage to tell
them what names I was being called there, that, you know, I was
attacked pretty regularly there and suffered injuries behind
those attacks. I wanted to be a man. I wanted to stand up for
myself, even as a boy.
I can recall suffering with depression ever since 10 or 11
years old because I was very hopeless in things ever changing
for me. I distinctly remember when they killed Martin Luther
King that I lost hope in the country, I lost hope in having a
different future. And I am not saying everybody responded to
things the same way. This is the way that I responded. I think,
you know, I am a sensitive person by nature.
I would just like to say that we really need to focus on
alternative to incarceration programs. I went through one. It
changed my life. I went to MICA treatment, got around people
that understood me, got on medication, went to therapy. The
reason I was able to go there was because I went through a drug
court that allowed me to finish my time in there, and if
successfully completed, dismissed the case against me.
Chairman Durbin. Mr. Fuller, I have given you----
Mr. Fuller. I am sorry.
Chairman Durbin. I have given you more time than others--
intentionally.
Mr. Fuller. Right. No problem.
Chairman Durbin. You deserved it because you have a
perspective on this none of us have. But I want to have a
chance to ask some questions and ask you to react and others to
react to your life experience.
Mr. Fuller. Sure.
Chairman Durbin. But I really appreciate your coming. I
seriously do, and I want to make sure we get everything done
here before we have to wrap it up today. But thank you for
coming, and sit tight, we have got some questions for you.
Okay?
Mr. Fuller. Thank you.
[The prepared statement of Mr. Fuller appears as a
submission for the record.]
Chairman Durbin. The first question I am going to have is
one that I have asked some of the experts, and you are the only
one at the table in either panel that can speak from firsthand
experience. It is a real basic, open-ended question. What is
the impact of isolation on the mentally ill?
Mr. Fuller. It is cruel and unusual punishment. I was
shocked to hear some of the replies that the other panelists
gave. Almost invariably people with mental illness in isolation
get worse. I do not know many who stay stable.
Chairman Durbin. Should there be a limit? I mean, you
understand why they do it in some cases.
Mr. Fuller. I do.
Chairman Durbin. Should there be a limit?
Mr. Fuller. I do not think it is a simple answer. I think
they should never be there in the first place. Isolation does
serve a purpose, a safety purpose for inmates and officers. I
think the problem is that these people are being punished
because they are sick, and they are in a jail that they should
not have ever been in in the first place.
Mental illness is highly underreported within inmates
because inmates understand the consequences by going public. So
I guess my question is that--I do not have an answer to limits,
but I will say it is cruel and unusual punishment, and I have
not been psychotic since I got out of isolation.
Chairman Durbin. Mr. Maynard, you were on the 2006
commission I talked about earlier that said that there should
be a limit to this.
Mr. Maynard. Yes, sir.
Chairman Durbin. I would like to ask you to react to the
same basic question. What is the impact of isolation on the
mentally ill?
Mr. Maynard. I think it causes deterioration with mentally
ill inmates. I think it makes their conditions worse. I agree
with a lot of the testimony that we in the prison system, as a
need to deal with violence, inmates who would be dangerous to
staff or to other inmates or to themselves and who misbehave,
we put them in isolation.
I think as a rule we typically keep people longer than they
should be on isolation. In some cases, they need to stay a long
time just for everybody's protection. In other cases, they need
to move more quickly through disciplinary and administrative
segregation.
But, again, I do not think there is any question about the
impact of isolation on the mentally ill. I think that is
something that most corrections directors would say is
something that we need some solutions in order to move away
from that.
Chairman Durbin. For the record, Mr. Randle is new to his
position with a new Governor in our State, and he has been
assigned a pretty tough assignment to take a look at the Tamms
Correctional Facility, our supermax State facility.
According to the Belleville News-Democrat--and you can
correct this report if it is wrong--54 inmates at Tamms have
been held in solitary confinement for more than 10 years,
including 39 who have been there since 1998 when the prison
opened. George Wellborn, the first warden at Tamms, said, ``I
think they should have been given an opportunity to go back to
a reduced security facility. It was not intended to be a place
where guys would be there for 8 to 10 years.''
Mr. Randle, should there be a limit on how long an inmate
can be held in isolation in Tamms?
