Prison alternatives needed for mentally ill

Saturday’s column provided a closer look at a Johnson County criminal case involving a 29-year-old man on the autism spectrum who is facing 45 years in prison for crimes related to his obsession with a former girlfriend.

When the man is sentenced to prison later this month — and there is little reason to believe he will not be sent to prison — he will join the ranks of some 8,000 Iowans who live behind bars. Of those inmates, according to the latest annual report by the Department of Corrections, about 47 percent have a mental health diagnosis for a chronic condition. Within that percentage are seven other individuals who share the Johnson County man’s diagnosis of Aspergers Syndrome.

While the most common diagnosis among inmates is substance abuse disorders and depression, the report notes about 28 percent of the prison population has been diagnosed with a serious mental illness such as schizophrenia, bipolar disorder, dementia and recurrent psychosis.

Iowa Prison Population, June 30, 2013 (Source: Iowa Department of Corrections, FY 2013 Annual Report)
Iowa Prison Population, June 30, 2013 (Source: Iowa Department of Corrections, FY 2013 Annual Report)

“This population is difficult to treat, has cyclical episodes despite stability on medication, and often has a course that shows functional decline over the years despite the best of interventions the system uses to provide stability,” the report acknowledges.

This is also the prison population that, because of the need for medical and psychiatric intervention, uses “significant resources.”

JOHNSON COUNTY

Daniel Jason, the 29-year-old man found guilty of stalking and extortion in Johnson County and awaiting final sentencing, has been diagnosed with Aspergers, a neurodevelopmental disorder on the autism spectrum. Generally, individuals with Aspergers are high-functioning and non-violent. They often find social interaction uncomfortable or difficult and can become fixated on specific interests or repetitive behaviors.

Because the syndrome has been classified as part of the autism spectrum, it is not considered a psychiatric disorder — but in adolescents and young adults, it does often coexist with psychiatric disorders. While health professionals can prescribe medications in an effort to alleviate anxiety, for instance, there are no medications specifically for autism spectrum disorders, including Aspergers. There is no cure and some with the disorder have argued there is nothing that needs to be cured; that the syndrome is just an alternate neurological way of being.

FINDING JUSTICE

There is ongoing debate regarding prisons as instruments of punishment or rehabilitation, but most people are comfortable with a belief that the overriding purpose of prison is the safety of specific individuals or the community as a whole. This belief is manifested in the discretion provided by society throughout the justice system. We do want punishments to fit the crime and we do want law enforcement, prosecutors and court officials to take individual circumstance into consideration when choosing to arrest, place on trial and sentence those who commit criminal acts.

As noted in Saturday’s column, justice in the Jason case must include safety for the former girlfriend who was terrorized as well as her family and friends. There is no doubt that placing Jason behind bars would achieve this goal, but it is doubtful it would fulfill the need to keep the larger community safe.

IDEAL WORLD

Jason has time and again produced exceptionally violent statements and depictions. While those closest to him have weighed such behaviors alongside his Aspergers, it is doubtful fellow inmates will be willing to make that same leap. Unless he is kept separate from a general prison population, it is highly likely his behaviors will incite physical violence.

How does a man, already challenged to conform to a societal norm, behave within society after serving decades in a prison system that is only de facto tasked with housing and treating individuals with mental illness?

While Aspergers should not be used as an excuse for crimes, it should signal a need for more nuanced sentencing. Unfortunately, since a rightfully outraged public began calling for the closure of large, residential psychiatric facilities because of neglect and abuse, such options rarely exist. While the move to community-based treatment for mental illness has brought numerous positives, it is time to learn from the mistakes of our past and for the pendulum to swing again in the direction of more institutional options.

Most important, we — read: schools, parents, churches, law enforcement, courts — need to better identify and respond to behavioral health issues before criminal activity, and not be so skittish about it.

Most individuals with mental illness will never become violent. Providing mentally ill offenders with placements outside of a prison does not excuse their crimes, nor does it hinder justice.

In June 2011, the Iowa Department of Corrections released a study entitled "Iowa Recidivism Report: Prison Return Rates." The study documents that Iowa's three-year return rate to prison for offenders released during FY2007 decreased from 33.9 percent for the previous three-year period studied to 31.8 percent. More dramatic was the decrease in the percent of offenders with mental illness returning to prison. "Chronic" mental illness was defined as conditions that are managed rather than "cured."
In June 2011, the Iowa Department of Corrections released a study entitled “Iowa Recidivism Report: Prison Return Rates.” The study documents that Iowa’s three-year return rate to prison for offenders released during FY2007 decreased from 33.9 percent for the previous three-year period studied to 31.8 percent. More dramatic was the decrease in the percent of offenders with mental illness returning to prison. “Chronic” mental illness was defined as conditions that are managed rather than “cured.”

In June 2011, the Iowa Department of Corrections released a study entitled "Iowa Recidivism Report: Prison Return Rates." The study documents that Iowa's three-year return rate to prison for offenders released during FY2007 decreased from 33.9 percent for the previous three-year period studied to 31.8 percent. More dramatic was the decrease in the percent of offenders with mental illness returning to prison. "Chronic" mental illness was defined as conditions that are managed rather than "cured."

The above chart includes all chronic mental illnesses (MI), not just the seriously mentally ill (SMI). Offenders with diagnoses in more than one category are counted more than once. (Source: Iowa Department of Corrections, FY 2013 Annual Report)
The above chart includes all chronic mental illnesses (MI), not just the seriously mentally ill (SMI). Offenders with diagnoses in more than one category are counted more than once. (Source: Iowa Department of Corrections, FY 2013 Annual Report)

 

The above chart includes all chronic mental illnesses (MI), not just the seriously mentally ill (SMI). Offenders with diagnoses in more than one category are counted more than once. (Source: Iowa Department of Corrections, FY 2013 Annual Report)
The above chart includes all chronic mental illnesses (MI), not just the seriously mentally ill (SMI). Offenders with diagnoses in more than one category are counted more than once. (Source: Iowa Department of Corrections, FY 2013 Annual Report)
The cost associated with pharmacuetical needs for the mentally ill in Iowa's prisons comprises about one-quarter of total pharmacy costs for offenders. The chart above provides a view of spending for the final quarter of FY 2013. (Source: Iowa Department of Corrections)
The cost associated with pharmacuetical needs for the mentally ill in Iowa’s prisons comprises about one-quarter of total pharmacy costs for offenders. The chart above provides a view of spending for the final quarter of FY 2013. (Source: Iowa Department of Corrections)
The chart above references Critical Incident Reports that involved inmates with a mental health (MH) diagnosis. It is organized by correctional facility, and incorporates data from FY 2013. (Source: Iowa Department of Corrections, FY 2013 Annual Report)
The chart above references Critical Incident Reports that involved inmates with a mental health (MH) diagnosis. It is organized by correctional facility, and incorporates data from FY 2013. (Source: Iowa Department of Corrections, FY 2013 Annual Report)

This column by Lynda Waddington originally published in The Gazette on June 1, 2014. Graphic source: Iowa Department of Corrections, FY 2013 Annual Report