S. HRG. 111–975 

HUMAN RIGHTS AT HOME: MENTAL ILLNESS IN 

U.S. PRISONS AND JAILS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HUMAN RIGHTS AND THE LAW 

OF THE

COMMITTEE ON THE JUDICIARY 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 15, 2009 

Serial No. J–111–45 

Printed for the use of the Committee on the Judiciary 

( 

HUMAN RIGHTS AT HOME: MENTAL ILLNESS IN U.S. PRISONS AND 

JAILS 

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WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

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66–207 PDF 2011

S. HRG. 111–975 

HUMAN RIGHTS AT HOME: MENTAL ILLNESS IN 

U.S. PRISONS AND JAILS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HUMAN RIGHTS AND THE LAW 

OF THE

COMMITTEE ON THE JUDICIARY 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

SEPTEMBER 15, 2009 

Serial No. J–111–45 

Printed for the use of the Committee on the Judiciary 

( 

(II) 

COMMITTEE ON THE JUDICIARY 

PATRICK J. LEAHY, Vermont, Chairman 

HERB KOHL, Wisconsin 

DIANNE FEINSTEIN, California 

RUSSELL D. FEINGOLD, Wisconsin 

CHARLES E. SCHUMER, New York 

RICHARD J. DURBIN, Illinois 

BENJAMIN L. CARDIN, Maryland 

SHELDON WHITEHOUSE, Rhode Island 

AMY KLOBUCHAR, Minnesota 

EDWARD E. KAUFMAN, Delaware 

ARLEN SPECTER, Pennsylvania 

AL FRANKEN, Minnesota 

JEFF SESSIONS, Alabama 

ORRIN G. HATCH, Utah 

CHARLES E. GRASSLEY, Iowa 

JON KYL, Arizona 

LINDSEY GRAHAM, South Carolina 

JOHN CORNYN, Texas 

TOM COBURN, Oklahoma 

BRUCE A. COHEN, Chief Counsel and Staff Director 

MATTHEW S. MINER, Republican Chief Counsel 

SUBCOMMITTEE ON HUMAN RIGHTS AND THE LAW

RICHARD J. DURBIN, Illinois, Chairman 

RICHARD J. DURBIN, Illinois 

RUSSELL D. FEINGOLD, Wisconsin 

BENJAMIN L. CARDIN, Maryland 

EDWARD E. KAUFMAN, Delaware 

ARLEN SPECTER, Pennsylvania 

TOM COBURN, Oklahoma 

LINDSEY GRAHAM, South Carolina 

JOHN CORNYN, Texas 

JOSEPH ZOGBY, Chief Counsel 

BROOKE BACAK, Republican Chief Counsel 

(III) 

C O N T E N T S 

STATEMENTS OF COMMITTEE MEMBERS 

Page 

Coburn, Hon. Tom, a U.S. Senator from the State of Oklahoma ........................ 3 

prepared statement .......................................................................................... 140 

Durbin, Hon. Richard J., a U.S. Senator from the State of Illinois .................... 1 

prepared statement .......................................................................................... 142 

Feingold, Hon. Russell D., a U.S. Senator from the State of Wisconsin, prepared statement ................................................................................................... 185 

Franken, Hon. Al, a U.S. Senator from the State of Minnesota .......................... 5 

prepared statement .......................................................................................... 187 

WITNESSES 

Bagenstos, Samuel, Deputy Assistant Attorney General, Civil Rights Division, 

U.S. Department of Justice, Washington, DC ................................................... 8 

Fuller, David L., Outreach and Housing Coordinator, Manhattan Outreach 

Consortium, Brooklyn, New York ....................................................................... 31 

Lappin, Harley G., Director, Federal Bureau of Prisons, Washington, DC ........ 5 

Leary, Mary Lou, Deputy Assistant Attorney General, Office of Justice Programs, U.S. Department of Justice, Washington, DC ....................................... 10 

Maynard, Gary D., Secretary, Maryland Department of Public Safety and 

Correctional Services, Towson, Maryland .......................................................... 25 

Randle, Michael P., Director, Illinois Department of Corrections, Springfield, 

Illinois ................................................................................................................... 27 

Zenoff, Kathryn E., Presiding Justice, Illinois Appellate Court, Second District, Rockford, Illinois ......................................................................................... 29 

QUESTIONS AND ANSWERS 

Responses of Samuel Bagenstos to questions submitted by Senator Coburn ..... 44 

Responses of Harley Lappin to questions submitted by Senator Coburn ........... 46 

Responses of Mary Lou Leary to questions submitted by Senator Coburn ........ 54 

Responses of Gary D. Maynard to questions submitted by Senator Coburn ...... 58 

Responses of Michael P. Randle to questions submitted by Senator Coburn ..... 61 

Responses of Kathryn E. Zenoff to questions submitted by Senator Coburn ..... 63 

Questions submitted by Senator Coburn to David Fuller (Note: Responses 

to questions were not received as of the time of printing, May 10, 2011) 

SUBMISSIONS FOR THE RECORD 

American Civil Liberties Union, Michael W. Macleod-Ball, Acting Director, 

Joanne Lin, Legislative Counsel, Washington, DC, statement ........................ 68 

American Psychological Association, Washington, DC, statement ...................... 79 

Amnesty International, New York, New York, statement ................................... 84 

Bagenstos, Samuel, Deputy Assistant Attorney General, Civil Rights Division, 

U.S. Department of Justice, Washington, D.C., statement .............................. 87 

Burr, Richard, Attorney, Houston, Texas, prepared statement ........................... 93 

Byrne/JAG Appropriations, grant .......................................................................... 98 

Campaign for Youth & Justice, Liz Ryan, President and Chief Executive 

Office, Washington, DC, statement .................................................................... 100 

Council of State Governments, Justice Center, Fred C. Osher, Director of 

Health Systems and Services Policy, New York, New York, statement .......... 128 

Department of Justice, Office of Justice Program, Washington, DC.: 

Bureau of Justice Statistics, Special Report .................................................. 145 

Bureau of Justice Statistics, Bulletin ............................................................. 157 

Page

IV 

Federal Grant Programs Available for Treatment of Mentally Ill Offenders ..... 183 

Fuller, David L., Outreach and Housing Coordinator, Manhattan Outreach 

Consortium, Brooklyn, New York, statement .................................................... 193 

Griffin, Gene, J.D., Mental Health Services and Policy Program, Northwestern University Feinberg School of Medicine, Chicago, Illinois, statement ...................................................................................................................... 206 

Heartland Alliance’s National Immigrant Justice Center, Chicago, Illinois, 

statement .............................................................................................................. 208 

Human Rights Watch, New York, New York, statement ..................................... 214 

Lappin, Harley G., Director, Federal Bureau of Prisons, Washington, DC., 

statement .............................................................................................................. 228 

Leadership Conference on Civil Rights, Wade Henderson, President & Chief 

Executive Office, Washington, DC, statement ................................................... 236 

Leary, Mary Lou, Deputy Assistant Attorney General, Office of Justice Programs, U.S. Department of Justice, Washington, DC., statement ................... 241 

Maynard, Gary D., Secretary, Maryland Department of Public Safety and 

Correctional Services, Towson, Maryland, statement ....................................... 329 

Mental Health America, Alexandria, Virginia, statement ................................... 334 

National Council for Community Behavioral Healthcare, Linda Rosenberg, 

President & CEO, Washington, DC, statement ................................................. 339 

National Council on Disability, John R. Vaughn, Chairperson, Washington, 

DC, letter and attachment .................................................................................. 344 

National Disability Rights Network, Protection & Advocacy for Individuals 

with Disabilities, Washington, DC, statement .................................................. 349 

New Yorker.com, Atul Gawande, March 30, 2009, article ................................... 357 

Randle, Michael P., Director, Illinois Department of Corrections, Springfield, 

Illinois, statement ................................................................................................ 368 

Rebecca Project for Human Rights, Malika Saada Saar, Executive Director, 

Kathleen Shakire Washington, Policy Director, Washington, DC, joint statement ...................................................................................................................... 372 

Rights Working Group, Washington, DC, statement ............................................ 382 

Rohr, Gretchen, Director, DC Jail Advocacy Project, University Legal Services, Washington, DC, statement ........................................................................ 383 

SAVE Coalition, statement ..................................................................................... 401 

VERA Institute of Justice, Alex Busansky, Director, Washington, DC, statement ...................................................................................................................... 403 

Witness Justice, Helga Luest, President & CEO, Frederick, Maryland, statement ...................................................................................................................... 405 

Zenoff, Kathryn E., Presiding Justice, Illinois Appellate Court, Second District, Rockford, Illinois, statement ...................................................................... 437 

(1) 

HUMAN RIGHTS AT HOME: MENTAL ILLNESS 

IN U.S. PRISONS AND JAILS 

TUESDAY, SEPTEMBER 15, 2009 

U.S. SENATE, SUBCOMMITTEE ON HUMAN RIGHTS AND THE LAW, Committee on the Judiciary, 

WASHINGTON, DC. 

The Subcommittee met, pursuant to notice, at 9:58 a.m., in room 

SD–226, Dirksen Senate Office Building, Hon. Richard J. Durbin, 

Chairman of the Subcommittee, presiding. 

Present: Senators Durbin, Franken, and Coburn. 

OPENING STATEMENT OF HON. RICHARD J. DURBIN, A U.S. 

SENATOR FROM THE STATE OF ILLINOIS 

Chairman DURBIN. This hearing of the Human Rights and the 

Law Subcommittee will come to order. The subject at today’s hearing is ‘‘Human Rights at Home: Mental Illness in U.S. Prisons and 

Jails.’’ 

At the outset, I want to thank Judiciary Committee Chairman 

Pat Leahy for reestablishing this Subcommittee. This is another 

measure of his commitment to human rights. I also want to thank 

Jeff Sessions, the Committee’s Ranking Member, for his support of 

the re-creation of this Subcommittee. 

I want to express personal appreciation to my colleague Senator 

Tom Coburn, who not only is serving again as Ranking Member of 

this Subcommittee, but spoke up and said, ‘‘Why would you not 

have this Subcommittee? ’’ That is a nice thing to hear from your 

colleague, and I think we proved in the first 2 years of our existence as a team on this Subcommittee that we could accomplish 

some good things. 

In the 110th Congress, this Subcommittee focused and reflected 

on issues like genocide in Darfur, Internet censorship in China, 

and rape as a weapon of war in the Democratic Republic of Congo. 

But, in all honesty, we must also reflect on ourselves. 

Today in the United States, more than 2.3 million people are imprisoned. This is, by far, the most prisoners of any country in the 

world and, by far, the highest per capita rate of prisoners in the 

world. African Americans are incarcerated at nearly six times the 

rate of white citizens. And many of these prisoners are non-violent 

drug offenders and individuals with serious and persistent mental 

illness. 

Now, Senator Jim Webb of Virginia has introduced legislation 

creating a commission to examine our criminal justice system and 

make recommendations for reform. This comprehensive review is 

2 

really needed. But there are critical reforms needed right now and 

we should not wait to address them. 

Earlier this year, Senator Lindsey Graham of South Carolina 

and I held a hearing on the sentencing disparity between crack and 

powder cocaine, which leads to excessive prison sentences for many 

non-violent drug offenders. We are working with all the members 

of the Committee to try to come up with legislation to address this 

problem. 

Today, we are going to address another aspect of the criminal 

justice system that raises important human rights issues: the 

treatment of mental illness in U.S. prisons and jails. 

My late friend and mentor, former Senator Paul Simon, brought 

this issue to my attention many years ago. The problem has only 

grown worse since then. 

In 2006, the Bureau of Justice Statistics found that more than 

half of all prison and jail inmates, including 45 percent of Federal 

prisoners, 56 percent of State prisoners, and 64 percent of local jail 

inmates suffer from a mental health problem. 

In fact, the three largest mental health facilities in the United 

States of America are the Los Angeles County Jail, Rikers Island 

Jail, and the Cook County Jail. 

Women and children are especially vulnerable. The Bureau of 

Justice Statistics found that 61 percent of females in Federal prisons have mental health problems, compared to 44 percent of males. 

In a recent survey, two-thirds of boys and three-fourths of girls 

detained in juvenile facilities in Cook County, Illinois, have at least 

one mental illness. Juvenile offenders with serious mental illnesses 

are more likely to be abused by other juvenile offenders and have 

their incarceration extended because of conduct related to their 

mental illness. 

By allowing our prisons and jails to become one of our Nation’s 

primary providers of mental health services, we have taken a step 

backward in time. Two hundred years ago, people with mental illness were incarcerated in jails and prisons. By the beginning of the 

20th century, we transitioned from that model to State mental institutions and hospitals. Growing public revulsion about conditions 

in mental hospitals led to a movement for deinstitutionalization 

around 40 or 50 years ago. Community mental health services were 

supposed to step in to replace State mental hospitals, but that did 

not happen. It is stunning to read that 8 years ago the GAO found 

that 9,000 children were surrendered by their families to the juvenile justice system so that they could receive basic mental health 

services. 

As a result of all this, many people with mental illness cycle in 

and out of correctional institutions, presenting a danger to themselves, correctional officers, and the public. We have returned to 

the loathsome, indefensible practice of incarcerating the mentally 

ill. While in prison, many mentally ill prisoners have limited or no 

access to mental health services, and their conditions frequently 

deteriorate. They often have difficulty complying with prison rules 

and, as a result, are disproportionately represented in solitary confinement, which only makes their mental illness worse. 

I am deeply troubled by reports about conditions for persons with 

mental illness at Tamms Correctional Center, a super-maximum 

3 

security facility in my own home State of Illinois. Governor Pat 

Quinn recently ordered a review of Tamms, and I look forward to 

discussing this issue with one of our witnesses, Michael Randle, 

who heads the Illinois Department of Corrections. 

I want to salute Gary Marx of the Chicago Tribune and especially George Pawlaczyk and Beth Hundsdorfer of the Belleville 

News-Democrat for their provocative and thorough articles on the 

Tamms Correctional Center. 

I look forward to hearing from our witnesses about the best practices for dealing with people with mental illness in the criminal 

justice system, including mental health courts to divert appropriate 

individuals into treatment and a continuum of care for individuals 

from entry screening to discharge planning. 

Our country was founded on the principle that all people are created equal and endowed with certain inalienable rights. This was, 

and still is, the promise of America. For generations, this singular 

idea has inspired freedom fighters, toppled ruthless dictators, and 

given hope to the disempowered and disenfranchised around the 

world. We must keep faith with our Founders by working to keep 

America’s promises not only abroad but at home. 