Mr. Randle. Thank you, Chairman. First of all, I think
there should be a limit in terms of how long a person could be
held in isolation. I would also add the number of 54 inmates
being held at Tamms since--I believe it was 1998, that is an
accurate number that comports with my review.
Chairman Durbin. Accurate or inaccurate?
Mr. Randle. It is accurate.
One of the first things that Government Quinn asked me to
do is do a comprehensive review of the conditions at the Tamms
Correctional Facility. Even prior to my formal start as
director, I began to gather information. In fact, my second day
on the job, I spent about 9 hours at Tamms, walked through
every cell block, talked to over 50 inmates at Tamms, spent an
entire day looking at the operations in Tamms.
From that, and other research over the past 2-1/2 months of
my tenure as director, I have recently submitted--in fact, just
last week--a report to the Governor with a second of ten
recommendations for reforms at the Tamms supermax facility. One
of those recommendations involves the release or the beginnings
of a step-down process for approximately 48 inmates who have
been in Tamms between the 1998 and 2004 period.
So, indeed, I did have a concern about the extended stay of
offenders, among several other operational things that I
discovered at Tamms.
Chairman Durbin. How many of those inmates at Tamms or any
other part of the Illinois correctional system who have been
held in isolation for extended periods of time--let us say
beyond 1 month, for example--would you classify as mentally
ill, for example, using as an objective criterion, whether they
are receiving psychotropic medication?
Mr. Randle. On any given day, there are about 4,500
offenders in the Illinois correctional system that have a
diagnosis of a mental illness. Of that population, about 12
percent of the--I am sorry, about 12 percent of the entire
population, 45,000 are on psychotropic medications.
There is and continues to be times where those inmates wind
up in isolation for various periods of time. I think the key
for me as a director is to ensure a couple things: Number one,
that we have clinicians making decisions about whether or not
an offender is appropriate for isolation.
I think one of the things that sometimes gets overlooked is
that there are various degrees of mental illness.
Chairman Durbin. Well, how many staff psychiatrists do you
have in the Illinois Department of Corrections?
Mr. Randle. There are no State-employed psychiatrists. We
have a contract provider that provides psychiatric services to
our entire system. Those ratios, there is at least one full-
time psychiatrist assigned to every facility. Some facilities
have more than one full-time psychiatrist assigned to them. It
is based on full-time equivalents rather than a specific
number, Chairman.
Chairman Durbin. I am just looking here to make sure I find
out how many--you have 28 facilities.
Mr. Randle. Yes, sir.
Chairman Durbin. So you are saying there are 28 full-time
psychiatrists under contract to the Department of Corrections?
Mr. Randle. There are 28 full-time equivalent
psychiatrists, yes.
Chairman Durbin. That is what I meant, under contract.
Mr. Randle. Yes.
Chairman Durbin. The same thing. I hope that is the same
thing. And so that roughly means that you have--let me try to
do some math here quickly -1,500 patients for every
psychiatrist?
Mr. Randle. That potentially could sound about right.
Chairman Durbin. It sounds like a heavy caseload.
Mr. Randle. Yes, it does.
Chairman Durbin. And so let me ask you this: What is your
opinion of the impact of isolation on the mentally ill?
Mr. Randle. I think it can cause decompensation in
offenders.
Chairman Durbin. You might define that term for us, please.
Mr. Randle. It can cause your mental health condition to
worsen. In some cases, it could lead to suicidal tendencies. It
could lead to exacerbate your mental health condition, or make
it worse.
I think, though, the key, at least from my perspective,
again, is to ensure that access to clinicians is available
whether you are in segregation or whether you are in general
population, and that does not always just mean a psychiatrist.
I want to emphasize that. There are psychologists, there are
licenses clinical counselors. There is an array of mental
health clinicians that all provide services to the population.
Chairman Durbin. My last question in this round, and if you
do not mind, I will come back and perhaps want to ask Judge
Zenoff and others some questions.
The Belleville News-Democrat found that of the over 250
inmates transferred to the Tamms Correctional Facility in the
last 10 years since 1999--of the over 250 inmates--only 6 of
those went through mental health screening and were placed in
the prison's special treatment unit for mentally ill prisoners.
That figure seems extremely low based on the 12 percent figure
that you mentioned earlier for those who are receiving
psychotropic medication.
