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How to Stop the Dangerous 'Revolving Door' of Jailing the Mentally Ill

America's jails and prisons aren't meant to be mental health care facilities, but with nowhere else to go, the mentally ill often end up incarcerated. The result is poor care — and a lack of safety for all involved.
Photo via Wikimedia Commons

This article is part of VICE News' collaboration with the American Justice Summit. Watch the livestream on VICE News on Friday, January 29.

While confined in a jail, a prisoner must contend with a wide array of unknowns. Some have to do with getting out: When will I be released, when will I speak to a lawyer, when will I see a judge, how will my case be resolved, will I be sentenced to prison time? Others with life on the outside: What will happen to my family, my home, my job? And still others concern safety while inside: Will my property be stolen, will I be assaulted, am I safe if I go to sleep?


For anyone, the stress is enormous. For a person with a mental illness, however, the stress can increase symptoms — depression, anxiety, suicidal thoughts — and for a small minority of those with a mental illness, it can prompt a spiral into a state of mania or psychosis. Not only is the jail not a conducive environment to successfully treat people, but due to the severity of some individuals' disorders, those who are mostly indigent and homeless are unable to advocate for themselves. As a result, they become lost in the system and languish within jail walls.

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The average stay at New York City's Rikers Island jail is 42 days. Those diagnosed with a mental illness are incarcerated for an average of 215 days.

During my 18 months as a mental health counselor practicum student at Rikers, I met several mentally ill people who had lingered at the jail for years, waiting to proceed to trial. Many frequently appeared confused and highly stressed. Others sat in the jail for months after they were deemed incompetent to stand trial, waiting for a bed at a psychiatric hospital. They were forced to live in a correctional setting and to be treated as any other inmate despite the fact they had not been found guilty of any crime and/or were found unfit to proceed within the legal system.

At Rikers, a team of highly dedicated, well-trained mental health professionals provide the best care possible. This includes providing treatment in crowded dormitories huddled in a corner in an attempt to provide some confidentiality; sitting in a makeshift office trying to talk over the loud yelling of inmates and correctional officers just outside the door; or conducting group therapy in a room where those participating are shackled to the wall and floor for the clinician's and other inmates' safety. For the majority of those treated, the services provided are adequate to maintain stability. But for those unable to cope, their mental health deteriorates.


This creates a rotating door, not between jail and the outside world, but between jail and the forensic psychiatric ward at Bellevue Hospital, where inmates are sent to be stabilized. Upon return to jail, they mentally unravel again, and the revolving door keeps spinning.

Despite the fact that some mentally ill individuals have difficulty distinguishing between reality and delusions, and in some cases struggle to simply maintain basic hygiene, they are still expected to follow the rules and regulations of a jail. They are supervised and given orders by correctional officers who are not trained to handle the mentally ill.

In many cases, when these inmates do not follow a directive, it creates hostile situations between the officer and inmates, leading to violence toward the inmates or the inmates acting out and assaulting officers or civilian personnel. A study in 2012 by the City of New York Board of Corrections indicated that at Rikers Island, people diagnosed with a serious mental illness commit 60 percent of serious assaults on staff and other inmates.

In 2014, I was the victim of such an assault. While I worked on a specialized unit for the seriously mentally ill, a man who was displaying signs of mental health deterioration after being jailed was transferred to my unit to receive a higher level of care. For unknown reasons — although likely related to mental illness — he punched me in the face, breaking my jaw in three places and causing multiple facial fractures.


After the assault, my assailant spent weeks at Bellevue Psychiatric Hospital receiving inpatient mental health treatment, but was then returned to Rikers before he was sentenced and transferred to state prison. I can only speculate that if he was placed in a psychiatric hospital and received intensive care initially instead of spending time in county jail, he would have not deteriorated to a point where he committed the assault.

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Significant changes need to be, and can be, implemented to assist in providing better treatment for those who suffer from serious mental illness. People who are seriously mentally ill, who are unable to cope within the jail setting, need to be placed in housing where effective treatment can be provided. For those who are indigent and without a support system, advocates must be appointed who can meet them at the courts to help explain the process, possibly reducing stress and mental health deterioration. Training, not only for correctional officers, but also for all personnel in the jail and prison systems that have contact with the mentally ill, needs to be conducted to increase understanding.

These steps would increase the safety of those working with this population. Assaults like mine can be avoided.

Stephanie H. Procell is a clinical psychology doctoral candidate at Fielding Graduate University who completed her clinical practicum at Rikers Island. Follow her on Twitter: @Procell

Photo via Wikimedia Commons