Wednesday, June 12, 2013

Treatment of individuals with serious mental illness in jails and prisons - a survey

Edwin Fuller Torrey.jpgDear NAMI leader,

We can all agree that individuals with serious mental illnesses do not belong in jails or prisons.
The reality, however, is that many such individuals are in jails and prisons as a result of the increasingly failed mental illness treatment system. Many jails and prisons now report that 20 percent or more of their prisoners have severe mental illness as a primary diagnosis, frequently complicated by substance abuse.
Being in jail or prison when your brain is working normally is difficult enough, but being in jail while you are psychotic is a nightmare. And practices for psychiatrically treating such individuals vary widely, even within a single state. In fact, there appears to be considerable confusion among families, and even among some jail and prison officials, regarding the legal circumstances under which individuals with serious mental illness can be involuntarily treated in jails and prisons when they are psychotic and unaware of their own illness.

For this reason, the Treatment Advocacy Center is undertaking a state-by-state survey of laws and practices for treating jail inmates who refuse treatment for a severe and persistent mental illness. This information is being collected by Mary Zdanowicz, a lawyer. When it is complete later this year, the survey will be permanently posted on the website of the Treatment Advocacy Center and be accessible to everyone, along with the other state-related information already available there.

As part of this survey, we are collecting anecdotal information about the experiences of individuals with serious mental illness (e.g., schizophrenia, bipolar disorder, schizoaffective disorder or severe depression with psychotic features) who should have been treated involuntarily while they were in jail or prison but, for whatever reason, were not treated. I am aware that some of these cases end up as disasters. Conversely, I am aware that some such individuals are involuntarily treated with a good outcome. We are interested in collecting examples of both bad outcomes when involuntary treatment was not provided and good outcomes when it was provided.

Could you please forward this request to any of your NAMI members who may have a family member in jail or prison and may be interested in the involuntary treatment problem? I would like them to send us the details of that treatment situation. In our report, we will not identify the individuals or the jail/prison by name, only by state, except in cases in which the information is already public.

NAMI members who wish to contribute such information can send it to me directly at It should be sent to me by August 1.

Thank you for your help with this survey. When we release it later this year, we will send you a copy.

E. Fuller Torrey, MD