Mr. Randle. Mr. Chairman, specifically at the Tamms
Correctional Facility, historically there was a file review
that would take place as part of the placement process. One of
the recommendations, as part of my plan to the Governor,
requires a full mental health evaluation to take place for
every placement into the Tamms Correctional Facility.
Chairman Durbin. Thank you.
Senator Franken.
Senator Franken. Thank you, Mr. Chairman.
Mr. Randle, you talked about a disinvestment in community
mental health services. Do you think that if we fully funded
these services that we can better manage the mentally ill,
incarcerate fewer of them, and end up actually saving money for
the taxpayers while also making our communities safer?
Mr. Randle. Senator Franken, that is absolutely correct. I
do believe that one of the key things, especially with our
population in the State of Illinois that have a mental illness,
is as part of their release process we give them about a 14-day
supply of psychotropic medication. Unfortunately, we do not do
as good of a job linking them with a community mental health
provider, so in a lot of cases, these offenders, while we may
do a referral, sometimes it often takes weeks or months before
they are actually in to see a psychiatrist to have that
medication continued.
Unfortunately, by then they have run out of medication.
They have decompensated and, unfortunately, they wind up in
jail and ultimately back in prison. Traditionally, these are
low-level, non-violent offenders who often are accused of theft
crimes and those sorts of things, but often wind up back in the
prison system.
So I think part of this charge is working collaboratively
with community mental health providers and also the State
Department of Mental Health in Illinois to recognize that in a
lot of cases we are dealing with the same individual at
different points in their life, and work together to share
information and provide that sustainable linkage when they
leave.
Senator Franken. Thank you.
Judge Zenoff, you talked about mental health courts and
they are relatively new, and that the research is new, but that
you have seen real trends. And I am wondering if those
correspond to results you have seen and research you have seen
about drug courts.
Justice Zenoff. I am not as familiar really with the
research on drug courts. I think drug courts have been found
certainly to have made a significant difference. I think one
area that the researchers are looking at with respect to mental
health courts is whether or not to change some of the treatment
to mirror in some ways what the treatment is in drug courts--
that is, to address some of the criminogenic factors that have
to do with recidivism and why people commit crimes. And I think
they would like to see if that will, in addition to treatment
for the mental illness, help reduce recidivism and allow people
to stay out of the criminal justice system.
Senator Franken. Thank you.
Mr. Fuller, thank you for co ming in today and for your
testimony. I am curious about this MICA program, because you
said that you had been in and out of rehab, right?
Mr. Fuller. Yes.
Senator Franken. What was it about the MICA program that
worked for you? Was it that you were just ready at that point?
Or was there something about the design of the program that
made it work for you?
Mr. Fuller. Well, I think being ready is part of it, but a
MICA program is a place where you can address substance abuse
and traditional mental illness in the same physical setting
basically at the same time. You are connected with peers that
have similar experiences as you do because you can even find
discrimination with ``straight substance abusers'' or
``straight mental illness,'' believe it or not.
That is the unique part of it, that you are able to address
the whole person. It is usually a treatment failure when you
try to separate mental illness from substance abuse. Substance
abuse is an Axis I diagnosis, and if you do not think it is a
thought disorder, you have never known an addict before. They
should be treated the same. They should be in the same
category. But at this present time, I guess for funding
reasons, they are separated and have historically been
separated.
Senator Franken. Excuse me, but what worked for you is that
the MICA program combined the discipline of mental illness
treatment and drug or chemical dependency treatment?
Mr. Fuller. Yes.
Senator Franken. Okay. Thank you.
Mr. Maynard, you talked about collaboration and
collaborating relationships. Could you talk about the potential
opportunities for collaboration between the corrections system
and the Substance Abuse and Mental Health Services
Administration?
Mr. Maynard. Yes, sir. I think, Senator Franken, that if
somebody works in corrections, runs a corrections agency and
they are not accustomed to collaboration, they better get used
to it, because we are big agencies in the States, but we have--
we have custody resources, but we have little other resources.
So I think it is incumbent on us to reach out to substance
abuse agencies, like in Maryland, the judge mentioned NAMI,
another group that in all the States I have worked in have been
an active partner in working with the mentally ill. I think
SAMHSA is an organization that has the technical credibility. I
think the more we can get involved with them, the more funding
that might be available, the more leadership they could
provide, the more protocol, I think it would be good for our
organization, for our system.
