In my opinion, it is critically important that Michigan engage in serious mental health reform in its prisons and jails. Here are my evidence-based suggestions for reform:
1. Humanize ‘Detainees’ and deliver transparency in place of opacity
The Best Practices template released by the Cook County Jail emphasizes re-humanizing inmates and ensuring transparency by invited watchdogs IN jails and prisons (not keeping prisons treatment of the Mentally Ill out of sight and out of mind).
Pulitzer-Prize winning historian, and University of Michigan professor, Heather Ann Thompson often writes about the importance of prison transparency to ensuring meaningful reform. For instance, she argued that the long-standing opacity of prison has continuously reaffirmed a systemic bias in the public’s mind:
“But throughout American history, we’ve really hidden, at least, the institution of prisons, while we have made very public supposedly the archetypal prisoner. So we’ve seen the prisoner on a chain gang, or we’ve seen the prisoner working beside the road, picking up trash, often marked by a certain uniform or a certain way in which we know that they must have done something wrong, but we have absolutely no sense of, what are these institutions they return to? And we really never have. And so there have been various legal fights to try to get the public aware of what’s happening inside, primarily because what’s happening is brutal, and, indeed, the public needs to know that, because that’s what they’re paying for, right? It’s not just a confining of somebody, but often an abuse of someone, a torture of someone.”
As long as our prisons and jails remain a black box, it will be hard to ensure that best practices are being implemented (not just funded).
As long as our prisons and jails remain a black box, it is impossible to ensure that our mentally ill prisoner bodies aren’t being used to perpetuate a system of neglect and abuse.
It is very hard to find up to date information on the practices in place in prisons and jails in Michigan and part of that is because there is not much transparency as to how Michigan addresses the mental health needs of its inmates.
2. Provide advanced mental health training to all Law Enforcement and Corrections personnel
The Cook County report (cited above) explains the importance of mental health training for personnel:
“With jails bursting at the seams with mentally ill inmates, the capacity for tension and unpredictable behavior increases in turn. And the transient nature of jail populations means a disproportionate number of inmates are fresh off the streets, where they may not have been taking the medication they desperately need. All jails are forced to manage inmates who demonstrate actively psychotic behavior, which requires officers who are well trained in how to diffuse situations through words in lieu of force. Numerous Counties have had to make multi-million dollar payouts as a result of officers utilizing excessive force on mentally ill inmates, which potentially could have been avoided through an investment in CIT training.”
There are also moral arguments for why we should ensure that the people with the power of life and death over inmates should also understand the impact their decisions can have on those inmates. Way too often, as I mentioned above, treatment for the mentally ill means a steady diet of drugs and a long-term stay in solitary confinement. There is no excuse for returning someone to society (and over 90% of inmates will return to society) in worse mental shape than when they entered.
3. Redefine What Treatment Means
If you do the research, you will see many official documents talking about how much money is going to mental health treatment or how mental health treatment is organized in the prison system but very few documents about what kind of treatment is being provided or the quality of the people providing it.
I can tell you from experience (and with backing from the studies that I have already cited) that Jails and Prisons are primarily concerned with preventing suicides and not with treating prisoners. A meta-analysis of prison mental health care describes the problem I am describing like this:
“It was expected that the results of this review would provide clinicians with empirical guidance on which to develop or base their services; however, results of this review reinforced the conclusion that “treatment outcome research on mentally ill offenders specifically is almost nonexistent” (Rice & Harris, 1997, p. 164), and “are as scarce now as they were 30 years ago” Too few programs are being developed and too few promising programs are being tested with the rigor that would yield the proof needed to label them as evidence-based” (Snyder, 2007, p. 6). Given the prevalence of OMI in the criminal justice system (approximately 1,000,000 individuals) as previously described, it is surprising that so few studies (n = 26) meet the scientific inclusion criteria to effectively examine the effects of services for OMI. The almost complete absence of randomized controlled clinical trials is particularly disappointing as clinicians treating OMI are without sufficient efficacy or effectiveness data on which to base their practices. Unfortunately, the results of this review provided less additional data than expected. Nevertheless, two therapeutic elements, admission policies and use of homework, were identified as contributing to enhanced therapeutic outcomes.”
Providing treatment is not the same as ensuring that the treatment that you provide is based on evidence or on best practices.
Providing treatment is not the same as ensuring that the people delivering treatment are good therapists.
Providing treatment is not the same as ensuring that the people delivering the treatment are qualified and trained for the kind of work they will be facing in prisons and jails.
Providing treatment, to be effective, must include evidence-based programs for recovery from addiction and other co-occurring problems. We know what to do but we aren’t doing it:
“The components of quality, comprehensive mental health care in prison are well known. They include systematic screening and evaluation for mental illness; mechanisms to provide prisoners with prompt access to mental health personnel and services; mental health treatment that includes a range of appropriate therapeutic interventions including, but not limited to, appropriate medication; a spectrum of levels of care including acute inpatient care and hospitalization, long-term intermediate care programs, and outpatient care; a sufficient number of qualified mental health professionals to develop individualized treatment plans and to implement such plans for all prisoners suffering from serious mental disorders; maintenance of adequate and confidential clinical records and the use of such records to ensure continuity of care as prisoners are transferred from jail to prison and between prisons; suicide prevention protocols for identifying and treating suicidal prisoners; and discharge planning that will provide mentally-ill prisoners with access to needed mental health and other support services upon their release from prison. Peer review and quality assurance programs help ensure that proper policies on paper are translated into practice inside the prisons.”
