Broken Behind Bars: Mental Health in Local Prisons

The Number of Inmates Suffering From Mental Illness is Exploding. Local Prisons and Jails are Woefully Unequipped.



Illustration by Matt Haddaway

In April 2015 24-year-old Jamycheal Mitchell was arrested for stealing a Mountain Dew, Zebra Cake and Snickers bar from a Portsmouth 7-Eleven. Though the junk food was worth just $5, he was denied bond and detained for 101 days while awaiting trial. That Aug. 19, he was found dead in his cell at the Hampton Roads Regional Jail.

The scene was grotesque. Feces were smeared across the walls, urine puddled in the floor. Mitchell, who was a healthy 182 pounds when arrested, had lost more than 44 pounds. For the past three months he’d been starving himself.

“According to family members, he’d suffered from schizophrenia and bipolar disorder throughout his life,” says Dahlia Lithwick, a senior editor at Slate who specializes in courts and law, and covered Mitchell’s death. Though a judge had twice ordered Mitchell to be moved to a state mental health hospital, there were not enough beds, and he remained in the HRRJ. “That a mentally ill man could starve to death in a jail when he should have been in a mental health facility for treatment is unimaginable,” continues Lithwick. “Except of course it happened.”

But that’s not the worst of it. When Mitchell’s family filed a $60 million federal lawsuit against the institution, its 112 pages read like notes for a Stephen King novel. The scope of abuse was horrific.

It claimed Mitchell was “dragged naked out of his cell and put on display like a circus animal.” Inmates said guards withheld meals for days at a time or placed them out of reach as punishment and that correctional officers sometimes turned off the water in Mitchell’s cell. Additionally, they reported frequent beatings, abuse and hearing Mitchell crying. He was routinely allowed to smear feces on cell walls without cleanup. And that’s on top of medical and clerical errors that resulted in lost paperwork, unfulfilled requests for emergency treatment and neglected transfers.

Though the lawsuit has yet to be decided, the severity of the allegations led to an ongoing investigation by the U.S. Justice Department into the HRRJ’s potential violations of prisoners’ rights. 

But Lithwick says the outcomes matter less than the problems that created the situation in the first place. Namely, that Virginia’s jails and prisons now hold more than 10 times as many people suffering from severe mental illness than state psychiatric hospitals.   

“Whether or not the abuses are ultimately proven, the reality is this: A severely ill young man wasted away, smeared in his own feces, under the watchful eyes of multiple healthcare workers, corrections staff and other inmates,” she says. The real tragedy is that, but for his death, Mitchell’s situation and the treatment he endured is far from uncommon. “Sadly, we know about [him] not because he was mentally ill, or poor, or lost in the paper bureaucracy of our prison system like so many others. We know about him simply because he is dead.”

According to a 2018 report by the Virginia chapter of the American Civil Liberties Union, more than 17 percent of the Commonwealth’s 120,000-person prison population suffers from some form of mental illness. In 2015, the demographic accounted for 27 percent of the HRRJ’s population and 28 percent of the Chesapeake City Jail, respectively.

And the numbers could be much higher than that. “Screening in jails is often conducted by employees who are not mental health professionals, which could lead to undercounting or other errors,” the report warns. In her 2018 book, America’s Criminal Treatment of Mental Illness, former Marketplace reporter Alisa Roth says the figure is more like 50 percent.  

What does all this mean? People who would be better served by alternative treatments are being imprisoned at an alarming rate. And what’s worse: They’re getting stuck there.

“For years sheriffs, mental health advocates, families and prosecutors have sounded the alarm about the number of people with mental illness arrested and locked up, many for minor crimes,” writes Virginian-Pilot investigative journalist Gary A. Harki. According to a 2015 Virginia House of Delegates report, about 49 percent are arrested for trivial, nonviolent offenses like trespassing or disorderly conduct and another 22 percent for drug offenses. Compared to healthy counterparts charged with the same crime, on average they are detained about twice as long. “Yet jails are the default treatment center for many with mental illness in America,” Harki continues. “And they are woefully ill-equipped for the job.”

A recipient of Marquette University’s prestigious O’Brien Fellowship in Public Service Journalism, Harki has been investigating the subject of mental health in American prisons since 2017. Interviewing law enforcement officers throughout the nation, he reports they repeatedly made statements like this one, expressed by former Norfolk Sheriff Bob McCabe, in 2016: “The mentally ill often end up in jail over low-level offenses simply because there is nowhere else for them to go. … What we do is try to manage it the best way we can. It’s really a challenge every day for jails. You don’t want to house people in … isolation, but when you have someone that’s a danger to themselves or others, sometimes you have to put them in a segregated area.”

Take Mitchell’s case as an example. According to Harki, he had been repeatedly warned to stay away from the 7-Eleven where he was apprehended—to the point of being threatened with trespassing charges. However, gripped by a mental compulsion likely brought about by disease, Mitchell continued to return, and even stole candy in plain sight. When apprehended, he responded in a manner that led a forensic psychologist to describe his behavior as “manic and psychotic.” To protect other prisoners, he was isolated in a cell. Though a judge deemed Mitchell mentally unfit to stand trial—and he was refusing to take medication—he was held alone in that cell for months awaiting transfer to a mental health facility.

