Prison culture: Think of a state

Think quick: Which U.S. state most symbolizes prison culture?

If you're like me, the state that came to mind was either Texas or California.

But the acquittal of a group of guards in the death of a 14-year-old boot camp resident is shining a spotlight on the Sunshine State, which houses the third-largest prison population in Prison Nation.

Last week's acquittal was reminiscent of a similar case eight years ago in Florida, in which prison guards were acquitted of stomping prisoner Frank Valdes to death in his cell, even though guards' boot prints were found all over his back.

Yesterday, Time magazine recalled that earlier verdict in a scathing expose on "the rot of Florida's corrections culture." As the article points out, mentally ill prisoners are at especially high risk of abuse:

"Despite its Sunshine State image, Florida's prisons and juvenile detention centers are often associated with the more troubled corrections systems of its Deep South neighbors. While no one is asking Florida to coddle its prisoners, adult or juvenile, many fear it has yet to break its dark habit of coddling abusive guards and other officials watching over those prisoners."

"The state is facing lawsuits alleging that its prisons subject too many inmates, including the mentally ill, to a prisoner 'warehousing' culture of unlawfully extreme isolation and deprivation, usually with little or no rehabilitation efforts to prevent recidivism. Other suits decry what one calls excessive as well as 'malicious and sadistic' use of pepper spray and other chemicals to keep mentally ill prisoners under control. In many cases the sprays have burned off inmates' skin, according to the suit."

It's one of a series of Time exposes on prison problems. Earlier this year, the magazine spotlighted both the crisis in California prisons and the burgeoning trend toward solitary confinement that literally drives some prisoners crazy. (I have more information on "segregation psychosis" on my website.)

Photo credit: The Black Commentator

Hot off the press: Mental health and criminal justice

The new issue of Criminal Justice, the American Bar Association magazine (Vol. 22 No. 3), features a roundup of cutting-edge topics at the intersection of psychology-law. The articles are written by notables in their fields and, best of all, they are available online and for free:

Mental Health and Criminal Justice: An Overview

By Andrew E. Taslitz

The Supreme Court's Recent Criminal Mental Health Cases Rulings of Questionable Competence

By Christopher Slobogin

For decades the subject of mental illness and criminal law languished in the legal "backwaters" at the U.S. Supreme Court. That changed in 2003 when the Court accepted the case of Sell v. United States (a defendant's right to refuse medication), followed quickly by two more seminal decisions in Clark v. Arizona (2006) (the scope of psychiatric defenses) and Panetti v. Quarterman (2007) (the definition of competency to be executed). But has this sudden interest in mental illness issues resulted in good law? The author argues to the contrary and details where and how the Court has erred.

Prosecutor as "Nurse Ratched"?: Misusing Criminal Justice as Alternative Medicine

By Gerald E. Nora

Traditionally, prosecutors approach claims of mental impairment by criminal defendants with skepticism, contesting competency defenses and sentencing mitigation. More recently, though, they find themselves as "diversionary gatekeepers" - seeking alternatives to trials and prison for those who more aptly belong in the medical arena. The author, a Cook County ( Illinois) state's attorney, finds neither role satisfactory and argues for reforms that will limit a prosecutor's responsibility for addressing a defendant's mental health needs through the justice system.

The Promise of Mental Health Courts: Brooklyn Criminal Justice System Experiments with Treatment as an Alternative to Prison

By Matthew J. D'Emic

Judge D'Emic tracks the establishment of one of the country's first courts to use diversionary treatment in dealing with mentally ill criminal defendants. He maps the defendant's journey from intake through assessment and treatment to "graduation" from the program.

Executing the Mentally Ill: When Is Someone Sane Enough to Die?

By Michael Mello

An opponent of the death penalty, Prof. Mello presents this personal account of advocating for mentally ill death row inmates. While detailing his clients' descent into madness and the tortured disconnect between the fantasy world of the insane and a justice system bent on accountability, the author looks at the impact of three high-profile cases.

Mental Health Status and Vulnerability to Police Interrogation Tactics

By William C. Follette, Deborah Davis, and Richard A. Leo

The authors offers a psychological explanation of how police interrogation methods affect the "average" person's ability to understand and exert his or her Miranda rights and what makes the mentally ill so much more susceptible to police coercion and likely to falsely confess.

Your jail is also your mental health center

This statement shouldn't be news for any of my regular readers. But you might want to know that it's the topic of an article in the new issue of Journal of Trauma & Dissociation, available online for a fee. The article, "Traumatized Offenders: Don't Look Now, But Your Jail's Also Your Mental Health Center," is co-authored by Philip Kinsler, Ph.D., of Dartmouth Medical School and Anna Saxman, JD, of the Office of the Defender General in Montpelier, Vermont.