That is true even for, in fact especially for, the least among us— 

whether it is a crack addict serving a mandatory minimum sentence or a person with mental illness who cycles endlessly through 

shelters, hospitals, jails, and prisons. This is the right thing for us 

to do, but it is also the smart thing to do because it will keep police 

and corrections officers and the public safer and dramatically reduce costs for incarceration at a time of fiscal crisis. 

Senator Coburn. 

STATEMENT OF HON. TOM COBURN, A U.S. SENATOR FROM 

THE STATE OF OKLAHOMA 

Senator COBURN. Well, thank you, Senator Durbin, and I thank 

our witnesses for being here. I do apologize to you in advance. I am 

conflicted with two other ongoing committees at the same time, and 

so I will be leaving in a short period of time. 

As a practicing physician, I have seen over the last 25 years a 

significant increase in how the stressors in our country and in our 

lives have impacted mental health, and there is no question the 

greatest factor, I believe, happens to be addiction to drugs and 

what that does to us. And the Chairman and I both have a desire 

at some point in time to see a different system of incarceration for 

those that are addicted. We think we can do it more economically. 

We know we can do it more successfully, and we know that good 

drug treatment programs make big differences in people’s lives to 

the tune of about 60 to 70 percent of them never walk that path 

again. 

In terms of our hearing today, the key is recognition and prevention. If we have some incarcerated that we have not recognized a 

significant illness, we are asking for problems for us as well as for 

them. And so intake screening and thorough evaluation is a must. 

We understand that. Treatment also is a must, especially in some 

of our more significant psychoses and tougher illnesses. 

The point that Senator Durbin made—I almost called you ‘‘doctor,’’ ‘‘Dr. Durbin.’’ The point that Senator Durbin makes about deVerDate Nov 24 2008 09:01 May 26, 2011 Jkt 066207 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 S:\GPO\HEARINGS\66207.TXT SJUD1 PsN: CMORC
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veloping mental illness in prison, it is easy to see. Depression, psychotic depression, which oftentimes those who work in our system 

are not prepared to understand that a psychosis is ongoing that is 

not the individual’s normal behavior, but it is a result of psychotic 

depression, which I could imagine very easily anyone could fall 

into. 

Where Senator Durbin and I differ is that, number one, I look 

for a constitutional role within the enumerated powers that we 

have the authority to fix it at the States. I am not sure we do, but 

the one thing I am in agreement with him on is we ought to model 

the absolute best practices at the Federal level, and that if we do 

that, lots can be learned from that, and that example can be utilized. 

Oklahoma is high in its incarceration rate. We have a pretty 

tough justice system, and this is a problem that we experience as 

well. 

The answer is not just more money. The answer is a great plan 

and set an example and let us see if we cannot markedly improve. 

The final point I would make—and I appreciated the testimony 

from Mr. Maynard in terms of his three suggestions, which I 

thought were very cogent in terms of the things that we need to 

do: 

Ensure a specific methodology at intake so that we know what 

we have got, know what we are doing, and make sure it is thorough. 

Second, technology improvement to identification ongoing while 

at intake; and cross-checking data bases with past history. You 

know, one of the biggest problems is we do not get thorough past 

medical histories. 

I will take just a little bit of liberty. I have a gentleman that is 

incarcerated today that had true manic-depressive disease, and all 

of his convictions are on the basis of when he was in a manic state, 

uncontrolled, undiagnosed, and he is now serving the minimum 

mandatory 15-year sentence simply because we failed. We failed to 

diagnose him. We failed to treat him, both inpatient and outpatient, in incarceration as well as outpatient. And so now he finds 

himself in a long-term situation, and he is a model prisoner because he is being controlled. His medicines are being given. He no 

longer has the disease. So it is a real problem, and we do not deny 

that. Then, finally, appropriate staffing levels in terms of mental 

health professionals and counseling that would go along with that. 

So I am very pleased we are having—I think it is a human right 

to have your health care diagnosed when we are going to incarcerate you, and I think we ought to set that example at the Federal 

Government, and I look forward to the witnesses’ testimony. I 

thank you all for being here. 

Chairman DURBIN. Thank you, Senator Coburn. 

Without objection, a statement by Senator Feingold will be entered in the record. 

[The prepared statement of Senator Feingold appears as a submission for the record.] 

Chairman DURBIN. I yield to Senator Franken, if you would like 

to make an opening comment or statement. 

5 

STATEMENT OF HON. AL FRANKEN, A U.S. SENATOR FROM 

THE STATE OF MINNESOTA 

Senator FRANKEN. Thank you, Mr. Chairman. I would like to 

make just a short statement and submit a fuller statement for the 

record, if that is okay. 

Mr. Chairman, Senator/Dr. Coburn, I appreciate the opportunity 

to participate in this hearing which touches on two issues that are 

of utmost importance to me: caring for those with mental illness 

and working to reform our country’s deeply flawed prison system. 

The sheer volume of people that we imprison in this country is a 

crime in itself, and as a society, we are most guilty of failing the 

thousands of young people who, instead of receiving education, support, and treatment, are growing into adulthood behind bars, a fate 

which virtually dooms these children from ever becoming productive citizens. 

I was very happy to hear Senator Coburn’s remarks on treatment 

and am very encouraged by that, and I am in complete agreement 

with him. So I would like to hear from the witnesses, and thank 

you, Mr. Chairman and Senator Coburn. 

Chairman DURBIN. Thank you, Senator Franken, and your opening statement will be admitted into the record at this point, without objection, and Senator Coburn’s as well. 

[The prepared statement of Senator Franken appears as a submission for the record. 

[The prepared statement of Senator Coburn appears as a submission for the record.] 

Chairman DURBIN. Now we turn to the first panel of witnesses 

for opening statements. They will each have 5 minutes. Their entire written testimony will be part of the record. I am going to ask 

them to stand, and as is the custom of the Committee, we swear 

in our witnesses. 

Would you please raise your right hand? Do you affirm that the 

testimony you are about to give before the Committee is the truth, 

the whole truth, and nothing but the truth, so help you God? 

Mr. LAPPIN. I do. 

Mr. BAGENSTOS. I do. 

Ms. LEARY. I do. 

Chairman DURBIN. Let the record indicate that all three have answered in the affirmative and, therefore, may proceed. 

Our first witness is Harley Lappin, the Director of the Federal 

Bureau of Prisons. He has served at BOP for 24 years, and has 

been the Director since 2003. Mr. Lappin is responsible for the Bureau’s 114 institutions and the safety and security of over 208,000 

Federal inmates. He holds a B.A. in forensic studies from Indiana 

University in Bloomington and an M.A. in criminal justice and correctional administration from Kent State University. 

Thanks for joining us today and please proceed. 

STATEMENT OF HARLEY G. LAPPIN, DIRECTOR, FEDERAL 

BUREAU OF PRISONS, WASHINGTON, D.C. 

Mr. LAPPIN. Good morning, Chairman Durbin, Ranking Member 

Coburn, and members of the Subcommittee. I am pleased to appear 

before you today to testify on the very important topic of mental 

illness in correctional facilities. Inmates with mental health probVerDate Nov 24 2008 09:01 May 26, 2011 Jkt 066207 PO 00000 Frm 00011 Fmt 6633 Sfmt 6633 S:\GPO\HEARINGS\66207.TXT SJUD1 PsN: CMORC
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lems present a host of challenges. I am well aware that the challenges we face in the Bureau of Prisons are not unique to the Federal prison system. State and local corrections systems have similar 

issues and often fewer resources at their disposal. I am committed 

to ensuring the Bureau of the Prisons does all it can to attend to 

this vulnerable population, but I know there are cases where individuals leave prisons with their mental illnesses untreated. We 

must do more if we want to prevent further criminal behavior and 

victimization in our communities. 

Since early 2000, the National Institute of Corrections has provided support to State and local corrections in the area of mental 

health, including holding public hearings, sponsoring Web-based forums, and providing technical assistance both directly and through 

a third party. We estimate that 19 percent of the inmates admitted 

to the Bureau of Prisons suffer from some mental illness. As in the 

community, the vast majority of these inmates are treated on an 

outpatient basis at the institution by Psychology Services staff 

working in collaboration with other staff, including therapists, 

counselors, social workers, and either a full-time or consultant psychiatrist, as indicated. Our staff also conduct an array of forensic 

evaluations for the courts. 

Group counseling is a very effective method for the delivery of 

mental health services to inmates in the Bureau of Prisons. Individual counseling is also provided at every institution to inmates 

with a need for more intensive services. 

Inpatient psychiatric services are provided for chronic and acutely mentally ill cases, as well as for court-ordered placements. These 

services are provided at the Bureau of Prisons medical referral centers, each of which is accredited by the Joint Commission on Accreditation of Health Care organizations. The chronically mentally 

ill remain at the centers for the duration of their sentence, but 

acute cases are treated, stabilized, and then returned to our mainstream institutions. 

All inmates coming in to the Federal prison system are screened 

for mental illnesses, and subsequent screenings are done during reviews of inmates in special housing units, as indicated. Treatment 

plans are developed for inmates found to be in need of treatment, 

and when necessary, inmates are transferred to different institutions. 

We offer a variety of residential or intensive treatment programs 

for mentally ill inmates of both genders at all security levels. My 

written statement describes these programs in some detail. 

We also operate a dual diagnosis residential drug abuse treatment program for inmates suffering from both a substance abuse 

disorder and a serious mental illness, and we offer this program to 

both male and female offenders. 

The Bureau of Prisons currently has more than 450 full-time 

psychology treatment staff, the majority of whom are psychologists, 

with some psychology technicians and treatment specialists. This 

figure does not include the drug treatment staff. 

We also have 30 full-time psychiatrists within the system. These 

psychiatrists are able to treat inmates at all of our institutions 

through the use of video technology, which is much less costly than 

relying on contract psychiatrist and also ensures continuity of care. 

7 

Many individuals who suffer from mental illnesses are at the 

risk of committing suicide. All Bureau of Prisons staff are trained 

to recognize signs indicative of potential suicide, to prevent suicides, and to understand and make appropriate use of the referral 

process. The Bureau of Prisons uses well-trained staff, skilled clinicians, frequent referrals, prevention techniques, and extended follow-up services to manage the suicide risk by Federal inmates. 

While any suicide is tragic, over the past 10 years, the Bureau’s 

suicide rate has been less than the rate for the general U.S. population. 

The Bureau of Prisons works hard to ensure the smooth transition of mentally ill inmates from prison to the community through 

the close communication with other authorities—the United States 

Probation Services, the Court Services and Offender Supervision 

Agency, as well as treatment providers in the community, through 

our network of residential reentry centers. 

The majority of the inmates transition through residential reentry centers—also known as community corrections centers or 

halfway houses—to help them to adjust to life in the community, 

to acquire post-release employment, and in many cases find suitable housing. The BOP’s Transitional Services staff coordinate and 

oversee treatment of inmates housed in residential reentry centers. 

Thank you for holding this hearing and bringing attention to this 

important topic. The mentally ill in prison are a unique population 

that poses real challenges for our agency. We are doing a lot, particularly given the budget restrictions we have experienced. But 

more can be done, particularly through collaborating with our partners around the country, State, local, and other Federal law enforcement agencies, mental health agencies, and community organizations. I think it is critically important, as Senator Coburn mentioned, that we work together to identify the presence of mental illness in offenders as early as possible in the criminal justice system, 

such as at arrest, and that there be a mechanism in place for that 

information to be passed on to those who will incarcerate that person or hold that person in the future. This will often avert harm 

to the offender and to others. 

We should provide the resources to meet the needs of mentally 

ill offenders during incarceration and support them upon release as 

they face the challenges of reentering communities. 

Finally, we should encourage jails, prisons, lock-ups, community 

corrections centers to seek accreditation from outside entities, 

thereby establishing a set of standards and expectations for staff 

to follow. 

Chairman Durbin, this concludes my formal statement. I am 

pleased to answer any questions at the appropriate time. Thank 

you. 

[The prepared statement of Mr. Lappin appears as a submission 

for the record.] 

Chairman DURBIN. Thank you, Mr. Lappin. 

Our next witness, Samuel Bagenstos, is Deputy Assistant Attorney General in the Civil Rights Division of the U.S. Department of 

Justice, an expert in disability law, taught at the University of 

Michigan Law School, the UCLA School of Law, Washington UniVerDate Nov 24 2008 09:01 May 26, 2011 Jkt 066207 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 S:\GPO\HEARINGS\66207.TXT SJUD1 PsN: CMORC
8 

versity School of Law, and Harvard. He has a B.A. from the University of North Carolina and a J.D. from Harvard Law School. 

Mr. Bagenstos, thank you for joining us, and the floor is yours. 

STATEMENT OF SAMUEL BAGENSTOS, DEPUTY ASSISTANT ATTORNEY GENERAL, CIVIL RIGHTS DIVISION, U.S. DEPARTMENT OF JUSTICE, WASHINGTON, D.C. 

Mr. BAGENSTOS. Thank you, Chairman Durbin and Ranking 

Member Coburn and members of the Committee. I am honored and 

pleased to be here today to testify about the enforcement of the 

Civil Rights of Institutionalized Persons Act and its application to 

protect the rights of individuals who have mental illness in prisons 

and jails. My name is Samuel Bagenstos, as the Chairman said, 

and as Deputy Assistant Attorney General for the Civil Rights Division, among my duties is supervising the Special Litigation Section, which has the responsibility for enforcing the CRIPA statute. 

In the nearly three decades since the enactment of the statute, 

the Division has investigated more than 430 facilities across the 

country and has been able to improve conditions for tens of thousands of individuals in those facilities. We currently has 24 ongoing 

CRIPA investigations involving jails and prisons, and we are enforcing compliance with consent decrees and other agreements covering 21 correctional facilities nationwide. And I should point out 

that those numbers do not include our investigations of juvenile 

justice facilities, of which we have 17 ongoing, about three-quarters 

of which raise issues of mental illness and treatment of people with 

mental illness. And those figures also don’t include our enforcement, which is a significant part of our duties, of the Supreme 

Court’s landmark Olmstead case, which we are applying to ensure 

that people with mental disabilities are served in appropriate settings in the community. 

Inadequate mental health care in the Nation’s jails and prisons, 

which is the subject of this hearing, poses a critical problem for inmate safety and can stand in the way of real rehabilitation for 

those who are incarcerated and do not have access to treatment. In 

our CRIPA enforcement, we have uncovered systematic deficiencies 

in mental health care in jails and prisons across the Nation, and 

we have aggressively pursued reforms to ensure that inmates are 

afforded their constitutional rights. 

I will just talk about a couple of examples, a couple of the key 

areas in my oral testimony, and maybe we can have questions 

about others. 

