Being mentally ill in the United States is hard as it is, but imagine being mentally ill in prison. A new report from Human Rights Watch says that one in five inmates in the United States has serious mental health problems. These problems can be anything from schizophrenia to being "actively psychotic."

A key factor driving so many mentally ill people into America's jails is that we don't really have a mental health "system," as the amount of interconnected services and facilities is not adequate to meet the needs of the public. Around 90 million Americans live in areas that have a shortage of mental health professionals. Beyond the lack of availability, the price of mental health is too high for many Americans. Nearly half of Americans who say they need mental health assistance say they cannot afford it. Consequently, many are arrested and jailed for things like indecent exposure or causing a public disturbance.

Prison staff have very little training.

Once they get to prison, things get worse. The Human Rights Watch report states that prison workers often don't know how to deal with mentally disturbed people, and jails and prisons across the United States are using brutal, sometime lethal, force against them

“Most [prison] staff receives very little training in the symptoms of mental illness and, in particular, techniques and tactics to use to minimize the need for force against them when they are acting out,” Jamie Fellner, a criminal justice expert and the author of the Human Rights Watch report, told ATTN:. She said that there are a few prisons out there that train employees to deal with people with mental health problems, but most do not.

Horrific abuses.

The report cites everything from bones being broken during altercations with the inmates to inmates being electrically shocked with weapons. One prisoner referenced in the report, named Anthony McManus, suffered from schizophrenia and bipolar disorder. He ended up in prison for indecent exposure, and he sometimes acted out by spreading his feces or urine across the walls and floor of his solitary confinement cell. He would also scream and speak unintelligibly. In response, the prison guards turned off the water in his cell and regularly refused to bring him food. They also pepper sprayed him at one point and did not offer him water to wash it off. He eventually died in the prison. He had gone from 140 pounds to 75 pounds in five months.

One prisoner referenced in the report was sprayed with pepper spray so many times he had to be taken to a burn treatment facility, and another was sprayed 12 times in a 36-hour period. Prisons often use pepper spray and tasers to deal with mentally disabled inmates.

Solitary confinement is another tool often used by prisons dealing with inmates with mental health issues. One inmate in the report had an IQ of 66 and a mood disorder. He was kept in solitary confinement for five months, until he tried to hang himself. They soon put him back in solitary, and he tried to hang himself again. The Center for Constitutional Rights identifies solitary confinement as a form of torture that actually causes mental health to deteriorate.

This is a huge, widespread problem.

The Human Rights Watch report says that the abusive treatment of mentally ill inmates is widespread and could possibly be found in as many as 5,100 jails and prisons across the country.

One of the major hurdles to fixing this problem is the extreme lack of good data. “The lack of transparency is directly correlated with the lack of accountability,” Fellner said. She believes that prisons should be keeping track of abuses and deaths so action can be taken to fix the problems. 

Fellner also says that prisons could benefit from increasing mental health services in prisons and by training staff to deal with mentally disabled prisoners. 

“Typically, [mental health services] are inadequate for the quantity, for the demand, and for the quality needed," she said. "There is an over-reliance on medication … often times there's nothing but medication, and medication in and of itself is rarely satisfactory for treatment.”

She said some people with some form of mental illness commit terrible crimes, and society will want to see that person put in a secure facility, but that doesn't mean the secure facility can't have treatments available to help the person with their health problems. Many mentally ill people who end up in prison eventually get out, and they typically end up back in prison after they're released. This is due to lack of mental health treatment in the facility and in the outside world.

“This country … has loved to build prisons and spend money on prisons and keep throwing people into prisons, and it hasn't paid a whole lot of attention to what goes on inside prisons,” Fellner said. She said psychiatric institutions were shut down all over the country in the 1960s and 70s because of poor conditions, which was a good thing, but there was little offered to replace the institutions. “The investments in the community never happened,” she said.

As we've noted before, private prisons often try to cut costs by offering fewer health services for inmates. Public prisons, too, appear to be offering an insufficient amount of care for special needs inmates. The United States has criminalized mental illness and abuses the mentally ill once they are in prison.