Here's the abstract:

There are more than a million prison and jail inmates in the United States who have mental illness. As funding for State Hospitals has decreased, funding for needed community programs has often not kept pace. This has led to a population of homeless mentally ill, many of whom have co-occurring substance use disorders. Society's perhaps unconscious response has been to create 24-hour mental health units within prisons and jails. The authors contend that by doing so, we have 're-criminalized' mental illness. The mentally ill prisoner is most often the victim of extreme family turmoil including physical and/or sexual abuse, parental substance dependence, and parental incarceration. Prisons and jails most often do not provide services for this highly traumatized population or recognize the need for such services. The authors report on problematic aspects of mental health care in prisons, and on several attempts to establish 'trauma-aware' care within the legal system.

Happy ending for wrongfully deported Mexican-American man

Two months ago, I posted here about a cognitively handicapped Mexican-American man who was illegally deported to Mexico and disappeared.

Pedro Guzman, born in the United States, was mistakenly deported after being jailed in his native Los Angeles on a minor trespassing charge. A former Special Education student, the 29-year-old is described by family members as a slow learner with memory problems.

In the last three months, Guzman said he made repeated attempts to get home, but was turned away by U.S. border agents.

Meanwhile, as he walked the 100 miles from Tijuana to Mexicali, eating out of garbage cans and bathing in rivers, his family was desperately searching for him. The family's pleas for help from both the U.S. and Mexican governments fell on death ears.

Guzman was finally picked up when U.S. authorities at the Calexico border realized he had an outstanding arrest warrant. The warrant, ironically, was for missing probation hearings during the time that he was trying to get home.

Although the U.S. government had promised to immediately notify the family if Guzman was located, he was instead jailed for two days before the family was notified and he was released.

Guzman appeared traumatized and was nearly unrecognizable, family members said at a news conference.

The family's last contact with Mr. Guzman had been on May 11, when he called his sister-in-law from a borrowed cell phone to say he had been deported. The call cut off. Although family members rushed to Tijuana, they were unable to find him.

This is not the first time that a U.S. native has been illegally deported. A similar case 30 years ago also involved a Mexican-American who was mentally disturbed and unable to care for himself. Like Guzman, Daniel Cardona of Clovis (near Fresno) wandered the streets of Tijuana for nearly five months while his frantic family searched for him.

The latest on the Guzman case is at the ACLU of Southern California’s web site.

AP coverage is online through the San Francisco Chronicle.

The “Witness LA” blog has also been covering the story.

But for the most extensive coverage of all, see the excellent L.A. Weekly feature by Daniel Hernandez, “Lost in Tijuana."

Photo (Guzman and his brother) posted with the permission of the ACLU of Southern California.

Mentally ill behind bars – a national crisis

Michael Moore’s new film Sicko documents the crisis for Americans who need medical care. But for those whose illnesses are mental, the situation is even more dire. With almost no treatment resources left in the community, if you are mentally ill and poor you are likely to end up one of the 7 million Americans – or 1 in 32 adults – behind bars. Indeed, the behemoth L.A. County Jail now houses the largest psychiatric population in the country (and perhaps in the world?).

A Washington Post opinion piece calls for immediate action to address this "national emergency." The editorial, "The Wrong Place to Treat Mental Illness," is by Marcia Kraft Goin, a past president of the American Psychiatric Association:

Last month the Supreme Court rightly blocked the execution of Scott Panetti, a Texas man who was convicted of a double murder and who suffers from delusional schizophrenia. The case drew public attention to the intersection between mental illnesses and executions.

There is a pervasive attitude in this country that such people are getting what they deserve: After all, like Panetti, they are in jail for something.

But did you know that the Los Angeles County Jail houses the largest psychiatric population in the country? That's not justice. That's emblematic of a national emergency.

Before the 1960s, people with mental illnesses were generally cared for in institutional settings, mostly state-run psychiatric facilities. Many advocates correctly saw this as "warehousing" people who could be cared for in less restrictive settings. Federal legislation and the courts powered a move toward deinstitutionalization, calling on states and counties to provide resources for social services, vocational rehabilitation and treatment services. The introduction of effective antipsychotic medications also drove the trend toward deinstitutionalization.

In the decades since, community-based services have helped many people. But the situation today constitutes a national failure.

What's gone wrong?

Most important, the necessary community resources didn't materialize in anywhere near the level that was needed. Also, antipsychotic medications, while powerful treatments, don't work in isolation. Patients need a relationship with a psychiatrist, clinic or other stabilizing force to ensure adherence to drug regimens and achieve the best possible recovery.

