Journalism in the Public Interest

The Best Reporting on Mental Illness in Prisons

More than half of U.S. inmates suffer from a mental health problem. Here’s some of the best deep-dive reporting on the issue.


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Last week, we published an investigation into the New York prison system, and how, despite protections, inmates with severe mental illness are still ending up in solitary confinement.

But New York is far from unique. Prisons and jails across the country are filling with mentally ill inmates, while access to community mental health services dwindle. The Department of Justice estimated in 2006 that over half of all U.S. inmates suffer from a mental health problem.

Those prisoners also often end up in the isolated cells known as “special housing units,” “secure housing units,” solitary confinement, or simply, “the box.” There, inmates can be locked down for 23 hours a day with little human contact. Studies show such isolation can cause or exacerbate psychiatric problems in prisoners.

We’ve rounded up some of the best deep-dive reporting on the mentally ill in U.S. prisons. Did we miss any? Let us know in the comments below.

Mental Illness Among Inmates

My Name is Not Robert, New York Times magazine, August 2000
A mentally ill man from Los Angeles is mistaken for a wanted criminal, and ends up in a maximum security prison in upstate New York. His kafkaesque story details the bureaucratic breakdown and flaws in mental health care that led to his imprisonment.

The New Asylums, Frontline, May 2005
Frontline documents the movement of America’s mentally ill away from shuttered psychiatric hospitals, and into the nation’s jails and prisons. The result is a massive strain on the minds of afflicted inmates, and on the strapped prison system tasked with treating them.

An American Gulag: Descending into Madness at Supermax (three-part series), The Atlantic, June 2012
Federal prison policy says mentally ill inmates shouldn’t be housed in the maximum-security prison ADX-Florence (also known as Supermax) in Colorado. But a lawsuit against the facility found many troubled inmates were still locked down at Supermax, where they were neglected or out-right abused by prison staff.

Trouble in Mind, Texas Monthly, March 2013
Andre Thomas had been hearing voices since he was 10 years old, and made multiple attempts at suicide. Eventually, his psychotic breakdown led him to brutally murder his wife and her two children. As Thomas awaits execution for his crimes in Texas, his story “forces uncomfortable questions about the intersection of mental illness and the criminal justice system,” writes journalist Brandi Grissom.

The Impact of Solitary Confinement

A Death in the Box, New York Times Magazine, October 2004
Inmates battling psychological problems often find themselves in “the box” for failing to comply with rigid prison policies. But what toll does isolation take on an already fragile mind? Mary Beth Pfeiffer details the death of one New York inmate who committed suicide after being stuck in solitary—rather than provided treatment. Pfeiffer’s 2011 investigationfor the Poughkeepsie Journal shows how even with new protections, the number of suicides in New York prisons spiked in 2010.

Hellhole, New Yorker, March 2009
Atul Gawande explores the trauma of long-term isolation, a daily reality for tens of thousands of U.S. prisoners. “The wide-scale use of isolation is, almost exclusively, a phenomenon of the past twenty years,” Gawande writes of confinement, a tactic meant to separate the most dangerous inmates. But while solitary can have a massive impact on inmates’ mental health, studies show it’s done little to reduce prison violence.

New York's Black Sites, The Nation, July 2012
While solitary is used across the country, New York stands out for using it to punish violations as minor as having too many postage stamps. Jean Casella and James Ridgeway (also editors of the website Solitary Watch) detail how New York State came to house roughly 4,500 inmates in solitary confinement, cutting them off from almost all human contact, often for months at a time.

Solitary in Iran Nearly Broke Me. Then I Went Inside America's Prisons, Mother Jones, November 2012
After being held for over two years in an Iranian prison, journalist Shane Bauer was shocked by what he found at California’s Pelican Bay prison: their solitary confinement cells were, in many ways, even worse. “Here, there are no windows,” Bauer writes. California uses solitary confinement to isolate thousands of inmates they claim are gang-affiliated, putting many in “the box” for up to decades.

You fail to recognize severe mental illness as an issue induced by the solitary confinement !