Probably the most urgent issue that we encounter in our investigations is the lack of adequate procedures for the detection of suicide risk and the lack of measures for suicide prevention. So in our 

investigations, we often find that jails and prisons process and 

house inmates without regard to their suicidal history or their 

mental health history. One example was a jail that failed to take 

precautions even when warned by a family that an inmate was suicidal, and the inmate committed suicide within hours of his arrest. 

We have found problems including the failure to remove features 

in jail cells that have proven conducive to suicide, like protuberances that people can hang themselves from and other situaVerDate Nov 24 2008 09:01 May 26, 2011 Jkt 066207 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 S:\GPO\HEARINGS\66207.TXT SJUD1 PsN: CMORC
9 

tions where individuals who are suicidal have not been adequately 

supervised. 

Another example of our enforcement, we detected in a facility 

where an inmate attempted to commit suicide by cutting himself 

had hoarded 30 razors in his cell. Yet 4 months later, another inmate committed suicide by cutting himself with a razor. In other 

facilities we have found a lack of adequate safety equipment, such 

as cut-down tools, to quickly respond to suicide attempts. Suicide 

is a major part of the problems we find in the treatment of people 

with mental illness in prison, as Director Lappin testified. 

We also frequently find that jail and prison staff use harmful 

methods of isolation, seclusion, or restraint as a substitute for mental health treatment, often in response to behaviors that inmates 

cannot control because of their mental disabilities. 

In one facility we investigated, because of a lack of staff detainees were regularly placed on suicide watch, which meant they were 

isolated for 23 hours a day, sometimes for days or weeks at a time. 

They did not receive adequate assessment or treatment. They 

sometimes waited days for an initial evaluation, initial psychiatric 

evaluation, and several times detainees placed in isolation injured 

themselves due to psychosis-related behavior. In one instance, an 

individual was slamming himself against the wall of his cell while 

wrapped in a blanket, which protected his body somewhat. Correctional staff removed the blanket. That was their response. 

We have also found that inmates with mental disabilities are 

subject to attack by other inmates, and jail and prison officials fail 

to provide proper protection. We have some examples of that in the 

written testimony. 

And we find generally that the deficiencies that we uncover stem 

from two basic problems: first of all, the failure to commit sufficient 

resources to provide adequate care to people who are put in prison 

and kept away from their own opportunity to get medical care; and, 

second, the failure to provide adequate training to jail and prison 

staff. 

We found one facility that had 217 detainees who received psychotropic medications, and yet there were only two part-time psychiatrists at that facility. 

In other instances, when we find that staff are not trained to 

deal with people with mental disabilities in the prisons, they respond by using force appropriately. We have examples of people 

who were beat up by prison guards for engaging in conduct that 

was a result of their mental illness. 

We have been successful in resolving the vast majority of the violations we discover through voluntary agreements, without contested litigation. We have some examples in the testimony of working cooperatively with, for example, the State of Wisconsin, with 

their only women’s correction facility where we found significant 

issues relating to the constitutional rights of inmates with mental 

illness, but we have worked cooperatively to lay out a set of specific 

remedies, a detailed action plan that the State of Wisconsin has followed and that has at this point been successful. That agreement, 

as with all of our agreements under CRIPA, is one that we closely 

monitor to ensure compliance. And we find that access to mental 

health care is a critical need in jails and prisons across the Nation, 

10 

so we are committed to ensuring inmates with mental illness receive adequate treatment in safe conditions. 

Thank you again for the opportunity to testify before this Committee, and I look forward to your questions. 

[The prepared statement of Mr. Bagenstos appears as a submission for the record.] 

Chairman DURBIN. Thank you very much. 

Our next witness, Mary Lou Leary, is the Deputy Assistant Attorney General for the Justice Department’s Office of Justice Programs. Previously, she served as the Executive Director of the National Center for Victims of Crime, Acting Assistant Attorney General of OJP, and U.S. Attorney for the District of Columbia. She 

has a bachelor’s degree from Syracuse University, a master’s degree in education from Ohio State University, and a law degree 

from Northeastern University School of Law. 

Ms. Leary, thank you for being here. Please proceed. 

STATEMENT OF MARY LOU LEARY, DEPUTY ASSISTANT ATTORNEY GENERAL, OFFICE OF JUSTICE PROGRAMS, U.S. DEPARTMENT OF JUSTICE, WASHINGTON, D.C. 

Ms. LEARY. Thank you very much, Mr. Chairman, Ranking Member Coburn, and Senator Franken. I am very happy to be here to 

discuss the Department of Justice’s efforts to improve the response 

of State and local criminal justice systems to people with mental 

illnesses. We are very pleased that the Subcommittee is interested 

in this issue. 

As you all are very well aware, many people entering the criminal justice system in this country have problems with mental illness. According to a report from the Council of State Governments 

that was funded in part by the Office of Justice Programs, 16.9 percent of the adults in a sample of local jails had mental illness, a 

serious mental illness. That is three to six times the rate for the 

general population. And also troubling is that while the rate was 

14 percent for men, it was 31 percent for women. If you applied 

these rates to the 13 million jail admissions in 2007, the study suggests that more than 2 million bookings of persons with serious 

mental illness take place every year. 

So to help address this issue, OJP’s Bureau of Justice Assistance 

administers a program called the Justice and Mental Health Collaboration Program, bringing together the mental health system 

and the criminal justice system to work collaboratively to address 

these needs. And the program helps State and local governments 

and tribes design and implement collaborative efforts between the 

criminal justice system and the mental health systems. The goal is 

to improve access to effective treatment for people with mental illness. That improves public safety, prevents recidivism, and provides effective treatment for those who need it. 

From fiscal year 2006 through 2008, BJA awarded 76 of these 

grants—that is a total of about $12 million—to 32 States, D.C., and 

Guam. Many of these programs support—many of the grants support programs for adults, but some also go to juveniles, and there 

are a number of grantees who are addressing both of those populations. 

11 

Also, projects have been targeted, through the Bureau of Justice 

Assistance, to the National Institute of Corrections, and Council of 

State Governments to jointly to provide training and technical assistance to communities across this country regardless of whether 

they have received funding. Training and technical assistance is 

really critical when we talk about replicating good practices. 

In just a very short period of time, we have already seen significant progress. We know that the majority of women inside prisons 

have mental health problems, and yet only a very few of them receive treatment while they are incarcerated. 

In New Jersey, their Department of Corrections received a grant 

in 2008 to provide trauma-informed care and reentry life skills to 

women in the New Jersey State prison. This program teaches basic 

life skills—health, nutrition, job applications, things of that nature—but they also take part in something called ‘‘Seeking Safety,’’ 

and that is a trauma-informed therapeutic program that gets at 

the roots of trauma and provides treatment and an outlet for 

women who are in this program. 

In Cass County, North Dakota, in 2005 only 191 detainees were 

even referred for a psychological assessment, and out of these, only 

92 of them actually got treatment because there just were not 

enough resources to provide that treatment. They received grant 

funding in 2008 to address these issues, and in just the first 5 

months of 2009, 550 detainees received an assessment; 373 of them 

were referred for treatment and services, and 10 of them were actually taken for hospitalization or inpatient evaluation. 

Encounters with law enforcement we know often play a very critical role in whether or not people with mental illness end up recycling in and out of the criminal justice system. In order to address 

this, there are many law enforcement departments that are 

partnering with mental health specialists around this country to 

make it easier from the get-go, from the first encounter with law 

enforcement, to refer the appropriate people for mental health services. These programs are often called ‘‘co-responder teams’’ or ‘‘crisis intervention teams,’’ and these kinds of models are eligible to 

receive funding under the program at BJA. 

Seven jurisdictions in the country have used BJA funds to start 

or enhance law enforcement response programs that link people 

with mental illness to treatment and services, and this is the best 

kind of diversion from the criminal justice system for people with 

these problems. 

BJA has also partnered with the Council of State Governments 

and the National Association of Counties on a number of publications to help other communities learn about best practices and how 

to implement these models. Those publications address things like 

law enforcement response, mental health courts, effective reentry 

practices for people with mental illness, and I have included copies 

of these publications with my testimony, so I hope you will have 

a chance to look at those. 

Please be assured that the Department of Justice will continue 

with its work and its commitment to addressing this issue. In fiscal 

year 2009, we will be awarding 43 grants, a total of nearly $8 million. These grants include projects in Illinois, Minnesota, Oklahoma, Pennsylvania, South Carolina, Texas, and Wisconsin. AddiVerDate Nov 24 2008 09:01 May 26, 2011 Jkt 066207 PO 00000 Frm 00017 Fmt 6633 Sfmt 6633 S:\GPO\HEARINGS\66207.TXT SJUD1 PsN: CMORC
12 

tional funding will support training and technical assistance efforts. Also, there are many grants under the Second Chance Prisoner Reentry Act that will specifically address mental illness and 

pre-release services and treatment as part of a comprehensive reentry effort. 

This concludes my statement, and I am really grateful for the opportunity to testify today. I will take any questions that you have. 

[The prepared statement of Ms. Leary appears as a submission 

for the record.] 

Chairman DURBIN. Thanks, Ms. Leary. 

Mr. Lappin, you testified that 19 percent of incoming offenders 

into the Federal correctional system in 2002 and 2003 suffered 

from mental illness. That translates to well over 30,000, maybe 

40,000 in your total population with mental illness. You testified 

that Bureau of Prisons psychologists conducted 37,263 individual 

counseling sessions in fiscal year 2008, which sounds like a large 

number until you consider that somewhere between 30,000 and 

40,000 inmates are mentally ill. 

How many inmates received individual counseling sessions during fiscal year 2008? And how frequently did these sessions take 

place? 

Mr. LAPPIN. I am not sure that I have the actual number of individual counseling sessions that took place. I can try to gather that 

and provide it for the record, but it is all determined on a case-bycase basis. Obviously, as well staffed as we are—and I have to 

state we are probably much better staffed in the area of mental 

health needs than many States and locals—it is still a huge challenge to address the needs of that many individuals. 

And just so you know, our definition of ‘‘mental health’’ is meeting the criteria of the Axis I Disorder and the Diagnostic and Statistical Manual of Mental Disorders. It does not include—as part 

of that Axis I, it does not include folks diagnosed with antisocial 

behavior or drug abuse disorders. So we have not included those 

in that category even though they fall within the Axis I. If we add 

those folks in, it would be a much higher number. 

Chairman DURBIN. How many Bureau of Prisons inmates receive 

psychotropic medication? 

Mr. LAPPIN. In excess of 16,000, and we are working on—it is a 

little confusing because psychotropic medication is actually provided for some disorders other than mental health issues, so we are 

sorting through that. We will be able to provide a more accurate 

number in the not too distant future. But we spent $61 million last 

year on medications, and $11.5 million was spent on psychotropic 

medication. So you can see it is a large portion of that medication 

that we do provide. 

Chairman DURBIN. $11.5 million? 

Mr. LAPPIN. $11.5 million. We only provide medications for those 

that have a clinical need for medication. So not all folks who suffer 

from mental illness get medication. 

Chairman DURBIN. With 30 full-time psychiatrists at the Bureau 

of Prisons located primarily at your medical referral centers and 

other BOP facilities receiving psychiatric services via video or contract psychiatrist, this translates to roughly one psychiatrist for 

every 1,000 inmates with mental illness, and apparently one psyVerDate Nov 24 2008 09:01 May 26, 2011 Jkt 066207 PO 00000 Frm 00018 Fmt 6633 Sfmt 6633 S:\GPO\HEARINGS\66207.TXT SJUD1 PsN: CMORC
13 

chiatrist for every 530 inmates who are currently on psychotropic 

medication. That is an incredible caseload. 

Mr. LAPPIN. There are also a number of contract psychiatrists— 

I can get that number—that support those 30 psychiatrists. But 

you are right, it is a large number. We are able to do it more efficiently because of the use of telepsychiatry in lieu of people having 

to travel to assess and determine appropriate medications and utilization of psychotropic medication. 

But it is, it is a large number. We struggle in some locations recruiting and retaining not only psychiatrists but psychologists as 

well, in part because of the rural nature of some of our facilities 

on the one side, and, two, high cost-of-living areas. Those are our 

two most challenging areas. 

To our benefit, which unlike States, we have the flexibility of 

moving those inmates to locations that have more of those staff and 

services available. And so I sympathize with some States that are 

very rural and struggle across the board, whereas we do have the 

ability to move the inmates who have the needs to other locations 

where those services can be provided. 

Chairman DURBIN. The Seventh Circuit Court of Appeals at the 

Federal level is not known as a liberal court of appeals. They characterize the lack of an onsite psychiatrist in the Indiana State prison system as ‘‘a serious system deficiency, contributing to a finding 

of deliberate indifference to a serious medical need.’’ That is a 

standard established by our court system, which Mr. Bagenstos has 

spoken to. 

I would like to ask, of the inmates who are currently in the Federal Bureau of Prisons system, how many are being held in segregation or isolation? 

Mr. LAPPIN. Well, that varies. There are two types of segregation: 

disciplinary segregation and administrative detention. And we can 

get an actual—it varies from day to day to day. But I know at our 

highest-level institution, administrative maximum security facility 

in Florence, of the 208,000 there are about 450 inmates there who 

are in controlled housing. We do not call it ‘‘solitary confinement,’’ 

but they are in controlled housing. Then every facility has a segregation unit for inmates who are either misbehaving or are fearful 

to be on a compound or just need to be removed from the general 

population. 

So the number varies, but we can get an actual number on a 

given day and provide it for the record. 

Chairman DURBIN. What do you think is the impact of segregation and isolation on a mentally ill prisoner? 

Mr. LAPPIN. We have not seen as a consequence of conditions of 

confinement of that nature a result being an increase in mental illness. So at, for example, ADX Florence, we have not seen an increase in mental illness, we believe, driven by the fact they are 

confined in that nature. 

Now, realize although isolated or controlled, they are seen by 

staff daily. They interact daily. They are removed for recreation. So 

it is not like they are locked in a cell and there is no external contact. 

We have a pretty heavy presence of medical and mental health 

professionals there who do ongoing assessments. There are no unVerDate Nov 24 2008 09:01 May 26, 2011 Jkt 066207 PO 00000 Frm 00019 Fmt 6633 Sfmt 6633 S:\GPO\HEARINGS\66207.TXT SJUD1 PsN: CMORC
14 

stable mentally ill inmates. If they become unstable, we remove 

them from there. We put them in a hospital until we gain their stability, at which time they would be returned to those conditions. 

So there are inmates there who have mental illnesses, who came 

there with mental illnesses, but they are controlled and they are 

stable during the period of time they are there, and they are monitored very closely. 

Chairman DURBIN. I am not an expert in this field. I am trying 

to learn. 

Mr. LAPPIN. Yes. 

Chairman DURBIN. In June of 2006, a bipartisan national task 

force, the Commission on Safety and Abuse in America’s Prisons, 

released its recommendations after a year-long investigation. It 

called for ending long-term isolation of prisoners. 