Deinstitutionalization has succeeded in decreasing the overall number of hospital beds, but an unforeseen consequence has been the proportional increase in the number of people with mental illnesses housed in the criminal justice system. Worse, once imprisoned, people with mental illness are shown to have much longer incarcerations than other inmates, primarily because a prison environment and lack of treatment aggravate the very illness that has led to their objectionable or antisocial behavior.

While no one would argue that Scott Panetti belongs on the streets, his case compels us to consider the justice system's role: Is it to mete out punishment that seeks retribution, or are there cases where real justice means effective treatment that seeks rehabilitation?

Consider again Los Angeles County: In 2002 there were 38,600 psychiatric evaluations at the inmate reception center of the Twin Towers jail. Of these, 23,190 people (60 percent) were found to be in need of mental health treatment. A reasonable person could not fail to see the correlation between decreased funding for mental health resources, the closure of hospital beds, homelessness and the criminalization of mental illnesses. Untreated and lacking access to long-term care, people with mental illnesses often end up with symptoms and behaviors that result in jail time.

Cuts in state Medicaid budgets promise to exacerbate these problems. Not only is this shift in funding a blight on our society, it also costs money -- a lot of money. Corrections officials, mental health workers, medication, amortization of buildings and time spent by police in court all cost more than treating patients appropriately in their community. This doesn't make financial sense, much less humanitarian sense.

When considering the direction of public policies that affect those with mental illnesses, politicians and other officials must be guided by the latest research.

Government-funded studies have shown in recent years that jail-diversion programs, which help people get the treatment they need, result in positive outcomes for individuals, communities and the criminal justice system. While jail diversion does generally result in lower criminal-justice costs and greater treatment costs, studies are underway to analyze the differential.

The question the court answered in the Panetti case was about one's fitness to be executed, but in many more cases, the question is about the appropriateness of incarceration at all.

Posted with written permission of the author, Marcia Kraft Goin.

Supreme Court Blocks Execution of Psychotic Man

In a widely awaited ruling, the U.S. Supreme Court ruled 5-4 today that Texas cannot execute schizophrenic killer Scott Panetti.

The highly polarized court sidestepped the controversial issue of the Constitutionality of executing the mentally ill. Rather, the decision barred Panetti's execution because he was not allowed to submit evidence of his psychiatric disorder at the state court level.

Panetti, who killed his estranged wife’s parents, was found competent to stand trial after two jury trials on that issue. He represented himself at his 1995 murder trial. He was floridly psychotic and delusional, rambling insanely and attempting to subpoena Jesus Christ, John F. Kennedy, and other dead people.

In the 1986 case of Ford vs. Wainwright, the Supreme Court held that executing a person who is severely mentally ill constitutes cruel and unusual punishment, banned by the Eighth Amendment. However, the "Ford standard" is vague as to the required severity of the mental condition, and people on all sides of the issue had been hoping for clarification from the high court.

The Court's opinion and a dissenting opinion are available online.

More background on the Ford standard and on Panetti's case is available on my blog entry of April 20, “Too Sick to Die?”

A 28-minute video, "Executing the Insane: The Case of Scott Panetti," is available at: http://blip.tv/file/282532.

Mentally retarded man disappears after accidental deportation

The 2005 remake of "Fun with Dick and Jane" has a scene in which Jim Carrey – reduced to the status of a day laborer outside a Home Depot - is mistaken for a Mexican and deported.

If the scene seems a bit implausible, it is not. Especially for someone with a Latino surname.

Last month, a developmentally delayed man who was born and raised in the United States was mistakenly deported to Mexico. Unlike Jim Carrey, Pedro Guzman did not have the cognitive or financial resources to sneak back across the border to his home. He disappeared, and his family has not been able to find him.

It all started when 29-year-old Guzman was arrested for misdemeanor trespassing at an airplane junkyard and was sentenced to serve 40 days in the Los Angeles County Jail.

During a pre-release interview, he said something that led a “custody assistant” to decide that he had “entered the United States illegally” and “had no legal right to be in the United States.” No one knows exactly what was asked of him or what he said. Like many individuals with developmental disabilities, Mr. Guzman covered for his intellectual handicaps by pretending to understand. Family members believe that he may have mentioned a family vacation to Mexico when he was 12 years old.

The jailer contacted ICE, Immigration & Customs Enforcement. Mr. Guzman then signed a form in Spanish agreeing to voluntary deportation. According to his family, he cannot read or write. Most especially – having attended only English-speaking schools in Los Angeles – he would not have been able to read a form written in Spanish.

