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December 13, 2004 - The New York Times (NY)

Column: How The Justice System Criminalizes Mental Illness

By Brent Staples

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Jesse McCann was a baby-faced teenager of 17 the day he hanged himself in a New York State prison.

The letters he had written to family and friends in the final weeks of his young life were not at all what one would expect of a person about to take his own life. In a letter dated March 16, 2001 - the final day of his life - he wrote passionately about wanting to pursue a degree in paralegal studies while in prison so that he could make a difference for young people in trouble.

He asked his Uncle Dennis for a shipment of coffee - and talked about Twizzlers, one of his favorite candies. He signed the letter, "Love you, Jesse," and added a smiley face to the salutation.

This optimistic tone probably came from the medication he was taking. It seemed to ease his panic attacks and the depression and rages for which he had been treated often. The mood on display in this last letter, however, was not destined to last.

According to official accounts, Jesse was being escorted to the mental health unit for his medication when he lost control - as inmates with mental problems often do - and began shouting obscenities. Predictably, a corrections officer tried to quiet him. Just as predictably, Jesse exploded. He struck the officer and was placed in the disciplinary housing unit, where unruly prisoners can be shut up for 23 hours each day.

Isolation, a hardship for even healthy inmates, is often catastrophic for those with mental problems. Their symptoms get worse and they often end up trying to harm themselves. Studies show, for example, that mentally ill inmates who are placed in isolation are far more likely to attempt suicide.

The prospect of being isolated as a result of the latest outburst was apparently too much for Jesse. Shortly after being placed in the cell, he tied one end of a sheet to the window, the other to his neck and hanged himself.

This story has become familiar in New York, which has been widely criticized for using isolation too freely, especially with the mentally ill. Studies of suicide in the state prison system, underscored with stories like Jesse McCann's, have led the New York State Legislature to consider passing a law that would give psychiatric workers more latitude in the handling of inmates with serious mental illnesses. The proposed statute aims to expand access to psychiatric treatment and prevent disturbed inmates from trying to hurt themselves.

The prison mental health crisis, which has gotten so much attention lately in New York, is actually national in scope.

Simply put, most of the mental institutions that would have once housed and cared for mentally ill people have been closed down - in most cases deservedly so, because they did their jobs poorly. But the community-based mental health system that was supposed to replace the mental hospitals never materialized.

As a result, prisons have been become de facto mental hospitals, but without the treatment that would allow mentally ill patients to control their symptoms and organize their lives.

The debate surrounding this problem goes well beyond the admittedly serious matter of suicide. Also at issue is the fact that mentally ill people often serve substantially longer sentences than other prisoners convicted of similar crimes. No one has yet accounted for the difference.

But it seems clear that mentally ill people often enter the criminal justice system for offenses and aberrant behaviors related to their illnesses. They end up doing longer sentences - and harder, more punitive time - for acting out in prison. To put it another way, people who hear voices - or who can't control themselves or follow even the most basic instructions - become automatic candidates for punitive sanctions like solitary confinement.

Jesse was not innocent when it came to breaking the law, but his case fits this category, too. He was arrested and confined to a county jail for a nonviolent offense. While there, he succumbed to hysteria and was charged with assaulting a corrections officer, which is a felony.

The offense seems to have drawn him special attention from corrections officers, who make it their business to keep close tabs on inmates charged with assaulting one of their own. Isolated and under more pressure than ever, Jesse McCann ended his life.

The federal government began to focus on the mental health problem when it became clear that mentally ill inmates were driving up the prison population and contributing to recidivism. Congress made a promising start when it passed a law that encouraged states to integrate community mental health services more closely into the corrections system.

What the country needs to do, however, is decriminalize mental illness. That means taking mental problems into account in the first instance - at least with nonviolent crimes - so that as many offenders as possible can go into treatment instead of into prison.

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