Richard Lehner,MSW, LCSW

Aug. 19, 2013, 4:59 p.m.

I’ve been working with children now 33 years. In my early years I worked in secure detention, (jail for minors). I was always thrown back by the number of teens diagnosised with conduct disorder by licensed psychiatrists. When I would bring it to the attention of people responsible for sentencing, including the county/state psychologist, they would respond to me that they did not count conduct disorder as mental illness. Thus no treatment just punishment and you can figure out where the adult prison system came from. The practice still continues here in Florida (floriduh) and I’m sure most places. Treating the mentally ill as criminals is business as usual. In Florida we just excited a man with a diagnosis of full blown schizophrenia. Need I say more?

Richard Lehner

Aug. 19, 2013, 5:03 p.m.

Many sorry’s, just read my post, my iPad self corrected executed and put excited,again very sorry, it attempted to it again just now. Should have read we in Florida just executed a man with a official psychiatric diagnosis of schizophrenia.

Dr. Henry Franceschi

Aug. 19, 2013, 10:18 p.m.

I’m a former forensic psychologist who worked at several maximum security forensic hospitals, Federal Bureau of Prisons penitentiaries, and worked with the Courts on dealing with the “worst of the worst.” You really need to do some conscientious research to get solid answers to the complex issues you raise.

Are you not aware that Ronald Reagan, as a cost-cutting strategy, released all the chronically mentally ill back to the community, closed major psychiatric hospitals, and then left the public who lived in the inner cities to deal with the drift of the mentally ill to the inner city where they created the “downtown blight” that still affects major cities.

Now, let’s do some numbers. Imagine a minimal incidence rate of 1% of the population who has the genetic susceptibility, exposure to birth trauma, or have been exposed to environmental toxins that produce the brain syndromes that lead to these serious mental disorders. Got it? 314 million Americans x 1% = 3.1 million persons who have to be civilly committed because of random violence against themselves or others. The only way to manage that level of random violence is keep perpetrators off the streets, in a maximum security forensic hospital, where you medicate so they can at least go to meals and to the “yard” without hurting themselves or others. If you don’t medicate them somebody predictably will get hurt. You can’t get 24 hrs of no violence from this type of inmate. Now, if they do hurt somebody while the State is responsible for them - and it happens often despite the efforts of valiant “psych techs” who are the ones who usually take the blows - the State is responsible before the Courts and the victims often will win significant settlements.

The law, however, says that to medicate someone who is civilly committed, you essentially have to violate their civil rights so you need qualified psychiatrists who are expert witnesses before the Courts to determine that, in prison, these inmates have committed acts dangerous to themselves or to others and so, the forensic reports will say, the inmate needs to be medicated. And, like it or not, the seriously mentally ill do function better for a time on anti-psychotics and lithium, but it requires a full-time psychiatrist qualified in these serious illnesses because the biochemistry of major psychotic or mood disorders is constantly changing as is the risk of random violence. The problem is that a full-time psychiatrist costs the State on average $350/hr: not just to prescribe the meds but, more importantly, to be legally responsible, before the Courts, for the civilly committed inmate(s) that the psychiatrist is legally in charge of.

3.1 million is the equivalent of the population of a small developing country totally populated by seriously mentally ill, dangerous, people. What’s the solution? First, they’re our responsibility as a society; it’s that 1% of Americans that the roll of the dice made dangerous. Second, talk therapy, groups, cognitive behavior therapy does t nothing for these disorders; only medications have the rapid, lasting effect that these biochemical, metabolic disorders require. Third, we have to protect State employees from these seriously ill folks - the Psych Techs, the guards, and the professional staffs from injury and meds are the only thing that works to achieve that goal and sustain it. Furthermore, psychiatrists qualified before the Courts as expert witnesses are the only ones who can medicate on the long-term manner that the Courts will allow. Fourth, when the Feds or the State want to produce significant budget cuts, where do you tink the “quick and dirty” place is to get a significant amount of money to cut? Obviously cut the psychiatrists time. Fifth, now you know why seriously ill prisoners in the penal system are exposed to the terrible conditions you cited.

