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Commentary: When prisoners are mentally ill

This article first appeared in the St. Louis Beacon, Sept. 27, 2009 - Michael Randle got it right. Prodded by inmate advocates and probing journalists, the state's new prisons chief acknowledged substantial mental health issues among more than a fifth of the nearly 240 convicts at the Super Max, a Dantean penitentiary planted in the secluded woods of deep southern Illinois to isolate the most incorrigible of the incarcerated.

To discount the illnesses, even among the worst of the worst, demeans a civilized society and begs legal challenges. Thus, the screenings, evaluations and other adjustments Randle prescribes for the foreboding facility at Tamms should blunt the calls to dismantle an operation that has enhanced the security of employees and inmates at other prisons.

But what about the more than 6,000 prisoners elsewhere who have been diagnosed as having serious psychiatric and psychological disorders? Or the 5,000 prisoners who are not as ill but still deemed by professionals to have genuine mental health issues frequently complicated by substance abuse problems? (The Illinois Department of Corrections is responsible for management of 45,000 adult inmates and supervision of 35,000 parolees.)

In the 1970s, many of us pressed successfully for deinstitutionalizing treatment of mental illness. We pushed to depopulate state hospitals and rehabilitate our fellow human beings near their families and friends, using locally provided services to restore them to productive and fulfilling lives. The reform benefited thousands and thousands but clearly fell short. Failure to adequately fund community-based service networks has brought re-institutionalization - not in hospitals but in prisons and jails.

"We ended up criminalizing mental health. That's just the sad truth. Prisons are not the places to be dealing with these types of problems," says Hanke Gratteau, executive director of the John Howard Association of Illinois, a leading penal reform organization.

She and others face blowback from lawmakers fearing voter backlash. Most people with mental illness do not break laws; indeed, many become crime victims because of their vulnerability. Why be perceived as catering to lawbreakers? But, even if the reform resisters scoff at bleeding hearts, they should focus on the hemorrhaging state treasury.

Gov. Patrick Quinn's Taxpayer Action Board, hardly a gang of liberals, cited savings in the tens of millions of dollars annually that could be achieved by releasing thousands of no-violent offenders, closely monitoring them and providing substance abuse treatment and mental health counseling as well as educational, job training and employment opportunities.

Quinn and the legislature took a major step in the right direction by enacting legislation spearheaded by Paula Wolff, senior executive at Chicago Metropolis 2020, to deal with low-risk offenders in their communities and divert them from much more expensive stays in prisons.

Studies have shown the approach works. But the savings, rehabilitation successes and public safety gains will not materialize without the state substantially bolstering community resources. Providers have lengthened waiting lists, pared services and even folded as the state has slashed funding and cavalierly delayed payments. Support for mental health and substance abuse treatment has taken a nearly $80 million hit this year, according to Frank Anselmo, chief executive officer of the Community Behavioral Healthcare Association.

Moreover, mental illness treatment within the prisons and greater coordination with local agencies must get a higher priority to properly prepare inmates for reintegration into their communities. "We definitely have a long way to go, but we're in a better position than we have been," says Dr. Wendy Blank, chief of mental health services for the Department of Corrections.

She is buoyed by Randle's commitment to addressing mental health issues beyond Tamms. It is a commitment rarely seen among policymakers in Illinois, and we have paid the price in our pocketbooks and our sense of security.

Mike Lawrence retired Nov. 1, 2008, as director of the Paul Simon Public Policy Institute at Southern Illinois University. He is returning to his journalism roots as a twice-monthly columnist.