APA Backs Order for Major Prisoner Release

“Clinical experience supports the conclusion that crowding may create pervasive and intractable problems for the provision of minimally adequate mental health care,” the brief states. “To ensure that prisoners are evaluated for mental illness and afforded minimally adequate treatment, there must be sufficient clinical staff, space in which to provide treatment and perform screening and clinical evaluations, and clinical facilities to accommodate inmates requiring higher levels of care.”

Such overcrowding, which necessitates the use of gyms and community rooms as dormitories, has additional negative effects on inmates' mental health. The unavailability of gyms and community rooms for their designed purposes and the lack of proper sleeping facilities prevent activities needed to help keep prisoners mentally healthy, including proper sleep, exercise, and vocational activities, Lewis Bossing, a senior staff attorney at the Bazelon Center, told Psychiatric News.

APA was joined in its brief by the California Psychiatric Association, American Psychological Association, California Psychological Association, American Academy of Psychiatry and the Law, Forensic Mental Health Association of California, National Alliance on Mental Illness, and Bazelon Center for Mental Health Law.

“We thought it was important to remind everyone that there is a constitutional standard for mental health care,” Bossing said.

Despite a federal court takeover of the supervision of California's prisoner health care system in the 1990s and successive increases in clinical staff and treatment facilities, the state has been overwhelmed by a “tidal wave” of new prisoners in the last 15 years, Appelbaum said. An increase in the prison population was accompanied by a flood of inmates with mental illness, including up to 18,000 such inmates in 1995 and 34,000 in 2008, according to state estimates.

Such burgeoning prisoner populations nationwide led to the Prison Litigation Reform Act (PL 104-134), which was enacted in 1996 and authorized panels of federal judges to issue prisoner-release orders in state prison systems but only when prison overcrowding is the primary cause of a violation of a constitutional right and when no other action will correct the problem.

A three-judge in California ruled in January that although prison overcrowding was not the only cause of the constitutional violations, it was the primary cause of a lack of constitutionally adequate mental and general health care. The panel of judges concluded that reforms of the prison health care system were impossible until the overcrowding was addressed. They ordered California to cut its prison population within two years from 200 percent of its design capacity to 137.5 percent, which would require the early release of up to 46,000 inmates.

The California prison system population is currently 165,000, though it was designed to house only 80,000.

Any long-term solution to the conflict between the needs of burgeoning prison populations and the needs of inmates with psychiatric disorders, Bossing said, will have to include aggressive jail-diversion programs and other treatment interventions for those who are arrested. Otherwise large numbers of people with untreated psychiatric conditions will continue to add to the overcrowding and aggravate the problems of prisons' already inadequate treatment system.

The APA amicus brief in Schwarzenegger v. Plata is posted at <www.abanet.org/publiced/preview/briefs/pdfs/09-10/09-1233_AppelleeAmCu9MentalHealthGrps.pdf>. More information on the case is posted at <www.scotusblog.com/case-files/cases/schwarzenegger-v-plata/>.