In sum, it comes down to a matter of “pick your poison.” To have prisoners well treated and comfortable you will have to pay a very large bill. If you (or your elected representative) don’t want to pay the large bill, there is no way that prisoners will be well served, guards and all other State employees exposed to them will be well protected, the media maybe (but it’s doubtful) will do good research that explains to the public what the real stakes are, and the public that has relatives who are being held in prison will finally be enlightened as to what solutions really are – get the politicians to do things right, or vote them out.

Dr. A-F

jamas vonrockmann

Aug. 20, 2013, 1:24 a.m.

Geez Doc Henry,

You make it sound like Nursing Homes of the now and near future.

B. Cayenne Bird

Aug. 20, 2013, 1:35 a.m.

You missed a great one on this list.

Freefall into Madness: The Fresno County Jail’s Barbaric Treatment of the Mentally Ill by Mark Arax

Edmund Singleton

Aug. 20, 2013, 7:55 a.m.

You commit a crime for monetary gain or need, never because you need mental health help but the only avenue open to you is punishment…

Dr. Franceschi, thank you for taking the time to outline all these considerations. This is the kind of knowledgeable, experienced, technical analysis that is needed to identify opportunities for progress. I particularly note your attention to the safety of prison staff, a factor often swept under the rug, or even on some level justified by vilifying those workers.

Here in Canada we have moved to allowing non-MD’s to prescribe medication in certain circumstances. Nurse practitioners don’t cost $350 per hour, and they work under the supervision of doctors. Given so few options and limited efficacy of psych medications, as you mention, could this be an area for cost savings, in the short term?

Janet Schultz

Aug. 20, 2013, 3:54 p.m.

It is very disturbing that the prison system inspird by the Gulag has become dark, dungeonous, impenetrable and suffocating.  Words that inspire repulsion in any person able to conceive their true meaning.  Why do these systems exist?  And why do we have subintelligent humans controlling them? 

The same can be said for the so-called menal “hospitals” built to house and treat people who break down under the pressure of their personal worlds. 

The angst with which any relative feels when the relation has been detained and treated at any of the facilities is only the surface disturbance indicating sadistic “discipline” happening within the walls of these institutions.  Moreover, the fact that they are manned by civil servants, uninterested in accountability or responsibility, is truly frightening.  Not comforting in the least.

Is anyone listening?

Stephanie Anderson Evans

Aug. 20, 2013, 10:40 p.m.

While Dr. Franceschi’s information is valuable and relevant I disagree with the undertone of defending isolation. No one is denying that a violent person must be separated from others. The issue is they are not simply separated. They are put in boxs that perpetuate mental illness to only further contribute to additional offenses when they are released from the box. Isolation does not have to be to the extreme that it is to keep others safe. Thats a crock to even suggest! Its flat out abuse of human beings. These are still human lives and attempting to defend, explain, justify usage of this type of torture is unacceptable! Im not impressed or clouded by your credentials or past claims of experience throwing a human being in a small room with sensory depravation is psychological torture and is criminal! So dont try to come on here and say that it is for the safety of others. A cell with bars can separate while protecting staff just as easily that still affords the separated individual to have human contact figuratively speaking. Dog pounds are more humane then “the box”. The death penalty being carried out would be more humane then “the box”. By the way it has been reported again and again that this extreme isolation is overused and nothing is done. Why? Where was your knowledge when you worked for the system? Where was your expert opinion to weigh in on how isolation is not effective and better solutions are all too obvious. Its the so called doctors in the prison system that should be educating the officials on alternatives. Where is your voice? Someone with all the credentials and experience you claim surely would be heard before someone like me. So i ask you doctor what have you done to be apart of the solution and not apart of the problem? Educate us yes! Thank you. But do not try to for one minute act as if there is justification for the use of extreme isolation and for extreme amounts of time! I may not be a doctor but I know better! The guards do get a bad wrap many times but that comes from an honest place. Any of you guards reading this if you are honest with yourself you know exactly why guards do not receive respect and you can name a co-worker that as we speak is just as criminal as any inmates in their abuse of their position. That is why many guards suffer from their own mental anguish, stress, and pressure from co-workers to be equally as dirty so as not to pose a threat amongst the brotherhood of guards “the other inmates”. The system is corrupt and their are some guards who cannot watch. They go into a digferent line of work not because of the inmates but because of the corruption and the abuse of authority. That very job attracts narcissistic personality types that have captive victims. They feed their own mental illness and “daddy issues” by bullying and provoking and outright f*cking with the inmates for their own personal pleasures. I am thankful for the guards who go in there and refuse to become apart of that sickness, but lets not sugar coat and pretend that the bad wrap comes from thin air. Good Doctor I implore you to be active in doing something about this. You already should have but we cant do anything about that except move forward! I will gladly stand beside you and do my part. Will you step-up?