‘‘Beyond about 10 days, the report noted, practically no benefits 

can be found and the harm is clear—not just for inmates but for 

the public as well. Most prisoners in long-term isolation are returned to society, after all. And evidence from a number of studies 

has shown that supermax conditions—in which prisoners have virtually no social interaction and are given no programmatic support—make it highly likely they will commit more crimes when 

they are released. Instead, the report said, we should follow preventive approaches used in [other] countries.’’ 

What I just quoted was an article entitled ‘‘Hellhole’’ by Dr. Atul 

Gawande. I do not know if you have seen it. It was published in 

The New Yorker on March 30, 2009. Without objection, I will enter 

it into the record. 

[The article appears as a submission for the record.] 

Chairman DURBIN. Do you disagree with the conclusion of that 

task force? 

Mr. LAPPIN. I am going to speak to the supermax issue, and I 

disagree with that there is no benefit there. Let’s realize there has 

got to be a balance here. Without question, the inmates that are 

housed at that supermax—and I cannot speak to the States, but 

my guess is they are similar. These are very violent, aggressive, 

challenging, difficult inmates who have decided they are not going 

to listen to the rules in prisons, they are not going to adhere to the 

direction of staff. 

You cannot run safe prisons with folks like that out in the general population. 

Chairman DURBIN. Is there a middle ground between isolation— 

23 hours in a cell, for example—and general population? 

Mr. LAPPIN. I think there is, and that is when it comes to how 

those supermaxes are run. Is there contact with staff? Are there assessments that are done? Are there ongoing reviews? Is there a 

way for those folks to work their way out of those conditions of confinement? And, in fact, there are, as long as they agree to participate and abide by those rules. 

So our supermaxes, I am sure like many others, have a phased 

program that people can work their way through and eventually 

work their way out. But they have got to follow the rules. And the 

dilemma we have is if you look at this array of inmates that happen to be housed currently, the majority of them at ADX Florence—and I am sure other supermaxes similarly—are folks that 

15 

have routinely and frequently assaulted staff and inmates in our 

institutions, killed inmates, sometimes killed staff. 

And, again, although it is tragic and unfortunate, you cannot 

protect the other inmates, nor can you protect the other staff, without managing these inmates in a more controlled, more structured 

environment. 

If people have other suggestions as to how that can be done and 

we still protect the other inmates and the staff who work in those 

facilities, I assure you that myself and the other directors of corrections around this country will be listening. 

Chairman DURBIN. I will return to this, but, in fairness, Senator 

Franken has waited patiently. I have gone over my time. 

Senator Franken. 

Senator FRANKEN. Thank you, Mr. Chairman. 

Mr. Lappin, how many Federal prisons are there under the Federal Bureau? 

Mr. LAPPIN. We own and operate 115 Federal prisons. We contract privately with 14 large private contract facilities. They house 

primarily low-security criminal aliens. And then there are about 

8,000 to 9,000 inmates on any given day in 250 to 300 contract residential reentry centers. These are inmates who are transitioning 

from prison to the community. So we contract those services with 

companies and organizations in local communities—for a total of 

208,000 inmates. 

Senator FRANKEN. Thank you. You mentioned the dual diagnosis 

residential drug abuse treatment program, which seems like a very 

worthwhile investment for prisoners who have a dual diagnosis of 

mental illness and chemical dependency. At how many sites does 

the Bureau have this program? 

Mr. LAPPIN. We have this at three locations, and it is all driven 

on the number of inmates we see who have that dual diagnosis. If 

there are more inmates than we have room for, we would add more 

programs of that nature. 

But to give you an idea, 40 percent of our inmates have a diagnosis of drug or alcohol abuse in the Federal prison system; 92 percent of those inmates are volunteering for treatment. A portion of 

them have been diagnosed with a dual diagnosis condition, and we 

place them in these three programs to deal with both their addiction to drug or alcohol as well as their mental health issues. 

Senator FRANKEN. It just seems like out of all the prisons that 

you have, to have only three prisons with that program seems inadequate. 

Mr. LAPPIN. Well, I will check and return for the record, I will 

tell you how many folks are in that program, how many have been 

diagnosed—they have to volunteer for treatment—and how long 

the waiting lists are, because what we do is monitor that waiting 

list. And if we saw the waiting list was such that we could not 

treat the number of folks who have that need, we would add programs. But we will provide that information for the record. We will 

tell you how many folks are on the waiting list and whether or not 

we are able to get to everybody that we diagnose with that need 

who volunteer for treatment. 

Senator FRANKEN. Thank you. 

16 

Mr. Bagenstos, in your testimony you describe the methods of 

isolation that Chairman Durbin referred to that are used to control 

prisoners with mental illnesses. Are these tactics used with juvenile prisoners? 

Mr. BAGENSTOS. Yes, they are. So we have found in some of our 

juvenile investigations isolation and seclusion used as a replacement for mental health treatment in some of our investigations, 

even more shockingly than in some of our jail and prison investigations. So in an investigation of one set of juvenile facilities, there 

were individuals who violated prison rules or facility rules, were 

locked in a darkened room for 23 hours a day, was our finding. And 

so we have definitely found those sorts of problems in many juvenile facilities across the country. 

Senator FRANKEN. Are there other tools that are better than putting a juvenile in isolation in a darkened room for 23 hours? 

Mr. BAGENSTOS. We certainly think so. Our experts who we take 

on our tours certainly think so and who suggest minimum remedial 

measures to come into compliance with the Constitution. Often the 

problem in juvenile facilities is you are dealing with a population 

that has often undiagnosed mental illness problems, and for a variety of reasons, institutions do not provide the sorts of treatment or 

appropriate behavioral responses. And instead we have found in 

many cases seclusion restraint abuse as responses instead. 

Senator FRANKEN. Let me ask you, what percentage, in your 

opinion or your research, are dual diagnosis, people with mental illness and substance abuse problems? 

Mr. BAGENSTOS. In what class of facilities? In the juvenile facilities? 

Senator FRANKEN. Just in our Federal prison system. 

Mr. BAGENSTOS. Well, you know, our CRIPA enforcement authority does not extend to the Federal prison system, so I do not know 

that I am the best person to answer that question. 

Senator FRANKEN. Okay. Let me ask you this: What type of 

training do prison officials receive to help them identify mental illness and defuse conflicts with mentally ill prisoners? And do you 

think there should be a Federal requirement for this kind of training? 

Mr. BAGENSTOS. Well, it is an interesting question whether there 

ought to be a Federal requirement for this kind of training. We enforce the constitutional rights of inmates at facilities or residents 

at juvenile facilities, and what we have found contributing to violations of the Eighth Amendment and 14th Amendment is a lack of 

training. 

So the example that I give in the written testimony of the Wisconsin State prison for women, the Taycheedah Correctional Institution, is an example where systemic deficiencies in the treatment 

of inmates with mental illness was related directly to a lack of 

training, and the remedy that we negotiated with and adopted and 

worked cooperatively with the State to implement includes requirements for training of the people who work at that facility, both 

when they come into service and then in-service training. 

The lack of training is one of the essential problems that we have 

found contributing to constitutional violations around the country. 

17 

Senator FRANKEN. Ms. Leary, just a general question. Do you 

think there are just too many people in prison in this country? 

Ms. LEARY. I think there are too many people in prison in this 

country, Senator Franken, and part of the reason is that we are not 

addressing appropriately the needs of many people who do end up 

in prison—for instance, those with mental illness. Oftentimes, they 

are creating a disturbance, police are called to the scene, and they 

just lock them up. Then they end up in prison, and it starts a cycle, 

and they recidivate and they never get the treatment that they 

need. It just becomes a lifelong process in and out. That is just one 

example of the type of person who is in prison who should not be 

there. 

Senator FRANKEN. You know, I liked your testimony about the 

Bureau of Justice grantee program in New York City that combines 

mental health treatment with community service as an alternative 

to traditional incarceration. How much does it cost to run a program like that? And do you think that alternative programs to incarceration for the mentally ill save taxpayers money in the long 

run? 

Ms. LEARY. I can get you the figures on the costs for actually 

running a program like that. I do not have them with me. But we 

have seen an evaluation of several of these kinds of programs; we 

have seen that it does save the taxpayer money because you prevent recidivism and you can reduce the costs of incarceration. 

It is simply really beyond the capacity of the States to incarcerate all our problems. There are better and more cost-effective investments that we can and should be making in such things as diversion programs, mental health courts, drug courts, better reentry 

so that once you leave you will not be coming back. There are many 

ways to save taxpayer dollars and actually improve public safety 

outcomes. That is a lot of what we do at the Office of Justice Programs. 

Senator FRANKEN. Thank you. 

Thank you, Mr. Chairman. 

Chairman DURBIN. Thank you, Senator Franken. 

Mr. Lappin, returning to the one example you cited, when I 

asked you about isolation, you used the example of Florence, where 

you thought there were perhaps 450 inmates in isolation. Is there 

a resident psychiatrist at Florence? 

Mr. LAPPIN. Yes. 

Chairman DURBIN. One or two? 

Mr. LAPPIN. There is one psychiatrist at Florence. There are 

about 3,000 inmates there, but he spends a great deal of his time 

at the administrative maximum security facility. There are also 

seven or eight psychologists. 

Chairman DURBIN. And you indicated that if an inmate is put in 

isolation and there is a detection of a deteriorating mental condition, they are removed from isolation. 

Mr. LAPPIN. Well, we remove them to a hospital. 

Chairman DURBIN. To a hospital. 

Mr. LAPPIN. To return them to a stable condition. 

Chairman DURBIN. And who would make that observation of a 

deteriorating condition? 

18 

Mr. LAPPIN. Well, yearly we train all of our staff as to what to 

look for. Now, granted, our experts—our psychiatrists, our psychologists, our treatment staff—are the ones that do the diagnosis 

and the assessment. But an alert can come from a correctional officer, from a unit staff, from an education person, because as part 

of our training we train our staff what to look for and who to inform if they see an inmate acting in a certain manner. And so that 

report can come from anyone, and then a mental health professional would intervene and make an assessment. 

Chairman DURBIN. And what is the range of isolation, in terms 

of days, months, years, in the Federal Bureau of Prisons? 

Mr. LAPPIN. Typically very short. If you look at all the people 

who are in segregation as a whole, and on average, the amount of 

time they are there, typically their stays are short. That is our objective, to make that stay as short as possible and return them to 

a general population facility. So these supermaxes are the extreme 

only because these folks resist and they are not going to comply. 

And as a consequence, they end up in segregation or isolation for 

longer periods of time than what most inmates find themselves in 

those conditions that confine them. 

Chairman DURBIN. There was an editorial in the Washington 

Post this morning about sexual violence in American prisons and 

sexual exploitation. What is your experience or your knowledge of 

the connection between mental illness and sexual exploitation in 

our Federal Bureau of Prisons? 

Mr. LAPPIN. In general, that is a more vulnerable population, 

those that have mental illnesses—not only those that have mental 

illnesses, but the folks who come in who are young, inexperienced, 

do not have the wherewithal to manage in that social environment. 

So without a doubt, there are higher-risk groups who fall into the 

category of being manipulated or being taken advantage of. The 

mentally ill fall into that group. And it is unfortunate when, in this 

case, an employee violates the public trust in their capacity as a 

law enforcement officer and takes advantage of someone. It is unfortunate. Our policy is zero tolerance of that, and we try to aggressively identify that, investigate those incidents, and remove those 

folks if we have the evidence to do so. 

But, without a doubt, the mentally ill are more susceptible, more 

risky, and more vulnerable, as are some other unique groups of inmates within our population. 

Chairman DURBIN. Also, with the Bureau of Prisons, do you have 

a juvenile population? 

Mr. LAPPIN. Very small, 141, and we contract out with local communities typically to house those offenders, unless they are of a 

very violent nature, and then we have a few special locations 

around the country where we house them. But on that issue, our 

challenge is finding locations that have the adequate services and 

support for the juveniles because, I do not disagree, a higher incidence of mental illness and emotional concerns with the juveniles. 

We have limited locations because when we go—we just do not 

dump these folks in there. We go out and we visit them. We have 

a contract with them. We set expectations. And it is very difficult 

sometimes for us to find appropriate facilities to house even as 

small a number as 141. 

19 

Chairman DURBIN. So, Mr. Bagenstos, now that you have heard 

this discussion here and have told us that you are trying to put 

this in the context of the constitutional rights and legal rights of 

prisoners in these circumstances, what is your view of segregation 

and isolation, the treatment of the mentally ill in our prison system, the treatment of juveniles? Do you have a view as to whether 

or not there is work to be done here? 

Mr. BAGENSTOS. I think there is a great deal of work to be done 

in the treatment of inmates with mental disabilities, psychiatric 

disabilities, in State jails, State prisons, juvenile facilities. You 

know, we do a lot of that work, and I have to—— 

Chairman DURBIN. Can you speak to the Federal system? 

Mr. BAGENSTOS. Well, it is difficult for me to speak to the Federal system because that is not within our CRIPA enforcement responsibilities, so we have not done investigations of that. You 

know, when I speak to this Committee—— 

Chairman DURBIN. Who does? 

Mr. BAGENSTOS. Well, I think Mr. Lappin could talk about that. 

Mr. LAPPIN. First of all, let me just say we believe that isolation 

should be used very seldom for folks who are mentally ill. And so 

if you look at our inpatient cohort, you are going to find that we 

use isolation as seldom as possible for that group who have been 

diagnosed with that mental illness and who are exhibiting behavior 

that needs to be managed and controlled. So there is a combination 

of things, if you talk to our treatment specialists, besides isolation. 

There is medication in appropriate cases. There is more counseling, 

there are more, other ways of controlling that. So isolation is the 

one that we try to use the least. However, there are some cases 

where it is necessary. 

If there are complaints about treatment of inmates in the Federal Bureau of Prisons—and those complaints can come from staff, 

from inmates, from the public, from whomever—all of those complaints work their way to the Office of the Inspector General, who 

would make a determination as to whether or not they would investigate, and they may reach out to Civil in some cases and ask 

them to jointly investigate a concern or a complaint that has been 

made. But the Office of the Inspector General takes the lead on 

how and where and in what fashion a complaint will be investigated and dealt with. 

Chairman DURBIN. So, in addition to the court system, which is, 

of course, going to have the last word here, the internal mechanism 

is through the Inspector General’s office? 

Mr. LAPPIN. Yes. 

Chairman DURBIN. Which we probably should have invited to 

this hearing, but thank you very much. 

Mr. Bagenstos, we are going to hear later about the Tamms Correctional Facility in my State, a supermax facility. Have you received any complaints about Tamms? 