In response to the accusations of mismanagement and abuse, in August 2017, state and jail officials held a “Lessons Learned and Best Practices” training seminar on jail deaths.

According to Training Host and Executive Director of the Hampton Roads Criminal Justice Academy Vince Ferrara, the seminar was meant “to thoroughly discuss recent legislative and state developments requiring additional oversight of jail death investigations (a best practice); the role of jail administration, internal affairs, local police, the Department of Justice and the Virginia State Police, relevant National Commission on Correctional Health Care standards and NCCHC Mental Health care standards; and the need to be transparent and open with the public.” The point, continued Ferrara, was to discuss applicable standards. “We are committed to improving in this area to help prevent deaths, to ensure thoroughness and to build public trust.” 

Harki reports Mitchell’s resultant deterioration is more norm than anomaly. A 2018 report on solitary confinement practices in Virginia published by the VACLU confirms the assertion.

“For prisoners with pre-existing mental illness, solitary confinement often causes significant and rapid deterioration,” states the report. “Numerous studies confirm that prolonged isolation deprives prisoners of the basic human needs to function, with effects that become noticeable after as little as 10 days … Prisoners in solitary confinement, diagnosed with a range of disorders such as bipolar disorder, post-traumatic stress disorder as a result of abuse, manic depression, schizophrenia, report that mental health treatment consists solely of the administration of psychotropic drugs and that it is difficult to see a psychiatrist or any other qualified mental health professional.”

Though the practice is harmful—and has been correlated to much higher rates of suicide—the Virginia Department of Corrections has no policy excluding mentally ill patients from conditions qualifying as solitary confinement.

Again, the oversights point to a larger discrepancy.

Roth quotes corrections official Alejandro Fernandez in her book: “We’re not psychiatrists. As deputies, we know how to arrest people. We know how to put people in jail. We don’t know how to take care of people with mental illness.”

When Mitchell’s case was followed by additional tragedies at the HRRJ, a Richmond Times-Dispatch exposé revealed the facility was “the deadliest jail in Virginia for inmates.” The media attention left lawmakers scrambling to affect reform. Appointed the leader of a 12-person joint subcommittee to study Mental Health Services in the Twenty-First Century, State Senator Creigh Deeds is leading the push. 

“As a mental health reformer, I’ve told people for a long time it’s like eating an elephant,” Deeds told the U.S. News & World Report last May. “You take a bite and you feel full, but then you look at the work ahead of you and you realize that you haven’t really done much.”

The crux of the problem, he says, is funding.  

“The undertreatment [in jails and prisons] is exacerbated by budgetary constraints and cuts,” reports the VACLU. “To add one qualified mental health professional and mental health unit per prison would cost $1,519,000 annually for salaries, not including other costs such as additional staffing, part-time consultants and stipends.”

Meanwhile, a national poll ranks Virginia 42nd in the U.S. at providing citizens with access to mental health treatment. And beds in state psychiatric units have declined to around 1,500.

“To put that statistic into perspective, Eastern State Hospital, with 300 beds, is the largest remaining state psychiatric hospital in Virginia,” says Matt Farrauto, a spokesperson for the Treatment Advocacy Center (TAC) in Arlington. “The Greensville Correctional Center in Jarratt, the largest state prison, holds about 3,000 inmates. If 15 percent (451) of them have a serious mental illness, then the prison is de facto the largest ‘mental institution’ in the state.”

Both Deeds and the VACLU agree that investing in more robust mental health facilities and programs that keep nonviolent offenders suffering from mental illness out of jail is the quickest and most cost-efficient fix.

“Mentally ill inmates cost more than other prisoners for a variety of reasons, including increased staffing needs,” says Farrauto. According to a TAC report on prisons in Texas, the average prisoner costs the state about $22,000 a year, while those with mental illness ranged from $30,000 to $50,000 a year. Psychiatric medications are a significant part of the increased costs. Lawsuits like the $625,000 settlement paid by the HRRJ and its medical provider to the family of Henry Clay Stewart last July add to the expense as well. (Stewart died of a perforated stomach ulcer in August 2016 after filing grievances for a lack of medical treatment just two days before.)

“But if you have a real diversion program, you reduce the number of people with serious mental illness that are in our jails and prisons,” explained Deeds. “You’ve got to make sure that the jails and prisons—and the jails in particular—have a real connection with mental health.”

The VACLU points to the example of Florida Judge Steve Leifman, who oversees a jail diversion program with a straightforward goal: To steer nonviolent arrestees with mental illnesses away from criminal court and into treatment programs.

“Most opt for treatment and are connected with housing and other services,” writes Sam Dolnick in The New York Times. “Recidivism is low, patients get the support they need, and the prison system saves significant funds.” In just 10 years, Leifman has funneled more than 4,000 people away from the criminal justice system.

“The eyes are open,” former HRRJ Superintendent Ronaldo Myers told Harki following his resignation earlier this year. “Now, there are some dollars that need to be put behind everything to keep the system moving. Because if the system gets stagnant, guess what we’re going to do? We're going to fall back on the same old thing soon as everything quiets down."

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