Dr. Henry Franceschi

Aug. 21, 2013, 12:30 p.m.


Here’s an image that’s burned into my brain just for you. (1) She’s a 26 y/o beautiful, recently married 125 lb. female forensic psychologist. That means she completed her doctorate, got her license, specialized in forensic psych, qualified for an FBI security clearance, qualified for employment at maximum security forensic hospitals, then completed the intense hospital training on how to use your wits constantly and protect yourself from random violence on the locked wards. (2) He’s a 6’6” 325 lb. inmate, a patient of hers, who is walking up a 15’ hall lined by staff offices that have thick glass windows that face the hall - it’s thick glass because heavy wooden chairs have been thrown thru them in the past. She’s on the right next to the offices while he’s moving up the middle of the hall. She’s not aware he’s approaching but when she notices that there’s a body moving up on her, she turns slightly left, sees who it is and says “Good morning, George.” Without saying a word, without any outburst, without the slightest emotion, George slams her with his right arm and shoulder, lifting her completely off the ground and into the thick glass window. Her head crunches against the glass and she falls to the ground, out cold, bleeding from the mouth with a broken jaw and a fractured left collar bone. She was in the hospital for 3 weeks, and had to have her jaw wired. She came back to clear out her desk and to tell me that she had given enough and that was going to a job with the Courts where she said she could feel safer.

Stephanie, you’ve got a lot of good ideas and lots of mouth which is just what the Feds and the State need to hear more of, really. You’ve got what it takes. God knows I certainly didn’t. But I had my share of whacks and scars from working with this special group. But Stephanie, neither I nor my friend needed someone to stand by them. We went and tried, on our own, and you are right, we failed. But you go, now, you do your share. You turn that system around. Then come back and share with us how you did it. Because God knows the 3.1 million who are civilly committed - that means that the Courts have decided that the evidence indicates that you’re too dangerous to yourself or to others to be out in society - their relatives who have lived this, and all the professionals who have failed, urgently need your level of persuasion and professionalism right now.

Two places that most need you, right now, are Pelican Bay and the Coalinga Maximum Security Forensic Hospital where there are 1000 MDSOs (mentally disturbed sex offenders), pedophiles and rapists just waiting to hear your wisdom. Thx, you really turned me around.

Salt Lake City Weekly did a story in late 2012 on several mentally ill inmates who have been in solitary confinement for months or years because of behavior issues.

Edmund Singleton

Aug. 22, 2013, 11:26 a.m.

Please remember that their is an industry that needs bodies to stay in business, good works is not part of the business model…

Stephanie Evans

Aug. 22, 2013, 10:57 p.m.