Mr. BAGENSTOS. I cannot tell you the answer to that. I do not 

know whether we have received complaints about Tamms. I will 

certainly look into that, and, you know, we can provide that information to the Committee. 

Chairman DURBIN. Ms. Leary, one of the things that you said 

struck me as interesting. The first intake officer for someone menVerDate Nov 24 2008 09:01 May 26, 2011 Jkt 066207 PO 00000 Frm 00025 Fmt 6633 Sfmt 6633 S:\GPO\HEARINGS\66207.TXT SJUD1 PsN: CMORC
20 

tally ill about to enter our system is usually a policeman, and the 

obvious question is what skills do they have to recognize mental illness and its manifestations in contrast to simple criminal misconduct. 

Ms. LEARY. I think that is a very difficult situation, and I would 

say probably most police officers really do not have the kind of 

training that they would need to recognize that this is a person 

with a mental disability, not just someone who is committing a 

criminal act. 

That is where these teams come into play where you pair law enforcement officers with mental health professionals. They train as 

a team, and they respond as a team so that each has knowledge 

of the other’s role at the scene, and they can assess the situation 

appropriately, and then if the right thing to do is to get that person 

some mental health treatment, instead of throwing them in jail, 

that should be the outcome. 

When I was a prosecutor here with the U.S. Attorney’s Office in 

D.C. in the 1980’s, police officers who would encounter people with 

mental disabilities would just lock them up and drop them off at 

St. Elizabeths, and that was the end of it, or else in the D.C. Jail. 

And that situation is the wrong thing for everybody, and, frankly, 

it is dangerous. It is dangerous to the offender, and it is dangerous 

to the police. 

Chairman DURBIN. The second intake officer, the second level of 

intake, is likely to be our profession: lawyers, criminal defense lawyers who interview these patients. I cannot recall a moment in law 

school when anyone took the time to talk to me about what you 

should look for to recognize mental illness. 

What do you think about that? 

Ms. LEARY. I do not think it is taught at law schools, although 

I think it certainly should be taught in places like law schools, especially if you are working in a clinic. Say you are doing a prosecution clinic or a defense clinic, or any kind of clinical work, you really should have that training, and that should be encouraged. 

I think attitudes about mental illness have improved in general, 

in the general public in the last few years, but we still have a long, 

long way to go. 

Chairman DURBIN. What is your opinion of the impact of segregation and isolation on the mentally ill? 

Ms. LEARY. I do not have any knowledge of that. I have not, you 

know, researched that. Common sense would tell you that if that 

isolation and segregation means that the person truly is isolated 

from human contact, that is an aggravating circumstance that I 

would think has great potential to aggravate a mental illness. 

Chairman DURBIN. I have many more questions, but I know we 

have another panel and will not be able to go much longer. It is 

possible that some of these will be touched on in follow-up written 

questions, if it would be convenient for you, if you could respond. 

I would like to turn now to Senator Franken. 

Senator FRANKEN. Thank you, Mr. Chairman. I just am going to 

do a few questions. 

First of all, it seems to me, Mr. Lappin, that you are saying that 

when mentally ill patients are put in isolation, it is really because 

21 

they have acted out in a way that really affects the safety of other 

prisoners and of the guards at the prison, right? 

Mr. LAPPIN. Or themselves. 

Senator FRANKEN. Or themselves, okay. And you are talking 

about—I hear about a ratio of psychiatrists to prisoners of one to 

a thousand. Is it fair to say that psychiatrists at the prisons sometimes feel a little overwhelmed? 

Mr. LAPPIN. Well, let me clarify a little bit. For those that would 

end up in isolation, they are at medical centers. So our ratio of 

mental health professionals to staff is much smaller. There is going 

to be an abundance of—— 

Senator FRANKEN. You are saying that there are not mentally ill 

prisoners who end up in isolation in prison? 

Mr. LAPPIN. In our general population facilities, it can happen. 

If someone becomes unstable during their period of incarceration at 

a general population facility, we are going to move them—— 

Senator FRANKEN. Are you confident that everyone—— 

Mr. LAPPIN.—to a location where—— 

Senator FRANKEN.—with a mental illness has been diagnosed? 

Mr. LAPPIN. I am sorry? 

Senator FRANKEN. Are you confident that everyone with mental 

illness has been properly diagnosed? 

Mr. LAPPIN. Well, I think there is always—with that many inmates, there is always a chance there would be a missed diagnosis. 

I go back to the key, and that is, early diagnosis. In our intake 

screening, it is not only a case manager who interviews the inmate. 

Within 24 hours there is a psychological assessment as well as a 

medical assessment, and then a follow-up within 7 days. 

We also have a history, the pre-sentence report if there are indications there. So our psychology staff are alerted to that. So they 

can begin tracking whether or not a person has a mental health 

condition sometimes in advance of the inmate even arriving at the 

institution, because in advance of the inmate, we get all the court 

documents. And if those court documents reflect that, they are 

aware of that before the offender even arrives. But once they arrive, within 24 hours there is an assessment. And if the person is 

displaying that behavior upon intake, there is an alert made to our 

psychology staff who will then respond to them immediately—their 

highest priority is to respond to those who are displaying behavior 

consistent with a mental illness. 

So although it is not impossible for us to miss it, with thorough 

screening and competent staff and trained staff at all levels, we 

have a better chance of identifying those folks in advance. So if 

they become unstable and they end up in segregation at an institution and the psychologist there determines that I do not think this 

is the appropriate place for us to treat this person—sometimes they 

can, sometimes they cannot—they would refer them to a medical 

referral center. We would move that person to a location where 

there are more psychiatrists, more psychologists, more treatment 

staff. And typically that is where isolation occurs. And, again, isolation is the last resort, and we try to do it for the minimal amount 

of time to restore that person to the point that they are no longer 

a danger to themselves or somebody else. So that is how it works 

in our system. 

22 

Senator FRANKEN. I understand. There was one phrase you used, 

which was ‘‘with that many prisoners.’’ And I had asked Ms. Leary 

before, Do we have too many prisoners in prison in this country? 

And I believe we do. And I believe that it puts a burden on everyone, including the psychiatrists in these prisons. 

Mr. LAPPIN. Well, here is an example. We are going to add—just 

to give you an idea how it works in this system, which is probably 

similar to your systems. Not only are there 208,000 inmates, but 

we release 60,000 inmates a year. But we are going to admit this 

year 67,000 inmates. So we are going to add a 7,000 increment to 

the base, and you can assume that within that 7,000 there are 

1,500 who have a mental illness. So the number continues to grow, 

which puts an increased burden on those in institutions. 

So I go back to my original comment that early diagnosis, adequate resources in the institutions, and, as importantly, an issue 

we have not touched on is our inability—you are correct, most of 

these folks are going to release into our communities—is the inability to find contract support facilities for reentry that provide the 

level of services for this unique group. 

So there are three groups of folks, to give you a idea: 42,000 inmates in our system released back into the streets of the United 

States every year; 85 percent of those released through a halfway 

house. We believe the most appropriate manner in which to move 

someone from prison to the community is through a halfway house. 

The three most difficult groups to place, the 15 percent we are not 

getting, the vast majority of them are mentally ill inmates, sex offenders, and inmates who are very violent and disruptive even toward the end of their sentence. 

Let us just focus on the mentally ill. Why is it difficult? Again, 

because many of them are going to rural locations, where there 

may be a halfway house, but they do not have the wherewithal, 

they do not have the resources available in that halfway house to 

care for that individual who has unique mental health concerns, as 

well as the challenges we face in our more urban areas where it 

is very expensive. They struggle getting the resources necessary, 

because our contracts require that. 

So here we are, we have this mentally ill inmate who is going 

to release, and we prefer to put them into a halfway house to transition out, acquire the services they need, whether it is for medication, whether it is for treatment or ongoing therapy, before they go 

to the street. But we lack the services in many of those locations. 

And, consequently, the inmate goes to the community. 

One last issue: too many communities that continue to resist the 

fact that their citizens who happen to be offenders are going to return home. In some cases, we actually have to litigate to convince 

them to put a residential reentry center in their communities. And 

a consequence is these folks go directly to the street. 

Now, again, I think that common sense would tell you that it is 

much wiser of us to transition especially these more challenging 

folks out through halfway houses than for us to give them $100 

and a new suit and throw them on the street corner. 

I can tell you, in my community I prefer to have more supervision than that. But, again, we have many communities out there 

that continue to resist and say not here, not in my back yard, and 

23 

it is kind of like out of sight, out of mind, I do not want them here. 

And that is reality. That is tragic, but it is the truth. And it is even 

more complicated when you have the mentally ill, the sex offenders, and the more violent offenders who are going to go directly into 

our communities. 

I did not mean to get off track, but that is an area we really have 

not touched on. But I think it is critically important, because as we 

have all said, most of these folks in local, State, and Federal prisons, they are going to go home at some point in the future. 

Senator FRANKEN. They almost all go home. 

Now, just one last thing to wrap up. Ms. Leary, the Office of Justice Programs’ mission is to provide leadership and services and 

grant administration and criminal justice policy development to 

support local, State, and tribal justice strategies to achieve safer 

communities. That is in your testimony. 

Ms. LEARY. Yes, sir. 

Senator FRANKEN. So you have an overview of the whole prison 

system, right? 

Ms. LEARY. We work with the State and the local prison systems, 

that is right. And we also work with the National Institute of Corrections. 

Senator FRANKEN. Okay. So I am going back to this deal where 

we are talking—Mr. Lappin says eventually most of them get out, 

right? 

Ms. LEARY. Right. 

Senator FRANKEN. So we have got people we are putting in the 

system, and then they come out. In your opinion, do they come out 

better than they went in? And this goes, again, to my opinion that 

we have too many people in prison in this country. And I was 

struck with your talking about drug courts and mental health 

courts, which I was not aware of. So I guess it is—can you just respond to what you think I am getting at? 

[Laughter.] 

Ms. LEARY. Sure, I would be happy to. I think that there are 

many far better alternatives than incarceration for those who 

should not be incarcerated, so we are not talking about the most 

serious, violent offenders and those who really are big risks to public safety. 

One of the things that the Office of Justice Programs works on 

is helping communities figure out what these alternatives are and 

how can we improve public safety in our communities without locking everybody up. And it runs the gamut, and you have to look at 

the whole spectrum from prevention to alternatives which include 

all the problem-solving courts that we work on, like drug courts 

and veterans’ courts and mental health courts and so on, to provide 

people with the resources and the treatment they need so that they 

will not end up in prison, because the chances of them getting what 

they need while they are in prison are much slimmer than they are 

if you have a really effective community-based program to deal 

with people’s issues. 

Then, again, as I said, you have to look at the whole spectrum, 

and that is where I think reentry is so important for those who do 

end up incarcerated. Reentry planning has to start right from the 

24 

time of sentencing and follow all the way through your term of incarceration and back out into the community. 

Senator FRANKEN. Thank you. 

Thank you, Mr. Chairman. 

Mr. LAPPIN. May I add to that? There are some people that belong in prison. 

Senator FRANKEN. Absolutely. 

Mr. LAPPIN. And we will send you some research for the record 

that reflects the availability of programs to focus on skills they lack 

result in fewer of them coming back to prison. So for those that 

need to be in prison, the availability of programs and opportunities 

to improve on the skills they lack, it is shown, results in fewer of 

them returning to prison—better educated, have a vocational skill, 

learn work skills, learn to manage this mental illness that they 

sometimes come to prison with, because that is probably, in part, 

part of the problem for this unique group. We try to put programs 

in place that teach them how to manage their mental illness, and 

there is an array of other skills they lack. And we will send the 

research for the record that reflects that the availability of those 

programs and the willingness of those to volunteer and participate 

typically results in fewer of them returning to prison. And that is 

why we have a little bit lower recidivism rate than what you are 

seeing on the average. 

Thank you. 

Chairman DURBIN. Mr. Lappin, let me thank you for that last 

comment and add what probably does not need to be said but will 

be said. The safety and security of the people who are working in 

our prisons is the highest priority, and I do not think anything we 

have said today should diminish from that commitment, which we 

all have, to that end. And for those correctional officers who literally risk their lives in this business, that is the first thing: to 

make certain that they are safe. And the safety of America at 

large, of course, is an equally important priority. I think we have 

raised some interesting and challenging questions about those who 

are released from prison and the likelihood that they will commit 

another crime, find another victim. We certainly want to diminish 

that as much as possible. 

You mentioned during the course of your testimony that you are 

open to ideas. The Gawande article talks about things that are 

being done in Britain today as an alternative to our incarceration 

model. I do not know if you have had a chance to look into that, 

but it is at least worth a discussion, probably at another time in 

another setting. But I want to thank this panel, an excellent panel, 

for the testimony given. I am told it is extraordinary for the Department of Justice to make this kind of commitment, for several 

people to come forward for this kind of a hearing, and I appreciate 

it very much. You will receive some written questions, which I hope 

you can respond to in a timely fashion. Thank you all. 

Chairman DURBIN. We are now going to welcome our second 

panel, four distinguished witnesses, who will now come to the 

table. If you would just remain standing for a moment, I will not 

have to ask you to stand up again. 

25 

If you would please raise your right hand, do you affirm that the 

testimony you are about to give before the Committee will be the 

truth, the whole truth, and nothing but the truth, so help you God? 

Mr. MAYNARD. I do. 

Mr. RANDLE. I do. 

Justice ZENOFF. I do. 

Mr. FULLER. I do. 

Chairman DURBIN. Thank you. Let the record reflect that all four 

witnesses answered in the affirmative. 

Our first witness Gary Maynard, Secretary of the Maryland Department of Public Safety and Correctional Services, has over 30 

years of experience in the field, having served as Director of Corrections in three other States—Iowa, South Carolina, and Oklahoma. He was also the President of the American Correctional Association and a member for 32 years of the Army National Guard, 

having served as the Adjutant General to the Oklahoma Army and 

Air National Guard. Mr. Maynard is a native of Oklahoma, holds 

a master’s degree from Oklahoma State, a bachelor’s degree from 

East Central University in Ada. 

Mr. Maynard, thanks for being here. Please proceed. 

STATEMENT OF GARY D. MAYNARD, SECRETARY, MARYLAND 

DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL 

SERVICES, TOWSON, MARYLAND 

Mr. MAYNARD. Thank you, Mr. Chairman, Senator Franken. My 

name is Gary Maynard. I serve as Secretary of the Maryland Department of Public Safety and Correctional Services. I have been 

involved in corrections for 39 years, working in five States and the 

Federal Bureau of Prisons. Early in my career, I served as a prison 

psychologist. I rose through the ranks of management, serving as 

warden on two occasions, and eventually serving as the head of corrections in four States. I am the Immediate Past President of the 

American Correctional Association, an active member of the Association of State Correctional Administrators, and have worked 

closely with the American Jail Association over the past several 

years. All three of these national recognized organizations have 

provided data for the testimony I will offer today. 