I think they have the expertise. We did not come working in
prisons to be mental health experts. We run the security part
of it. We looked at education at the Federal level to provide
educational services. They do an excellent job reaching into
the prisons. I think that is a model for SAMHSA. They could do
the same thing. We provide----
Senator Franken. SAMHSA, once again, addresses both
substance abuse and mental health at the same time.
Mr. Maynard. Yes, sir. And I did want to, if I might, Mr.
Chairman, in talking about the segregation, the Vera Institute
of Justice is doing some pilot projects with reducing
segregation, and they did a pilot in the State of Mississippi
and their segregation population was pretty extensive. I think
they reduced it probably by one-fourth of what it was. In
Maryland, we have made a request to Vera to come look at our
population, because I think we have a large number on
segregation. I think it just happens, if you do not go back and
study it and try to figure out ways to reduce it, that it will
grow. So I think that is something, if we can do some models,
that might go across the country.
Senator Franken. Thank you, Mr. Maynard.
Thank you, Mr. Chairman.
Chairman Durbin. Mr. Randle, if I understand the
calculation, we estimate that each prisoner at Tamms costs us
$64,000 a year. Is that a rough calculation based on the budget
for Tamms?
Mr. Randle. Mr. Chairman, that is a number that is used to
describe the cost.
Chairman Durbin. Do you think that is close? Does it sound
close?
Mr. Randle. I think you have to look at the entire
operation and the impact that just Tamms has on our entire
prison system. So, yes, if you look at Tamms in an isolated
fashion, also if you look at--there are two parts to Tamms.
There is a 200-bed minimum security camp that provides that
support. I think that $64,000 figure is just looking at inside
the C-MAX portion of that facility.
Chairman Durbin. I see. Mr. Fuller, you can see where you
can get to $1 million in a hurry with that kind of expenditure.
Judge Zenoff, to go back to an earlier question here, I do
not remember the course in law school on psychology and
psychiatry----
Justice Zenoff. Nor I.
Chairman Durbin [continuing]. And psychiatric disorders and
your clients, civil and criminal. But it appears that the
intake in this process of justice starts with the law
enforcement officer, the attorneys, the judges, social workers,
and ultimately the correctional officers. And I guess the
issue, I think, Mr. Maynard just referred to was that most
correctional officers focus on security. And yet if they are
going to play the role that we expect them to, we need them to
be more observant of other things that relate to a prisoner's
well-being that may have a direct impact on security.
So when you get into this drug court atmosphere--I do not
know if your background is in psychology, psychiatry, or just--
--
Justice Zenoff. Not at all.
Chairman Durbin. Do you feel that our system of justice is
really equipped to deal with what we have decided as America
will be our future when it comes to mental health?
I can recall, just as an aside, that in 1970, then-
Lieutenant Governor Paul Simon took me, a young lawyer fresh
out of law school, on an onsite visit at the Lincoln State
School, 30 miles from Springfield--it was a day I will never
forget as long as I live. It was in the bitter winter, and we
went up to a building which housed 150 profoundly retarded
adult males. It was bedlam, pure bedlam. There were two
supervisors there for 150 people. There were people jumping out
of the windows in their hospital gowns, people running outside
in the bitter cold. It is an image I cannot forget, and now I
think we have decided to replace that horrible image with one
which is in many respects just as horrible: A corrections
system which has decided that it will become the largest
provider of mental health ``services,'' if you can put that in
quotes, in the Nation.
Is this the right thing for our system of justice? Is this
a fair outcome?
Justice Zenoff. You know, Senator Durbin, I agree with you
in terms of lawyers and judges not being educated in this
field. But I do think, given the problem we have before us and
the job of lawyers and judges to solve human problems, we are
becoming educated. We are learning to use the resources that we
have to be able to address the problems.
I think Mr. Fuller's story and really all of the testimony
we heard here today is the reason and are the reasons that
judges are out front, that judges have become leaders in
communities around the country to address this very human
problem. I think that the job of judges in this particular area
is actually to become educated, as I myself did. I did not have
any background in psychology or psychiatry. I had a mother who
had Alzheimer's, and at that point I learned a little bit about
that illness at that time. But actually, to digress 1 minute,
it was because of a community mental health leader in Rockford,
Illinois, who walked over to the courthouse and said, ``Open
your eyes. See what is happening in the Winnebago County Jail.
