Aug. 18, 2006 – For much of his adult life, paranoia and imaginary voices followed Ray Ortiz, pushing him into hospitals and homeless shelters. Eventually, they landed him in a tiny solitary-confinement cell, deprived of daylight and human contact as a way of controlling the symptoms of his mental illness.
Now 53 and out of prison for over a decade, Ortiz recalled how his time spent locked in isolation allowed his bipolar disorder and a borderline personality disorder to consume his mind until he contemplated suicide.
"Youâ€™re left with your demons all by yourself," he said.
On any given day, hundreds of New York Stateâ€™s mentally ill inmates are enclosed in solitary confinement, often called "special housing units" (SHUs), or "the Shoe" in prison lingo.
On Wednesday, Governor George Pataki vetoed a bill that would have banned solitary confinement for prisoners with severe mental illness. The move leaves it up to the state legislature, which overwhelmingly approved the measure, to decide whether to override the veto.
Meanwhile, the coalition of civil-rights and mental-health advocates that championed the bill is looking beyond this legislative session. For them, the move to ban solitary confinement of mentally ill prisoners is just a touchstone in the push to decriminalize mental illness.
New York State prisoners suffering from mental illness now number roughly 8,000 â€“ more than one in ten inmates. When living in the general prison population, mentally ill prisoners, like others, rack up citations for misbehavior from prison staff, or "tickets," which lead to disciplinary lockdown.
The legislation is just a touchstone in the push to decriminalize mental illness.
In solitary confinement, they are detained for at least 23 hours a day in settings that survivors have described as intolerable for any human being, and especially devastating to a person with mental illness. The desolate conditions â€“ which many activists deem a human-rights concern for all inmates â€“ are sometimes compounded by abusive guards, food deprivation and physical restraints.
Advocates for the mentally ill say that inmates with severe disorders are too often locked in the Shoe for conduct they cannot control, such as violent outbursts, defying guardsâ€™ orders or mutilating themselves.
Ortiz, who served numerous sentences for assault and other offenses, said that he was sometimes thrown into the Shoe for having paranoid delusions or refusing to sit still.
Robert Corliss, associate director of the New York branch of the advocacy network National Alliance on Mental Illness, said that prison personnel typically are minimally trained and ill-prepared to identify and handle the manifestations of psychiatric disorders. "Within the prison systemâ€¦ [prisoners are] first thought of as a bad guy," he said. "The fact that thereâ€™s a mental illness thatâ€™s underlying the behavior doesnâ€™t really come to the fore."
Solitary confinement involves lockdown for at least 23 hours a day in settings described as intolerable for any human being.
The vetoed bill would mandate full psychiatric screening within 24 hours of placement in isolated confinement. In addition, inmates with serious mental illnesses who are currently in solitary confinement would be routed to the prison systemâ€™s psychiatric-care services. The bill also calls for the development of residential therapy programs for inmates with mental illness, tighter clinical oversight of their treatment, and extra training for prison guards on mental-health issues.
New Yorkâ€™s Office of Mental Health reported that in 2002, 70 percent of prisoners who had committed suicide also had a history of mental illness. According to a 2004 report by the watchdog group Correctional Association of New York, about 800 of the 4,400 inmates in disciplinary confinement were diagnosed as mentally ill, over half with severe disorders like schizophrenia.
In a study sample of inmates with mental illness, the average reported length of solitary confinement was 38 months. Official state data indicates that lockdown sentences average five months for the general prison population. Jack Beck, head of the Associationâ€™s field-research program, said disturbed inmates often endure extended sentences because "they act out, and they get ticket upon ticket upon ticket," resulting in extra months or even years of detention.
Mental-health advocates say reliance on solitary confinement reveals the inadequacy of treatment-oriented programs for mentally ill prisoners. The Correctional Association found that the state-prison inpatient psychiatric program has enough beds for only about a tenth of the mentally ill inmate population.
Meanwhile, the few prisons that offer special treatment services inside their solitary confinement units can accommodate only a few dozen. The stateâ€™s reentry-planning program for the mentally ill, designed to reintegrate them into their communities, has roughly 30 beds. As an estimated 3,000 inmates with mental-health needs leave prison each year, advocates fear that many will end up returning.
Critics of solitary confinement view it as the tail end of a trajectory of failure throughout the mental-health system.
Critics of solitary confinement view it as the tail end of a trajectory of failure throughout the mental-health system, starting with the healthcare infrastructure of local communities.
Oscar Morgan, chief operating officer of the National Mental Health Association, said that while restricting the use of solitary confinement might alleviate immediate problems, ultimately, it speaks to the failure to keep people with mental illness out of prisons altogether. "[If] people can get the treatment they need in the community," he said, "people would not end up in the criminal-justice system to begin with."
Human Rights Watch (HRW) advocates diversion programs to place mentally ill offenders into treatment programs as an alternative to incarceration. Noting that inmates throughout the country lack access to even basic mental-health services, HRWâ€™s acting director of US programs, Alison Parker, said, "obviouslyâ€¦ prison is not the right place for someone who is seriously mentally ill."
Advocates say that the groups disproportionately impacted by the criminal-justice system, particularly poor people and people of color, also suffer the most from a glaring lack of mental-health resources.
Harvey Rosenthal, executive director of the mental-health advocacy group New York Association of Psychiatric Rehabilitation Services, said that despite efforts to expand treatment access, mental-health service providers have been largely unsuccessful in engaging communities of color. As the system fails to reach people of color, Rosenthal said, "disproportionatelyâ€¦ theyâ€™re the ones that are in the SHUs; theyâ€™re the ones that are predominantly in the prisons."
For now, critics of the prison mental-health system must contend with officials worried about inmates being treated too well. The governorâ€™s veto statement argued that prisons "cannot function without strong internal controls to regulate inmate behavior."
Though the solitary-confinement bill passed the New York Legislature with little opposition, Assembly Member David Koon told TNS he voted against the measure because he believed it would lead to "a lot more people pretending theyâ€™re mentally ill to get better treatment in prison."
But to survivors like Ortiz, concerns about possible "abuses" of the ban pale against the prison systemâ€™s own legacy of real physical and mental abuse.
"Weâ€™re having people coming into jail sick, and weâ€™re bringing them out sicker," said Ortiz. "If we have them in there, why canâ€™t we treat them, so at least they have some type of chance to live a productive life?"
By his own count, Ortiz bounced in and out of prison, the emergency room and homelessness about 28 times before finding his way, on his own, to a treatment program.
"When I started seeing a therapist," he said, "I stopped going to jail."
Now working as a mental-health advocate with the legal group Urban Justice Center, Ortiz is helping to lead the campaign to keep mentally ill prisoners out of solitary lockdown. In his view, a legislative ban would not eliminate the stateâ€™s prison mental-health crisis, but it could at least make it harder to ignore. "Take the Shoe away: now what do we do with them?" he said. "Now we have to have a plan, now we have to start doing something, you see. Before, we used to hide them in solitary confinement."