Correctional administrators across the country have an obligation to provide effective programming for all offenders. Over the 

past three decades, we have witnessed an increase in the number 

of inmates possessing mental health issues entering the criminal 

justice system. Many researchers point to the depopulation of the 

State-operated mental hospitals in the late 1960’s as one of the 

contributing factors to this trend. 

In 1959, there were over 550,000 mentally ill patients residing 

in State-operated mental hospitals. This number is now less than 

80,000. During this same period of time, we have seen the number 

of incarcerated individuals quadruple to close to 2.5 million annually. 

Corrections certainly does not dispute the concept of offering 

comprehensive community-based services to individuals with mental health needs. However, insufficient resources have led to an increase in the incarceration of these individuals, and the resources 

available to us are lacking. 

26 

The American Jail Association estimates that there were over 

650,000 bookings of persons with some type of mental illness in 

2008. A study by the Bureau of Justice Statistics estimates that 

more than half of the prison population has mental health issues. 

This population is at higher risk of incarceration due to a number 

of factors, including substance abuse. Law enforcement and correctional staff lack the training and education necessary to work with 

this population effectively. 

A study of Washington State prisons found that while only 18 

percent of their inmate population was classified as mentally ill, 

they accounted for 41 percent of the reported infractions. Lack of 

training and sufficient staff to work with the population leads 

many correctional agencies to use disciplinary segregation as a tool 

to manage the population. This type of isolation sometimes proves 

destructive to certain members of this population. 

Please understand that corrections professionals do not believe in 

abandoning this population and do not feel that segregation by 

itself is a useful practice. Though we believe strongly that the mental health system should hold the primary responsibility for this 

group, we understand that many of these become sentenced to our 

prisons and jails. We must make solid investments in working with 

this population. 

Leadership has come from our national associations who have developed policies and standards to guide correctional administrators 

in the treatment of mentally ill offenders. State and local corrections have adopted a number of methods to identify and provide 

appropriate treatment for this population. 

In Maryland, the Montgomery County Department of Corrections 

and Rehabilitation has served as a model in the use of a comprehensive screening and referral process that is overseen by public 

mental health professionals. In our department in Maryland at the 

State level, we have improved our methods to identify these inmates at intake. We have developed a system to share information 

with the Baltimore Mental Health System in order to protect our 

staff and prescribe appropriate treatment. 

Corrections agencies across the country have invested in services 

to carry the inmates from incarceration to reentry back into the 

community. In Cook County, Illinois, the Adult Probation Department’s Mental Health Unit employs officers with a mental health 

background to assist clients in accessing disability benefits upon release. 

The Wisconsin Department of Corrections works with community 

advocates to assist inmates in filing applications for Medicaid benefits before release. 

In Pennsylvania and Minnesota, reentry staff work with their 

psychologists and community providers to ensure that there is support available to returning offenders. 

In Maryland, our department partnered with the Mental Health 

Association to pass legislation at the State level to provide 30 days’ 

worth of medication for offenders being released in the community. 

Local health departments across the country have joined in release 

planning, staking a claim in the future of these individuals. 

Each of us in the corrections profession does what we can given 

our respective resources, but we know that more is needed. Work 

27 

has been done at the Federal level to assist us. In 2004, the Mentally Ill Offender Act was signed into law to provide agencies with 

the necessary resources to care for this population. However, due 

to limited funding, many corrections applications have been denied. 

In the period of 2006–08, only 11 percent of all applicants received 

funding. 

Corrections agencies need funding and technical assistance to 

continue building collaborative relationships to properly care for 

this population. The corrections field needs the Federal Government to define a clear role on behalf of this population. 

Specifically, we would benefit from supplemental funding for 

medication in prison, enhanced protocols, and proper training for 

our staff. We know these things exist, but working to provide a coordinated approach would greatly strengthen to serve this population. 

We would encourage the Substance Abuse and Mental Health 

Services Administration to take the lead in working with corrections and public health agencies. We understand the complexity of 

this population, but we know that funding, coordination, and Federal support will be a great step forward. I know corrections leaders across the country are ready to continue to identify effective 

practices to support the needs of this population. 

Thank you for inviting me to testify today. I would be happy to 

answer questions at the appropriate time. 

[The prepared statement of Mr. Maynard appears as a submission for the record.] 

Chairman DURBIN. Thanks, Mr. Maynard. 

The next witness is Michael Randle, Director of the Illinois Department of Corrections, operates 28 adult correctional centers, responsible for 46,000 adult inmates; previously served for 19 years 

in the Ohio Corrections System, most recently as Assistant Director 

of the Ohio Department of Rehabilitation and Corrections; a bachelor’s degree from The Ohio State University and a master’s degree 

from Ashland University. 

Mr. Randle, thanks for coming from Illinois to be with us today, 

and please proceed. 

STATEMENT OF MICHAEL P. RANDLE, DIRECTOR, ILLINOIS 

DEPARTMENT OF CORRECTIONS, SPRINGFIELD, ILLINOIS 

Mr. RANDLE. Thank you, Mr. Chairman, for this opportunity to 

speak with you. Thank you, Senator Franken. 

Prior to my appointment in Illinois, I served as Assistant Director in the Ohio Department of Rehabilitation and Corrections. In 

conjunction with the Ohio Department of Mental Health, I had 

oversight responsibility over a Community Linkage Program, which 

was charged with providing continuity of mental health care to 

mentally ill persons entering and leaving the prison system. 

The issue of mental illness in our prisons and jails is both complex and pervasive. In fact, a recent study conducted by the Bureau 

of Justice reported that up to 16 percent of the prison and jail populations are afflicted with mental illness, which is approximately 

four times higher for men and eight times higher for women than 

in the population at large. This disproportionate representation is 

primarily a result of policies that have shifted the emphasis from 

28 

community-based treatment of the at-risk populations and priorities that have diverted resources away from treatment providers. 

In recognition of these problems, Congress enacted the Mentally 

Ill Offender Treatment and Crime Reduction Act in 2004. The act 

required collaboration between justice and mental health program 

providers to help States and counties to design and implement collaborative programs within their communities regarding mental 

health treatment. While the Act authorized $50 million to be granted toward these efforts, only $21.5 million has been appropriated 

between fiscal years 2006 and 2009. Due in part to this lack of 

funding, coupled with record deficits, States and counties have 

found themselves in dire circumstances with respect to treatment 

and management of the mentally ill. 

In 1995, the State of Ohio created the Community Linkage Program, which was designed to facilitate mental health care for persons entering or leaving the prison system by assisting in policy development, providing information sharing, monitoring outcomes, 

and providing assistance. In essence, this program was created as 

a result of recognized and demonstrated need and out of legal necessity. 

At its core, the program is designed to bridge the gap between 

State and local criminal justice and mental health services; it provides a consistent, sustained link between these entities from the 

moment offenders enter the criminal justice system to the time 

that they are released into the community. 

Like other States, Illinois prisons and jails are facing crisis levels 

with regards to mentally ill offenders. Recent figures indicate that 

between 20 to 25 percent of the inmate population in Illinois are 

carried on the mental health caseload, with 12 percent requiring 

psychotropic medication. This large caseload, along with fiscal challenges and inadequate community resources, has created difficulties with managing these offenders while incarcerated, as well as 

difficulty in providing reentry services. 

The Illinois Department of Corrections has historically issued a 

14-day supply of psychotropic drugs to offenders upon release. Unfortunately, it usually takes a few months for such offenders to acquire access to the mental health services that they need; this gap 

from access to services can and does lead to decompensation and 

often recidivism. In light of this, the department has begun to initiate a linkage program similar to that of the Ohio Linkage Program. 

As director, I recognize that the challenges of providing proper 

care for mentally ill offenders while protecting them from themselves and the community will be ongoing. At both the national and 

State levels, we have made significant progress in recognizing and 

dealing with this issue. However, more needs to be done. 

With the passage of the Mentally Ill Offender Treatment and 

Crime Reduction Act, we have a vehicle to help provide these resources. I respectfully ask that you fuel this vehicle and fully fund 

the program. 

Thank you very much for allowing me to come before the Committee, and I will be obliged to answer any questions that the Committee may have. 

29 

[The prepared statement of Mr. Randle appears as a submission 

for the record.] 

Chairman DURBIN. Thank you, Director Randle. 

Kathryn Zenoff is a Second District Appellate Court Judge in Illinois. She served as presiding judge of the Criminal Division and 

Mental Health Court in the 17th Circuit. She is the national cochair of the Judges Leadership Initiative for Criminal Justice and 

Mental Health Issues. Justice Zenoff has a bachelor’s degree from 

Stanford University and a law degree from Columbia University 

Law School. 

Thanks for coming from Illinois. Please proceed. 

STATEMENT OF KATHRYN E. ZENOFF, PRESIDING JUSTICE, ILLINOIS APPELLATE COURT, SECOND DISTRICT, ROCKFORD, 

ILLINOIS 

Justice ZENOFF. Chairman Durbin, Senator Franken, I am grateful for opportunity to share my perspective. I hope that my experience is valuable to you. It may be somewhat unique as I can speak 

from the vantage points of having organized a 70-person community task force in Rockford, Illinois, to address the revolving-door 

syndrome of persons with mental illness being incarcerated in our 

jail in disproportionate numbers; of having presided for 2-plus 

years over a mental health court, which Senator Durbin visited a 

couple of years ago; of having collaborated with the Illinois Department of Human Services Division of Mental Health on a statewide 

mapping project to identify gaps in services for criminal justice-involved persons with mental illnesses; and of having the privilege 

of serving as the national co-chair of JLI. 

Mental health courts—that is, specialized dockets based on 

therapeutic justice or approaches that address an offender’s behavior and root causes—are relatively new. Long-term data on the effects of these courts on recidivism and public safety are not yet 

available, but the short-term reports reinforce their value and I 

think warrant continued, even increased, funding. 

Participants seem to be positively motivated to take responsibility for their own recovery. Jail and hospital days are greatly reduced, resulting in cost savings. I recall one 50-year-old man released from jail to our therapeutic intervention program, or TIP 

court, who was diagnosed as schizophrenic. He believed himself to 

be a retired army general and barked orders at me when he came 

into court. In a regular courtroom, he would have been held in contempt. But in this therapeutic setting, our team of legal and mental health professionals worked with him until he steadily took his 

prescribed medication, participated in therapy, and was able to assume more responsibility for his own life and recovery. He is now 

living semi-independently and is no longer delusional. He has not 

had any contact with the criminal justice system in 21⁄2 years. 

This story can be repeated numbers of times in the now over 175 

mental health courts in the country. Yet recent statistics still show 

disproportionate numbers of persons with mental illnesses in our 

jails. Stigma is still attached to mental illness. 

We all know more needs to be done. How do we move forward? 

What should be our focus for study and action? 

30 

We must continue to look for new ways to reverse the criminalization of mental illness and to improve public safety. Aware of 

that challenge, we have just established the Mental Health Court 

Association in Illinois to improve our coordination of statewide efforts. This is the first organization of its kind in the country. 

We know that our jails and prisons have become the so-called 

‘‘safety nets’’ of our unfunded and underfunded system of community mental health care in this country. Now is the time to focus 

our attention and our resources on continuity of care, establishing 

key linkages, and in funding the gaps in services. A few of my recommendations are: 

First, in expanding funding for mental health courts and diversion programs, which do provide the structure for integrated treatment outside of our jails and prisons, we should focus on wrapping 

our returning veterans into these programs as their mental illnesses and substance abuse problems put them at risk for entering 

the revolving door in and out of our jails. 

Second, we must improve the screening and mental health services in our jails. We know how expensive it is to house prisoners, 

especially those who are mentally ill. Using screening tools at booking may more readily identify those inmates. Needed medication 

and treatment can then be provided, resulting in earlier releases. 

What often happens, as we have heard today, is that inmates with 

mental illnesses act out due to their symptomatology and threaten 

guards and other inmates. Any good time they may have accumulated is taken away. Additional training for staff and separate pods 

may help. Sharing information between departments of human 

services and corrections, such as the Illinois Data Link Project, can 

help identify those prisoners who have a mental illness. 

Best practices, SAMHSA’s best practices—that is, a blend of the 

best research and clinical experience in the area—suggest an integrated approach to treatment of persons with mental illnesses in 

the criminal justice system. That includes not only medication and 

therapy but supported employment, supported housing, and trauma-informed services. To my knowledge, Medicaid does not cover 

these costs or covers them in a very fragmented way. A fresh look 

at this situation would be in order, along with allowing reimbursement for the case management linkage piece of release planning 

and diversion from our jails. 

Also, funding for Centers of Excellence on a statewide or even a 

regional basis would be important. These centers could facilitate 

necessary research and examination of best practices, help coordinate efforts at cross-disciplinary training for professionals, including police officers working in the field. They could involve consumers and NAMI. 

My other recommendations have been submitted to the Subcommittee in my full statement and include funding for technical 

staff assistance to JLI, our judges organization that has made significant contributions all across the country. Resources may be 

more limited than we would like, but we must persevere. 

In closing, I would like to share with you some sage advice by 

retired Illinois Chief Justice Mary Ann McMorrow to a group of 

new judges. These words describe very well why I as a judge feel 

31 

compelled to be involved and committed. Justice McMorrow offered 

this: 

‘‘As judges, we look beyond the legal formalities of a particular 

dispute, to remain aware of the human dilemma that underlies almost every case brought before us, and always within the bounds 

of our authority try to resolve the problems presented to us in a 

manner that satisfies both the legal and the human aspects of the 

case. Let us not forget that the law is first and foremost about 

human beings and their problems.’’ 

Thank you, Mr. Chairman and Senator Franken, for the honor 

and the privilege of being here today and assisting in this important work. 

[The prepared statement of Justice Zenoff appears as a submission for the record.] 

Chairman DURBIN. Justice Zenoff, thank you for being with us. 

Our last witness, David Fuller, is an outreach and housing coordinator for the Manhattan Outreach Consortium. Previously, he 

worked as the Director of the Supportive Housing Program for 

Community Access and a peer specialist for Bellevue Hospital’s 

psychiatric inpatient service. 

Mr. Fuller is a consumer in recovery from psychiatric disability 

and substance abuse who spent about 20 years cycling in and out 

of jail. Mr. Fuller now works to improve access to services for people with mental illness. He is a member of the National Leadership 

Forum on Behavioral Health and Criminal Justice. 

Mr. Fuller, the topic of today’s hearing has affected your life like 

it has no other witness. Thank you for being here today and having 

the courage to tell your story. Please proceed. 