To the good Dr. Franceschi and any others who share his opinion, you seem to think I am oblivious to the fact that there are people who need to be separated from others for safety. I am not! As i stated in my first comment and made very clear. Im not sure how your reply addresses my comment at all? The man who harmed your co-worker was roaming free down a hall? That has nothing to do with what im talking about unless your simply implying that these people dont deserve to be treated like humans? Maybe thats the point of your story. To desensitize the general public against this population because you obviously have grown hardened towards this population. I didnt read a word in your comment about the nonviolent offenders who spend 30-60 days in extreme isolation many times no windows, blank walls, no sounds. This is sensory depravation. This is used as torture in militant groups yet we use this daily in our prisons systems. I would be interested to know how many days in isolation that man spent prior to that act of violent against your co-worker? As studies have shown isolation does not do anything to improve behavior or change it. Actually on the contrary it produces something more broken and seething with anger and depression the went in. I also know that the psychiatric staff give the “ok” for individuals to spend long extended time in this isolation. After an individual has refused so many meals and the threat of “failure to survive” is in question the psychiatric staff are brought in to to assess and if need be the prisoner is removed and nursed back to health only to be returned to finish out long sentences in this isolation. Doctor i dont have doe eyes and im not disillusioned that there are awful evil people in this world that deserve the time of me or you trying to improve the prison lives. Its not those sick individuals i feel compelled to speak up for or be a “mouth” as you put it. Its the minor criminals who are doing 2 years or so and end up in isolation for having too many postage stamps or a messy cell. Thats unacceptable. The system is making this people into monsters and releasing them back into society. Take you or myself Doctor and put us in that extreme isolation for an extended amount of time and tell me what the outcome would be? Violent people need seperated from other i agree. Using isolation for minor offenses is just the guards abusing their authority and abusing human beings. Plain and simple. I would much rather see bring the chain-gang back put this people to work to do physical labor. Physical activity is much better for mind and it can be a productive use of prisoners time rather then throwing them in a box and forgetting about them. I am also a nurse and i happen to know that there are numerous medications on the market that interfere with the brains ability to react in a sudden explosive manner. Any violent offender could be medicated by injections if you are afraid of them refusing or pocketing meds. I dont just have ideas sir i have answers but some people as you know in that system are just as sick and sadistic as the criminals. Im not for cable or satelite for these criminals. im not for weight lifting rooms or equipment for them. Im for allowing them to pay their debts to society while finding a way to be productive. I heard of one prison in Gernany has their prisoner propell excercycles to generate the prisons electricity. This is genious. I am willing to do my part but where do i start. It seems the old “write a letter to your state rep” does nothing. Probably never even gets opened let alone read. I will continue to try to make the world a better place.


I have some mental health problems. My parents still love me and support me but I have no job, no friends and of course no girlfriend! However, my real problem is my inability to think straight I guess. My mind likes to wonder away and I seem to have no real desire to keep to mind focused on any thing in particular for any length of time. In fact this is so severe that I have no real desire to change my life around. I see no point in being financially independent and why this does not scare me makes me even more concerned for my mental health.

why is it the advocates of incarceration all work in this human trafficking business, or are some way economically tied to the prison industrial complex ?

Dennis, governments stand or fall on law and order, and most voters have no financial ties to prisons.

There is a conspiracy there of sorts, but not the one you suggest.

Kay Omholt-Montague

Aug. 29, 2013, 6:34 a.m.

Dr. Henry Franceschi:  With all due respect for your extensive background working in this area, I simply must present another side to your arguments.  The first comment that made the hair on my neck stand up was the one in which you referenced the mass deinstitutionalization, spearheaded by Ronald Reagan.  I actually got one of my first jobs at this time - working for a housing agency that was set up to receive folks with developmental disabilities, most of whom were coming from a state institution.  We certainly had our challenges but I did not witness much of the “downtown blight” of which you spoke.
Regarding one of your next points:  You stated that talk therapy, groups, CBT, etc. have no affect on helping folks who are diagnosed with chronic, severe mental illnesses.  You stated that medications are the ONLY effective mode of treatment for this category of “mental patient”.  While I do know that medication can be the most effective treatment modality for a small number of people, I completely disagree with your comment that “talk therapy, CBT, groups, etc. are essentially worthless for this group of folks.  I (and many folks with whom I have worked over the years) am living proof.  Psychotropic meds are “wonderful” for controlling behaviors - ie:  making a staff person’s job seem ostensibly easier.  Tragically, long-term use of psychotropic meds can lead to severe health problems (physical, mental, emotional and spiritual).
One last comment.  You came up with the number - 3.1 million Americans who would “have” to be civilly (your preference would be to lock them up in a psychiatric institution)  committed because they are a danger to themselves or others.  I have a real problem understanding where you got that figure and HOW you came up with the conclusion that these 3.1 million ““seriously mentally ill, dangerous, people””  -  are actually as sick and dangerous as you describe!