In addition, we are facing massive treatment deficits, many Michigan prisoners are kept on waiting lists for years prior to getting programming that is a quid pro quo for parole. I myself was denied parole twice, despite zero disciplinary actions in my three years in prison, solely because I had not completed programming that the MDOC had not suggested but that the parole board
considered mandatory.
Some will argue that per-prisoner costs are already too high to invest in more programming and treatment, but I would suggest that per-prisoner costs are the wrong metric to use for delaying reform:
First, recent research proves that the major drivers of prison costs in Michigan are personnel and facilities, not per-prisoner costs. Second, as I recently discussed with sociology professor and Criminal Justice Reform author John Pfaff, it is rational and even necessary that as facilities close down, per-prisoner costs should go up.
We have just spent several decades cutting services and programs because of the desire to be ‘tough on crime and now in order to ensure we can continue to close facilities and reduce our prison populations even further, we will need to help formerly incarcerated people reintegrate in the best shape possible to prevent recidivism and protect the returning prisoners and society from failure. This is still a problem that the MDOC, and the Michigan House, and Senate are not addressing.
Finally, the cost of each denial of parole is much higher than the costs of treatment. Generally, 12–15 prisoners are involved in each programming group while the cost of each denial of parole is approximately $35,000 per inmate. The cost of a therapist (who could cover multiple groups at a time) is far less than the cost of failure to provide programming (do the math, assuming a few people don’t complete programming in each group, it comes to millions in long-term savings per therapist).
Nothing that I saw or experienced in prison offended my moral sensibilities more than how Michigan’s jail and prison systems treated the mentally ill. There are a strong safety and cost-based arguments to be made for providing better mental health care for mentally ill and addicted inmates but, at the end of the day, no society that calls itself civilized (or a city on a hill) should treat its most vulnerable with such utter and callous disregard.
So I will conclude with a quote about what being in prison does to people in Michigan afflicted with mental illness and a quote about the scope of the crisis:
“In addition, reports suggest that stressors experienced during imprisonment are likely to exacerbate pre-existing mental illness. Psychological stressors include the thought of lifetime confinement, separation from one’s family, and the fear of victimization.”
And finally, as a 2005 assessment of the MDOC by Doctor Terry Kuper’s M.D. M.S.P put it:
The adequacy of mental health services cannot be measured solely in terms of staffing levels or the number of prisoners who receive mental health treatment or are placed in Suicide Observation, with or without medications. Adequate mental health treatment requires the availability of a trained clinician to develop a trusting relationship with a patient in a setting that permits privacy, where confidentiality is respected so that very personal themes can be explored and worked through. Adequate mental health treatment requires a variety of treatment modalities, including but not limited to crisis intervention; psychotropic medications as needed; the availability of a certain number of group activities such as group therapy, psychoeducational groups, facilitated socialization or recreational activities, and psychiatric rehabilitation groups that involve psychoeducational programs, training in the skills of daily living and medication compliance; admission to an acute psychiatric hospital as needed; social work outreach to family members as needed; and after-care planning so that the disturbed individual is not returned to the environment that caused a breakdown but rather is provided with the ongoing care and social supports needed to sustain his mental health. For example, placement in a cold observation cell with no clothing nor other amenities and a daily cell-front chat with a mental health worker, followed by a return to a segregation cell with nothing but brief cell-front follow-up assessments, by no means constitutes adequate treatment for depression with a suicidal crisis.
We need to do better for Michigan’s mentally ill (many of whom are in our prisons and jails). Thanks for your attention. If you want to help, submit these suggested reforms to the C.A.R.E.S. task force or message your State representative.
Here is a more formal list of requests to the Michigan C.A.R.E.S. task force:
1. Trained Mental Health social workers or experts should be involved in the immediate intake process at all of Michigan’s jails and prisons. The appropriate number of additional behavioral health professionals should be hired to meet the needs of Michigan’s prison and jail populations.
2. All prison and jail personnel should receive advanced mental health training as part of their continuing education (this could be accomplished through an ongoing training rotation).
3. All mental health operations in Michigan’s jails and prisons should err on the side of transparency and be open to members of the press and annual audit by experts in the provision of evidence-based correctional mental health services.
4. An audit should be done investigating not only the existence of care but also the kinds of treatment being provided. Suggestions should be made to ensure the best possible outcomes. Incentives should be created tying administration success to successful outcomes.
5. The practice of mental health treatment by use of solitary confinement should be discontinued. Any decision to use solitary confinement to treat inmates should have to be justified at a very high standard of proof.
6. The raw numbers (not inmate names) of wait lists for parole mandated and well-known but not officially codified parole mandated programming should be published on a regular basis.
Therapists, social workers, and qualified experts should be hired immediately to reduce the number of people receiving continuances as the result of delayed programming to zero. Incentives should be created that ensure all mandated treatment wait lists will reach zero for all people with an ERD in that calendar year annually. Zero means that all inmates would complete programming before their ERD is reached.