On May 10, Mr. Guzman called his family from a borrowed cell phone to say that he had been deported to Tijuana. His sister could hear him asking someone, “Where am I?” Then the line went dead. That is the last that his family has heard from him, despite their taking time off work to scour Tijuana for him.

Guzman knew no one in Tijuana. He was deported without any money and without the cognitive skills to get himself back home, according to his family.

Guzman has a birth certificate proving his U.S. citizenship. There are no circumstances in which the U.S. government may legally deport a U.S. citizen.

The family's pleas for assistance from the U.S. and Mexican governments have fallen on deaf ears.

Should jails be designated "treatment facilities"?

When criminal defendants are found incompetent to stand trial, they go to state hospitals for competency restoration treatment. But hospitals around the country have run out of beds, forcing psychotic defendants to linger in county jails for many months.

In response to this crisis, California is proposing to designate county jails as "treatment facilities" that can provide pretrial defendants with competency restoration treatment for up to six months.

Under Senate Bill 568, jails will gain the authority to forcibly medicate incompetent defendants. (This is a complicated area of law governed by the 2002 U.S. Supreme Court case of U.S. v. Sell. For background, see: www.jaapl.org/cgi/reprint/32/1/83.pdf.)

Forensic psychologists are voicing concern about this move.

First of all, jails are unlikely to do much more than administer antipsychotic medications, in some cases without proper legal review and oversight. Jail psychiatric services tend to be minimal and underfunded. They are not set up to provide effective competency restoration training.

A second concern is that the jail environment is not conducive to mental health. Prisoners with severe (and often complex) mental disorders need around-the-clock services from highly trained professionals in a therapeutic setting in order to become competent to stand trial.

The bill, backed by the sheriff’s departments that run county jails, appears to be in response to a recent Sacramento court ruling that incompetent defendants must be transferred quickly to state hospitals for treatment. A competing bill, Assembly Bill 1121, would require that defendants be transferred to state hospitals within 14 days of being found incompetent.

If SB 568 passes, other states with similar crises will likely try this solution as well, foisting their fiscal burdens onto cash-strapped county governments. It’s all part of the trickle-down effect of the criminalization of the mentally ill that began in the 1970s with the defunding of community mental health programs and escalated with the prison boom of the 1980s and 1990s.

Thanks to Robert D. Canning, Ph.D., Paul G. Mattiuzzi, Ph.D., and Philip J. Davis, Ph.D. for their contributions to this analysis.

Senate Bill 568 is available at: http://tinyurl.com/37rl53

Assembly Bill 1121 is available at: http://tinyurl.com/39cn6

Too ill to die?

Scott Panetti thinks Texas wants to kill him because it is in cahoots with the devil. The devil, he theorizes, wants to stop him from preaching the gospel to his fellow prisoners.

Panetti has a severe mental disorder. He had been hospitalized more than a dozen times before he killed his estranged wife’s parents back in 1992.

No one doubts that he is crazy (although the prosecution claims he is exaggerating). At his trial, he fired his attorney and represented himself. He flipped a coin to decide on whether to keep a potential juror on his panel. Wearing a purple cowboy suit and mimicking a John Wayne character called the Ringo Kid, he blamed the shootings on another personality named “Sarge.” As evidence, he tried to subpoena Jesus Christ, the Pope, and John F. Kennedy.

Now, the U.S. Supreme Court is set to decide whether he is too ill to execute.

In the 1986 case of Ford vs. Wainwright, the Supreme Court held that executing a person who is severely mentally ill constitutes cruel and unusual punishment, banned by the Eighth Amendment. The legal standard, known as the “Ford standard,” is whether a person is so insane that he cannot understand the link between his crime and the punishment.

But the Ford case did not give a precise definition of what constitutes competence for execution. Is a mere factual understanding enough? Or should the prisoner have a “rational” understanding of why he is going to be executed? That is the issue in Panetti's case.

The state argues that it is sufficient for Panetti to realize that he committed the murders and that he is being put to death. It is irrelevant that he thinks he is being executed for preaching the Bible.

Panetti's lawyers counter that a Constitutional execution requires more than this simple knowledge. The defendant should appreciate that the execution is society’s retribution for his crime. Panetti, living in a delusional world, cannot make that connection.

The American Psychological Association, the American Psychiatric Association, and the National Alliance on Mental Illness agree with Panetti's counsel. They have filed a joint petition arguing that people such as Panetti should not be executed because they “cannot rationally understand the reasons for their execution."

The highly polarized Supreme Court may sidestep this complex question on procedural grounds by asserting that Panetti’s appeals were exhausted. A decision is expected by July.