STATEMENT OF DAVID L. FULLER, OUTREACH AND HOUSING 

COORDINATOR, MANHATTAN OUTREACH CONSORTIUM, 

BROOKLYN, NEW YORK 

Mr. FULLER. Mr. Chairman, Senator Franken, I want to thank 

you for allowing me to testify today, and other distinguished members of the Committee that are not here today. I submitted written 

testimony, but there are some things I would like to talk about 

that are not in the written testimony. 

In my trip down here, I was thinking about an occasion when I 

was in the Suffolk County Jail in the early 1990’s, and I suffer 

with major depression, or I used to suffer with major depression. 

Today I manage it and live a very full life. But back then, things 

were not going so well, and I was homeless. I got arrested for petty 

larceny. I had stolen something to eat and some baby formula for 

my child at the time. I was arrested, put in Yaphank Jail, been up 

3 or 4 days. I was also abusing substances at the time, wasn’t very 

clean, depressed, preoccupied with my own death, most of the time. 

I viewed it as not having enough courage to actually take it out at 

that time. 

When I got to Yaphank Jail, all through this time no one asked 

me did I have a mental illness or a substance abuse problem. I saw 

no opportunity to reach out for help to a medical professional. 

While I was in the holding cell going through the intake process, 

an officer yelled out something at me, and I was hearing voices, 

too. Isolation back then used to create psychotic episodes for me, 

32 

especially when I was sent to the box. And I think he had told a 

group of us to get up, stand up from the bench, and I didn’t stand 

up fast enough. And one of them punched me in the head, threw 

me to the ground. I was handcuffed behind my back, and then one 

of the officers saw fit to jump off the bench into my rib cage and 

broke two of my ribs. 

I was put in the box after this and left there. In my mind, not 

to be too dramatic, but I felt I was left there to die. I had no visitors. The medical personnel were not allowed to see me. I could 

hear them talking at the door. The officers would not let them in. 

I later found out when my family was looking for me, I was told, 

they were told I was not in the jail. 

What saved me was I had a warrant for petty larceny in New 

York City at the time. The officers came to get me because my 

name was in the system. I come to find out later those New York 

City police officers had a hard time getting me out of Yaphank Jail. 

When I was finally produced, they basically looked at me and 

asked the Suffolk County officers, ‘‘What is this? What happened 

to him? ’’ And I really do not remember what they said. All I know 

is they laid me down in the back seat of their car, took me to the 

next county, Nassau County, and I stayed in Nassau County Medical Center for another 10 days. 

The first 3 days, the doctors were going back and forth of whether they would have to put a tube in my chest because my lung was 

collapsing at the time. Luckily, that did not happen. 

The sad thing is this was not a unique experience in my time in 

jail. I spent 6 to 8 years cumulatively in city jails in New York 

City. The sad thing is that there are a lot of my peers that are not 

able to testify before you because they are no longer with us. They 

either committed suicide in jail or after they got discharged out of 

jail. 

It is difficult to talk about this topic without thinking about the 

other more complicated, overlapping issues of racism, social and 

economic disability, cultural incompetence when it comes to getting 

services within the jail system. And I think that is like a sarcastic 

statement when I say ‘‘getting services within the jail system,’’ because you really do not. 

There is no HIPAA inside a jail. There is no privacy in your care. 

I put in my written testimony, I remember the first time that I got 

the courage up, you know, to tell people about what was going on 

with me, my suicidal thoughts, my complete engulfment in hopelessness, that I would put in a pen with 30 other guys, you know, 

officers would yell out, ‘‘Fuller, are you here to see the psychiatrist 

or the medical doctor? ’’ If I wanted to see the psychiatrist, I would 

have to acknowledge in front of 30 or 40 people that I did not know 

that that is what I was doing. 

When I met with the psychiatrist, it was in a little cubicle, you 

know, like in an office pool or something, no solid walls, no door, 

expected to talk about the most personal aspects of my life. I could 

hear other so-called medical professionals talking about previous 

patients and their personal information, and it scared me. I said, 

‘‘Well, when I leave, are they going to be talking about my information the same way they are talking about others? ’’ So I would kindVerDate Nov 24 2008 09:01 May 26, 2011 Jkt 066207 PO 00000 Frm 00038 Fmt 6633 Sfmt 6633 S:\GPO\HEARINGS\66207.TXT SJUD1 PsN: CMORC
33 

ly shut my mouth and not really discuss the issues that were going 

on with me. 

A few times I took medication in jail. It is a very embarrassing 

situation. In Rikers Island, when you go to medication, you are 

standing on a line with—I do not know—50 to 100 other inmates, 

other inmates going on the other side of the hall. You are taking 

your medication right there in front of everybody at a window. Everybody knows what you get. There are other illicit activities that 

go on in the medication line, you know, the selling of illicit drugs, 

selling of medication, things like that. 

I really, you know, have to reiterate my experiences are not the 

worst experiences. I have been in the box three or four times. I became psychotic in the box twice. My diagnosis does not carry psychosis with it. I have not been psychotic since I have been in jail. 

But the isolation, combined with the depression, did create a couple 

of episodes for me. 

I did attempt suicide in jail one time. An inmate found me and 

untied my neck. He did not tell the officers because just like I 

knew, to tell them what happened would just exacerbate the problem. I would have been put on suicide watch, which was basically 

the box, and isolated and probably would have felt worse, if possible, than I already did. I do not know him name today, but I always thank him for that. 

What helped me was the last time I was in jail I was asked by 

someone did I consider treatment, and I told the person directly 

that if I couldn’t go to some place that would address my psychiatric disability and my substance abuse, it was really a waste 

of time. I had graduated three long-term drug treatment programs 

at this time, countless rehabs and detoxes. I really can’t remember 

how many-20, 30, 40. 

It is painful. Every failed treatment episode is very painful for 

a person, and at this point I just could not endure another failed 

treatment episode. I knew what I needed. The services just were 

not out there for me. 

This person actually said, well, we have something called a 

MICA program—and a MICA program stands for Mentally Ill 

Chemically Addicted residential program—would I be interested in 

that. I said yes. I sat in jail for another 2 months on a misdemeanor waiting for the service. But the good thing is when I got 

out, got engaged, I was able to get around people like me with 

similar experiences, got support, saw a doctor, got medication, got 

stable, decided I wanted a job, decided I wanted a family, became 

a father, a husband, a citizen, a man again, regained my role in 

the community. 

For many years, the State, city, and Federal Government have 

been wasting their money incarcerating and paying for inadequate 

services for me. Through my lifetime I easily have spent a million 

dollars of the Government’s money that did absolutely no good for 

me. I think it is a travesty, you know. Today, you know, I pay taxes 

instead of taking out of the tax coffers. I try to help people with 

similar experiences that I do. 

But I think what is needed is, like I heard some of the other panelists talking about it, it is really about supportive housing, employment, adequate community services. Yes, there are too many 

34 

people in jail. There are too many people in jail, and I do agree 

that there are a small number of people that thank God there are 

jails. You know, I met these people. Some people really need to be 

in jail. But 80 percent do not. Seventy to 80 percent of the people 

in prisons today are either there for drug offenses or committed the 

offenses while under the influence of drug and alcohol. A majority 

of these people have underlying childhood trauma, physical and/or 

sexual abuse. 

I think one of the things that allowed me to recover to the extent 

I did is that my trauma was not experienced in the home. I had 

great parents, loving parents. I have three siblings. All of them 

have post-graduate degrees, live very successful lives. 

I did not respond to the violence and the racism in the 1960’s as 

well as my siblings did. You know, I watched people beaten and 

killed when I was 6 and 7 years old because of the color of their 

skin. I went to all-white schools through elementary and high 

school because my parents wanted a better public education for me. 

I did not have the courage to tell them what names I was being 

called there, that, you know, I was attacked pretty regularly there 

and suffered injuries behind those attacks. I wanted to be a man. 

I wanted to stand up for myself, even as a boy. 

I can recall suffering with depression ever since 10 or 11 years 

old because I was very hopeless in things ever changing for me. I 

distinctly remember when they killed Martin Luther King that I 

lost hope in the country, I lost hope in having a different future. 

And I am not saying everybody responded to things the same way. 

This is the way that I responded. I think, you know, I am a sensitive person by nature. 

I would just like to say that we really need to focus on alternative to incarceration programs. I went through one. It changed 

my life. I went to MICA treatment, got around people that understood me, got on medication, went to therapy. The reason I was 

able to go there was because I went through a drug court that allowed me to finish my time in there, and if successfully completed, 

dismissed the case against me. 

Chairman DURBIN. Mr. Fuller, I have given you—— 

Mr. FULLER. I am sorry. 

Chairman DURBIN. I have given you more time than others—intentionally. 

Mr. FULLER. Right. No problem. 

Chairman DURBIN. You deserved it because you have a perspective on this none of us have. But I want to have a chance to ask 

some questions and ask you to react and others to react to your life 

experience. 

Mr. FULLER. Sure. 

Chairman DURBIN. But I really appreciate your coming. I seriously do, and I want to make sure we get everything done here before we have to wrap it up today. But thank you for coming, and 

sit tight, we have got some questions for you. Okay? 

Mr. FULLER. Thank you. 

[The prepared statement of Mr. Fuller appears as a submission 

for the record.] 

Chairman DURBIN. The first question I am going to have is one 

that I have asked some of the experts, and you are the only one 

35 

at the table in either panel that can speak from firsthand experience. It is a real basic, open-ended question. What is the impact 

of isolation on the mentally ill? 

Mr. FULLER. It is cruel and unusual punishment. I was shocked 

to hear some of the replies that the other panelists gave. Almost 

invariably people with mental illness in isolation get worse. I do 

not know many who stay stable. 

Chairman DURBIN. Should there be a limit? I mean, you understand why they do it in some cases. 

Mr. FULLER. I do. 

Chairman DURBIN. Should there be a limit? 

Mr. FULLER. I do not think it is a simple answer. I think they 

should never be there in the first place. Isolation does serve a purpose, a safety purpose for inmates and officers. I think the problem 

is that these people are being punished because they are sick, and 

they are in a jail that they should not have ever been in in the first 

place. 

Mental illness is highly underreported within inmates because 

inmates understand the consequences by going public. So I guess 

my question is that—I do not have an answer to limits, but I will 

say it is cruel and unusual punishment, and I have not been psychotic since I got out of isolation. 

Chairman DURBIN. Mr. Maynard, you were on the 2006 commission I talked about earlier that said that there should be a limit 

to this. 

Mr. MAYNARD. Yes, sir. 

Chairman DURBIN. I would like to ask you to react to the same 

basic question. What is the impact of isolation on the mentally ill? 

Mr. MAYNARD. I think it causes deterioration with mentally ill 

inmates. I think it makes their conditions worse. I agree with a lot 

of the testimony that we in the prison system, as a need to deal 

with violence, inmates who would be dangerous to staff or to other 

inmates or to themselves and who misbehave, we put them in isolation. 

I think as a rule we typically keep people longer than they 

should be on isolation. In some cases, they need to stay a long time 

just for everybody’s protection. In other cases, they need to move 

more quickly through disciplinary and administrative segregation. 

But, again, I do not think there is any question about the impact 

of isolation on the mentally ill. I think that is something that most 

corrections directors would say is something that we need some solutions in order to move away from that. 

Chairman DURBIN. For the record, Mr. Randle is new to his position with a new Governor in our State, and he has been assigned 

a pretty tough assignment to take a look at the Tamms Correctional Facility, our supermax State facility. 

According to the Belleville News-Democrat—and you can correct 

this report if it is wrong—54 inmates at Tamms have been held in 

solitary confinement for more than 10 years, including 39 who have 

been there since 1998 when the prison opened. George Wellborn, 

the first warden at Tamms, said, ‘‘I think they should have been 

given an opportunity to go back to a reduced security facility. It 

was not intended to be a place where guys would be there for 8 to 

10 years.’’ 

36 

Mr. Randle, should there be a limit on how long an inmate can 

be held in isolation in Tamms? 

Mr. RANDLE. Thank you, Chairman. First of all, I think there 

should be a limit in terms of how long a person could be held in 

isolation. I would also add the number of 54 inmates being held at 

Tamms since—I believe it was 1998, that is an accurate number 

that comports with my review. 

Chairman DURBIN. Accurate or inaccurate? 

Mr. RANDLE. It is accurate. 

One of the first things that Government Quinn asked me to do 

is do a comprehensive review of the conditions at the Tamms Correctional Facility. Even prior to my formal start as director, I 

began to gather information. In fact, my second day on the job, I 

spent about 9 hours at Tamms, walked through every cell block, 

talked to over 50 inmates at Tamms, spent an entire day looking 

at the operations in Tamms. 

From that, and other research over the past 2–1/2 months of my 

tenure as director, I have recently submitted—in fact, just last 

week—a report to the Governor with a second of ten recommendations for reforms at the Tamms supermax facility. One of those recommendations involves the release or the beginnings of a stepdown process for approximately 48 inmates who have been in 

Tamms between the 1998 and 2004 period. 

So, indeed, I did have a concern about the extended stay of offenders, among several other operational things that I discovered 

at Tamms. 

Chairman DURBIN. How many of those inmates at Tamms or any 

other part of the Illinois correctional system who have been held 

in isolation for extended periods of time—let us say beyond 1 

month, for example—would you classify as mentally ill, for example, using as an objective criterion, whether they are receiving psychotropic medication? 

Mr. RANDLE. On any given day, there are about 4,500 offenders 

in the Illinois correctional system that have a diagnosis of a mental 

illness. Of that population, about 12 percent of the—I am sorry, 

about 12 percent of the entire population, 45,000 are on psychotropic medications. 

There is and continues to be times where those inmates wind up 

in isolation for various periods of time. I think the key for me as 

a director is to ensure a couple things: Number one, that we have 

clinicians making decisions about whether or not an offender is appropriate for isolation. 

I think one of the things that sometimes gets overlooked is that 

there are various degrees of mental illness. 

Chairman DURBIN. Well, how many staff psychiatrists do you 

have in the Illinois Department of Corrections? 

Mr. RANDLE. There are no State-employed psychiatrists. We have 

a contract provider that provides psychiatric services to our entire 

system. Those ratios, there is at least one full-time psychiatrist assigned to every facility. Some facilities have more than one fulltime psychiatrist assigned to them. It is based on full-time equivalents rather than a specific number, Chairman. 

Chairman DURBIN. I am just looking here to make sure I find out 

how many—you have 28 facilities. 

37 

Mr. RANDLE. Yes, sir. 

Chairman DURBIN. So you are saying there are 28 full-time psychiatrists under contract to the Department of Corrections? 

Mr. RANDLE. There are 28 full-time equivalent psychiatrists, yes. 