The vast majority of people labeled as seriously mentally ill (schizophrenia, bipolar disorder, schizo-affective disorder, etc.) are actually somewhat less likely to be perpetrators of violence than the “normal” population.

Dr. - Have you experienced taking any of these potent medications for any length of time?  Have you experienced being locked up in a psychiatric hospital, in which you basically start with little to no rights?  Have you ever gotten sick in the hospital (vomiting) and then reported it to staff?  Only when you reported it to staff, they asked you if you “saved” the vomit so they could prove you really got sick?  By the way, they don’t tell you (during orientation) that - IF YOU DO GET SICK, BE SURE TO SAVE THE EVIDENCE - Well, I flushed the toilet, so the staff said they could not legitimize my being sick.  However, they did encourage me to save my puke (if it happened again) so that they could come see the “proof”.

Have you ever been on so many medications that you completely lost any sense of the person you were?  Or that made you so sleepy, you could barely get out of bed in the morning - much less get up and go to a job.  Or how about when you’re at the state hospital, and all patients MUST get up and out of their rooms - even those who are so drugged up on psychotropic meds, they can barely move, or talk, or think.

I have had great success working with some folks who others had pretty much written off as “hopeless”.  And, yes, we started out by talking 1 on 1 - just she and I.  She was hearing voices and I gently asked her to tell me about the voices and what they were saying.  One step at a time, I asked questions - such as how she felt about the voices or did she want to do anything about the voices?

I’ve got many, many stories to tell - uplifting (not always an easy process - but SO worth the effort).  I just fear that - after reading your comments - the general public will be even more afraid of folks with mental illness diagnoses - which will lead to an increase in stereotyping and prejudicial thoughts/actions.

Edmund Singleton

Aug. 29, 2013, 6:43 a.m.

No one in their right mind in any business would kill a cash cow. They want more laws and more bodies to keep and promote bigger prisons that have and will save a lot of small towns…

Francis Lopez

Sep. 5, 2013, 10:44 a.m.

I really think this is a great article and one which we should let people know. Not only are half the prisoners mentally ill but also drug users/addicts end up in prison. I am working on my masters in mental health counseling and find it a need to provide more rehabilitative services as well as offering more mental health community agencies to help these individuals. The way to treat this is through therapy not by solitary confinement who would drive anyone crazy! Something should be done as soon as possible to end this issue, and another negative factor is that us the people from the US are paying taxes for this instead of paying it to help these individuals not drown them more.

Mich. says mental health courts making difference
Posted: Aug 26, 2013 4:07 AM EDT Updated: Aug 26, 2013 4:07 AM EDT  
LANSING, Mich. (AP) - The agency that oversees Michigan’s court system is praising the performance of special courts that serve people with mental illness.

A study of 10 mental health courts around the state finds a lower level of repeat offenders compared to other courts. Participants also had better opportunities for work, education and treatment.

State court administrator Chad Schmucker says the survey checked up on 331 graduates of mental health courts. The goal is to get help for people instead of sending them to jail or prison for long periods for certain crimes. They may have schizophrenia, bipolar disorder or severe depression.

Mental health courts have been around since 2009. More than a dozen counties are participating.

Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Stephanie evans

Sep. 6, 2013, 3:27 a.m.

I think we can all see that the professionals in the system like Dr. Henry Franceschi become desensitized and forget that all prisoners are not rapist, pedophiles, and monsters. Many are serving short sentences drug crimes. Many mentally ill persons do self medicate and over indulge in alcohol consumption to numb the pain or escape the symptoms (hearing voices). These people can still be productive members to our society with rehab. Although finding genuine Doctors that give a dam has proven to be a difficult task, they are out there.

I would like to know who is policing the guards to ensure they are not becoming sick, and twisted and sadistic and overusing their power such as putting someone in extreme isolation for 90 days for having a messy cell?

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