It is important to understand that mental health care in Alabama is, just like its prisons, at the bottom of national rankings. Remember that Wyatt vs. Stickney (the decision that depopulated mental hospitals in the 1960s) occurred in Alabama because of the barbarous conditions in Bryce and other state hospitals. The severely mentally ill were locked away for life and deprived of basic humane treatment. People like Dr. Stan Brodsky of the University of Alabama, can relate the details.
Wyatt vs. Stickney concluded that the mentally ill have a 'right to treatment' and that they can not be held by force unless that treatment is provided. The ultimate outcome of that case, over several decades, was that those severely mentally ill were released, but very little treatment was provided in the community. There exists a community mental health system with many good people doing good work; however it is far from adequate. It is vastly underfunded and overwhelmed by the needs of the community. Waiting lists are long and there is a critical shortage of psychiatrists. Drug treatment for poor people in Alabama is practically nonexistent
Overthose decades, jails and prisons have become state mental hospitals. In fact, our prisons are mostly populated by the community's chronic problem people -- drug addicts, mentally ill and the socially incompetent who need job training and social skills training. A smaller number are dangerous people who need to be physically locked away. Those are the people who need our prisons. Punishment can actually be appropriate for them and can be effective. Punishment does not help the mentally ill, the drug addicts and the socially incompetent.
The prisons' mental health problems begin in each individual city and county. Police chiefs and sheriffs are keenly aware of the limited resources available to them for dealing with the mentally ill and all the other severely dispuptive citizens. Our jails are vastly more overcrowded and under- resourced than our prisons. One striking statistic is that jails have an inmate suicide rate ten times higher than prisons. There are no meaningful mental health or drug treatment programs available to divert those inmates out of the jails. The only relief that local officials can get from such difficult cases is to send them to prison. Thus the prisons have become what they are, warehouses of society's outcasts.
To address the question of what happens to mentally ill inmates after their release from prison, the answer is: Practically nothing, just as before their incarceration. The same principle applies with drug addiction and the generally incompetent. Without some treatment, they will be in worse condition after release, and they will be rearrested to start the cycle again.
So, what should we do? There is, in fact, a lot that can be done, but it will require a change in thinking and perspective. Prison, for punishment, should be reserved for those identified as truly criminal. Prison space is massively expensive because of the intensive security needed for the truly dangerous. Many of those other socially incompetent inmates do not need that level of security. But they do need treatment and they need to be separated from predatory inmates.
One idea is to create low security treatment modules of perhaps 200 inmates grouped by need -- mental health treatment, drug abuse, education, etc. At first, innovative programs can be established in modular buildings, surrounded by a security fence on the grounds of existing prisons. That would provide the immediate benefit of reducing population pressure in the main institution and also make it possible to offer needed programs.
There are many effective and affordable programs available. The federal Bureau of Prisons has constructed an excellent drug treatment program, including teaching curricula. Procedures for care of the mentally ill and the intellectually deficient are humane and helpful. Correctional psychologists serve on the management team of prisons along with wardens. Psychologists are especially important to the creation of programs. There is a large scientific literature on what works, and correctional psychologists study that research and can develop pilot programs to implement workable ideas.
Bureau of Prisons psychologists and wardens are eligible to retire at age 55. Many of them would likely be available to advise and consult. The University of Alabama has a correctional psychology specialty at the masters and doctoral levels. Students from there could be involved in mass screening and classification of inmates to decide who needs high security prison and who needs treatment.
These are some ideas, but there are many other knowledgeable professionals as well as community members who can come up with many others. The first step, though, is to make that change of thinking I mentioned. Use prisons as prisons. Set up smaller therapeutic settings for those who need and will benefit from specialized programs. Conduct scientific study of what works. Finally, those programs that work can be replicated in the community. Inmates who succeed in improving themselves in prison treatment are often very motivated to help others and could serve as paraprofessionals in community programs.
In terms of professional expertise, I would like to mention one of my mentors, Dr. John McKee, who was a pioneer in correctional research. I worked for him in Draper prison many years ago in a major research project funded by the U.S. Department of Labor. Sadly, he is gone, but he published on techniques for basic education and job training. I was involved in an assessment of a token economy which focused on improving inmates' behavior. Much more research is available through the federal Bureau of Prisons. The entire prison at Butner, North Carolina, was designed as a research tool. The original supermax prison in Marion, Illinois, had a remarkable, successful therapeutic community focused on 'the worst of the worst' gang members and violent criminals.
Alabama is in a bind with this problem. Our communities cannot handle such large numbers of disruptive people. The price of more prison cells that can pass constitutional muster is probably impossible to pay. I argue that we must think outside the box, so to speak. I am confident that there are better ways.
No comments:
Post a Comment