Chairman DURBIN. That is what I meant, under contract. 

Mr. RANDLE. Yes. 

Chairman DURBIN. The same thing. I hope that is the same 

thing. And so that roughly means that you have—let me try to do 

some math here quickly –1,500 patients for every psychiatrist? 

Mr. RANDLE. That potentially could sound about right. 

Chairman DURBIN. It sounds like a heavy caseload. 

Mr. RANDLE. Yes, it does. 

Chairman DURBIN. And so let me ask you this: What is your 

opinion of the impact of isolation on the mentally ill? 

Mr. RANDLE. I think it can cause decompensation in offenders. 

Chairman DURBIN. You might define that term for us, please. 

Mr. RANDLE. It can cause your mental health condition to worsen. In some cases, it could lead to suicidal tendencies. It could lead 

to exacerbate your mental health condition, or make it worse. 

I think, though, the key, at least from my perspective, again, is 

to ensure that access to clinicians is available whether you are in 

segregation or whether you are in general population, and that 

does not always just mean a psychiatrist. I want to emphasize that. 

There are psychologists, there are licenses clinical counselors. 

There is an array of mental health clinicians that all provide services to the population. 

Chairman DURBIN. My last question in this round, and if you do 

not mind, I will come back and perhaps want to ask Judge Zenoff 

and others some questions. 

The Belleville News-Democrat found that of the over 250 inmates 

transferred to the Tamms Correctional Facility in the last 10 years 

since 1999—of the over 250 inmates—only 6 of those went through 

mental health screening and were placed in the prison’s special 

treatment unit for mentally ill prisoners. That figure seems extremely low based on the 12 percent figure that you mentioned earlier for those who are receiving psychotropic medication. 

Mr. RANDLE. Mr. Chairman, specifically at the Tamms Correctional Facility, historically there was a file review that would take 

place as part of the placement process. One of the recommendations, as part of my plan to the Governor, requires a full mental 

health evaluation to take place for every placement into the 

Tamms Correctional Facility. 

Chairman DURBIN. Thank you. 

Senator Franken. 

Senator FRANKEN. Thank you, Mr. Chairman. 

Mr. Randle, you talked about a disinvestment in community 

mental health services. Do you think that if we fully funded these 

services that we can better manage the mentally ill, incarcerate 

fewer of them, and end up actually saving money for the taxpayers 

while also making our communities safer? 

Mr. RANDLE. Senator Franken, that is absolutely correct. I do believe that one of the key things, especially with our population in 

the State of Illinois that have a mental illness, is as part of their 

release process we give them about a 14-day supply of psychotropic 

38 

medication. Unfortunately, we do not do as good of a job linking 

them with a community mental health provider, so in a lot of cases, 

these offenders, while we may do a referral, sometimes it often 

takes weeks or months before they are actually in to see a psychiatrist to have that medication continued. 

Unfortunately, by then they have run out of medication. They 

have decompensated and, unfortunately, they wind up in jail and 

ultimately back in prison. Traditionally, these are low-level, nonviolent offenders who often are accused of theft crimes and those 

sorts of things, but often wind up back in the prison system. 

So I think part of this charge is working collaboratively with 

community mental health providers and also the State Department 

of Mental Health in Illinois to recognize that in a lot of cases we 

are dealing with the same individual at different points in their 

life, and work together to share information and provide that sustainable linkage when they leave. 

Senator FRANKEN. Thank you. 

Judge Zenoff, you talked about mental health courts and they are 

relatively new, and that the research is new, but that you have 

seen real trends. And I am wondering if those correspond to results 

you have seen and research you have seen about drug courts. 

Justice ZENOFF. I am not as familiar really with the research on 

drug courts. I think drug courts have been found certainly to have 

made a significant difference. I think one area that the researchers 

are looking at with respect to mental health courts is whether or 

not to change some of the treatment to mirror in some ways what 

the treatment is in drug courts—that is, to address some of the 

criminogenic factors that have to do with recidivism and why people commit crimes. And I think they would like to see if that will, 

in addition to treatment for the mental illness, help reduce recidivism and allow people to stay out of the criminal justice system. 

Senator FRANKEN. Thank you. 

Mr. Fuller, thank you for co ming in today and for your testimony. I am curious about this MICA program, because you said 

that you had been in and out of rehab, right? 

Mr. FULLER. Yes. 

Senator FRANKEN. What was it about the MICA program that 

worked for you? Was it that you were just ready at that point? Or 

was there something about the design of the program that made 

it work for you? 

Mr. FULLER. Well, I think being ready is part of it, but a MICA 

program is a place where you can address substance abuse and traditional mental illness in the same physical setting basically at the 

same time. You are connected with peers that have similar experiences as you do because you can even find discrimination with 

‘‘straight substance abusers’’ or ‘‘straight mental illness,’’ believe it 

or not. 

That is the unique part of it, that you are able to address the 

whole person. It is usually a treatment failure when you try to separate mental illness from substance abuse. Substance abuse is an 

Axis I diagnosis, and if you do not think it is a thought disorder, 

you have never known an addict before. They should be treated the 

same. They should be in the same category. But at this present 

39 

time, I guess for funding reasons, they are separated and have historically been separated. 

Senator FRANKEN. Excuse me, but what worked for you is that 

the MICA program combined the discipline of mental illness treatment and drug or chemical dependency treatment? 

Mr. FULLER. Yes. 

Senator FRANKEN. Okay. Thank you. 

Mr. Maynard, you talked about collaboration and collaborating 

relationships. Could you talk about the potential opportunities for 

collaboration between the corrections system and the Substance 

Abuse and Mental Health Services Administration? 

Mr. MAYNARD. Yes, sir. I think, Senator Franken, that if somebody works in corrections, runs a corrections agency and they are 

not accustomed to collaboration, they better get used to it, because 

we are big agencies in the States, but we have—we have custody 

resources, but we have little other resources. So I think it is incumbent on us to reach out to substance abuse agencies, like in Maryland, the judge mentioned NAMI, another group that in all the 

States I have worked in have been an active partner in working 

with the mentally ill. I think SAMHSA is an organization that has 

the technical credibility. I think the more we can get involved with 

them, the more funding that might be available, the more leadership they could provide, the more protocol, I think it would be good 

for our organization, for our system. 

I think they have the expertise. We did not come working in prisons to be mental health experts. We run the security part of it. We 

looked at education at the Federal level to provide educational 

services. They do an excellent job reaching into the prisons. I think 

that is a model for SAMHSA. They could do the same thing. We 

provide—— 

Senator FRANKEN. SAMHSA, once again, addresses both substance abuse and mental health at the same time. 

Mr. MAYNARD. Yes, sir. And I did want to, if I might, Mr. Chairman, in talking about the segregation, the Vera Institute of Justice 

is doing some pilot projects with reducing segregation, and they did 

a pilot in the State of Mississippi and their segregation population 

was pretty extensive. I think they reduced it probably by onefourth of what it was. In Maryland, we have made a request to 

Vera to come look at our population, because I think we have a 

large number on segregation. I think it just happens, if you do not 

go back and study it and try to figure out ways to reduce it, that 

it will grow. So I think that is something, if we can do some models, that might go across the country. 

Senator FRANKEN. Thank you, Mr. Maynard. 

Thank you, Mr. Chairman. 

Chairman DURBIN. Mr. Randle, if I understand the calculation, 

we estimate that each prisoner at Tamms costs us $64,000 a year. 

Is that a rough calculation based on the budget for Tamms? 

Mr. RANDLE. Mr. Chairman, that is a number that is used to describe the cost. 

Chairman DURBIN. Do you think that is close? Does it sound 

close? 

Mr. RANDLE. I think you have to look at the entire operation and 

the impact that just Tamms has on our entire prison system. So, 

40 

yes, if you look at Tamms in an isolated fashion, also if you look 

at—there are two parts to Tamms. There is a 200-bed minimum security camp that provides that support. I think that $64,000 figure 

is just looking at inside the C–MAX portion of that facility. 

Chairman DURBIN. I see. Mr. Fuller, you can see where you can get to $1 million in a hurry with that kind of expenditure. 

Judge Zenoff, to go back to an earlier question here, I do not remember the course in law school on psychology and psychiatry—— 

Justice ZENOFF. Nor I. 

Chairman DURBIN [continuing]. And psychiatric disorders and 

your clients, civil and criminal. But it appears that the intake in 

this process of justice starts with the law enforcement officer, the 

attorneys, the judges, social workers, and ultimately the correctional officers. And I guess the issue, I think, Mr. Maynard just referred to was that most correctional officers focus on security. And 

yet if they are going to play the role that we expect them to, we 

need them to be more observant of other things that relate to a 

prisoner’s well-being that may have a direct impact on security. 

So when you get into this drug court atmosphere—I do not know 

if your background is in psychology, psychiatry, or just—— 

Justice ZENOFF. Not at all. 

Chairman DURBIN. Do you feel that our system of justice is really 

equipped to deal with what we have decided as America will be our 

future when it comes to mental health? 

I can recall, just as an aside, that in 1970, then-Lieutenant Governor Paul Simon took me, a young lawyer fresh out of law school, 

on an onsite visit at the Lincoln State School, 30 miles from 

Springfield—it was a day I will never forget as long as I live. It 

was in the bitter winter, and we went up to a building which 

housed 150 profoundly retarded adult males. It was bedlam, pure 

bedlam. There were two supervisors there for 150 people. There 

were people jumping out of the windows in their hospital gowns, 

people running outside in the bitter cold. It is an image I cannot 

forget, and now I think we have decided to replace that horrible 

image with one which is in many respects just as horrible: A corrections system which has decided that it will become the largest 

provider of mental health ‘‘services,’’ if you can put that in quotes, 

in the Nation. 

Is this the right thing for our system of justice? Is this a fair outcome? 

Justice ZENOFF. You know, Senator Durbin, I agree with you in 

terms of lawyers and judges not being educated in this field. But 

I do think, given the problem we have before us and the job of lawyers and judges to solve human problems, we are becoming educated. We are learning to use the resources that we have to be able 

to address the problems. 

I think Mr. Fuller’s story and really all of the testimony we 

heard here today is the reason and are the reasons that judges are 

out front, that judges have become leaders in communities around 

the country to address this very human problem. I think that the 

job of judges in this particular area is actually to become educated, 

as I myself did. I did not have any background in psychology or 

psychiatry. I had a mother who had Alzheimer’s, and at that point 

I learned a little bit about that illness at that time. But actually, 

41 

to digress 1 minute, it was because of a community mental health 

leader in Rockford, Illinois, who walked over to the courthouse and 

said, ‘‘Open your eyes. See what is happening in the Winnebago 

County Jail. See who is cycling in and out of your jail. See why you 

have an overabundance of persons with mental illnesses in jail; 

why your jail is overpopulated,’’ that we started to become educated. 

And I think the reason that judges have learned about this problem is, as I said, it is a very human problem. I think what we do 

need to do is need to use our abilities to convene stakeholders in 

our communities and in the country to address the problem and to 

bring others together to actually keep persons with mental illness, 

with serious mental illnesses, out of the criminal justice system so 

that in the end they do not end up in our prisons. We would then 

have at least fewer people with mental illnesses in prison. Thank 

you. 

Chairman DURBIN. Thank you. 

Mr. Fuller, I am going to ask the last question of you. In the city 

of Chicago, which I am honored to represent, on the west side 

around the United Center where the Chicago Bulls and Michael 

Jordan had all their glory, we have more ex-offenders than any 

other section of our State. They are primarily African American, 

and they come to this community, this area for a variety of reasons. 

One of them is that many of the churches there have decided to 

give a helping hand to ex-offenders; and, I might add, they have 

a Congressman, Danny Davis, who has made this his passion and 

his dedicated purpose for serving in Congress to deal with this 

whole question of ex-offenders. And I have met with him and with 

some of the people at the churches there, and I know what you are 

doing today, and I want to give you the last word on this. 

What do we need to do to make sure those ex-offenders do not 

commit another crime, do not end up back in jail? I know the list 

is very long, but give me the top two or three things that your work 

will make a significant difference. 

Mr. FULLER. Okay. First, I will say in my written testimony I included a document, ‘‘A Call to Action.’’ 

Chairman DURBIN. I read it. 

Mr. FULLER. Please do. Supportive housing, supportive employment. 

Chairman DURBIN. Now, do you get help when it comes from our 

Government in terms of that housing? I mean, there have been 

questions as to whether Medicaid and Medicare are there for exoffenders, this question about housing. 

Mr. FULLER. Well, the third one is mutual support, peer support, 

and Medicaid does not pay for those services—peer-run centers, 

peer support. Sixty-four thousand for jail, 23,000 for supportive 

housing and a beautiful apartment with onsite case managers providing services. You just do the numbers, and it makes a whole lot 

more sense to provide services in the community than to send people to jail. 

Chairman DURBIN. Thank you. 

I am going to place into the record a long list of written statements, and since there is nobody to object, it is going in. 

[Laughter.] 

42 

[The information referred to appears as a submission for the 

record.] 

Chairman DURBIN. And if there are no further comments, I want 

to thank this panel in particular. This Human Rights and the Law 

Subcommittee was created as a kind of a special and risky undertaking, and they said do not step on the Foreign Affairs Committee, and be careful that you do not intrude on others’ jurisdiction. 

As best we can tell, there have not been too many hearings on 

this subject before Congress in the last few years, and I think that, 

as I mentioned earlier, Senator Webb’s idea of a reform commission, which I have cosponsored, is a step in the right direction. But 

this really is a human rights issue in our country, that we have 

reached this point where this is where the mentally ill find themselves more often than not, that you would have three jails as the 

facilities where more mental health services are offered than any 

place in America. We have got to open our eyes. If we were 

ashamed as a Nation over 100 years ago about the status of the 

mentally ill, what can we say today? What about our generation? 

What are we doing? What is the honest and effective way to give 

these people a chance and to keep our society safe? 

I urge everyone to reflect on the question that Mr. Fuller asked 

in his testimony: Why do they have to be punished so severely for 

so long for being sick? Mr. Fuller’s experience highlights the failures to provide many persons with mental illness who enter our 

criminal justice system with a meaningful opportunity to get well. 

These failures are costly in terms of lost human potential, lost 

years, the expense of incarceration, and the threat to public safety. 

But Mr. Fuller’s experience also shows that it is possible to design and implement programs that allow people to turn their lives 

around, and thank goodness you are here as proof of that today. 

I appreciate that so much. Making available the opportunities that 

you had to finally turn your life around has to be our goal as a Nation. This hearing is adjourned. 

Thank you. 

[Whereupon, at 12:13 p.m., the Subcommittee was adjourned.] 

[Questions and answers and submissions for the record follow.] 

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Æ 


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