See who is cycling in and out of your jail. See why you have an
overabundance of persons with mental illnesses in jail; why
your jail is overpopulated,'' that we started to become
educated.
And I think the reason that judges have learned about this
problem is, as I said, it is a very human problem. I think what
we do need to do is need to use our abilities to convene
stakeholders in our communities and in the country to address
the problem and to bring others together to actually keep
persons with mental illness, with serious mental illnesses, out
of the criminal justice system so that in the end they do not
end up in our prisons. We would then have at least fewer people
with mental illnesses in prison. Thank you.
Chairman Durbin. Thank you.
Mr. Fuller, I am going to ask the last question of you. In
the city of Chicago, which I am honored to represent, on the
west side around the United Center where the Chicago Bulls and
Michael Jordan had all their glory, we have more ex-offenders
than any other section of our State. They are primarily African
American, and they come to this community, this area for a
variety of reasons. One of them is that many of the churches
there have decided to give a helping hand to ex-offenders; and,
I might add, they have a Congressman, Danny Davis, who has made
this his passion and his dedicated purpose for serving in
Congress to deal with this whole question of ex-offenders. And
I have met with him and with some of the people at the churches
there, and I know what you are doing today, and I want to give
you the last word on this.
What do we need to do to make sure those ex-offenders do
not commit another crime, do not end up back in jail? I know
the list is very long, but give me the top two or three things
that your work will make a significant difference.
Mr. Fuller. Okay. First, I will say in my written testimony
I included a document, ``A Call to Action.''
Chairman Durbin. I read it.
Mr. Fuller. Please do. Supportive housing, supportive
employment.
Chairman Durbin. Now, do you get help when it comes from
our Government in terms of that housing? I mean, there have
been questions as to whether Medicaid and Medicare are there
for ex-offenders, this question about housing.
Mr. Fuller. Well, the third one is mutual support, peer
support, and Medicaid does not pay for those services--peer-run
centers, peer support. Sixty-four thousand for jail, 23,000 for
supportive housing and a beautiful apartment with onsite case
managers providing services. You just do the numbers, and it
makes a whole lot more sense to provide services in the
community than to send people to jail.
Chairman Durbin. Thank you.
I am going to place into the record a long list of written
statements, and since there is nobody to object, it is going
in.
[Laughter.]
[The information referred to appears as a submission for
the record.]
Chairman Durbin. And if there are no further comments, I
want to thank this panel in particular. This Human Rights and
the Law Subcommittee was created as a kind of a special and
risky undertaking, and they said do not step on the Foreign
Affairs Committee, and be careful that you do not intrude on
others' jurisdiction.
As best we can tell, there have not been too many hearings
on this subject before Congress in the last few years, and I
think that, as I mentioned earlier, Senator Webb's idea of a
reform commission, which I have cosponsored, is a step in the
right direction. But this really is a human rights issue in our
country, that we have reached this point where this is where
the mentally ill find themselves more often than not, that you
would have three jails as the facilities where more mental
health services are offered than any place in America. We have
got to open our eyes. If we were ashamed as a Nation over 100
years ago about the status of the mentally ill, what can we say
today? What about our generation? What are we doing? What is
the honest and effective way to give these people a chance and
to keep our society safe?
I urge everyone to reflect on the question that Mr. Fuller
asked in his testimony: Why do they have to be punished so
severely for so long for being sick? Mr. Fuller's experience
highlights the failures to provide many persons with mental
illness who enter our criminal justice system with a meaningful
opportunity to get well. These failures are costly in terms of
lost human potential, lost years, the expense of incarceration,
and the threat to public safety.
But Mr. Fuller's experience also shows that it is possible
to design and implement programs that allow people to turn
their lives around, and thank goodness you are here as proof of
that today. I appreciate that so much. Making available the
opportunities that you had to finally turn your life around has
to be our goal as a Nation. This hearing is adjourned.
Thank you.
[Whereupon, at 12:13 p.m., the Subcommittee was adjourned.]
[Questions and answers and submissions for the record
follow.]
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