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A federal district judge, referring in 1999 to conditions in Texas' prisons, made an observation that is still too widely applicable: Whether because of a lack of resources, a misconception of the reality of psychological pain, the inherent callousness of the bureaucracy, or officials' blind faith in their own policies, the [corrections department] has knowingly turned its back on this most needy segment of its population.In the most extreme cases, conditions are truly horrific: mentally ill prisoners locked in segregation with no treatment at all; confined in filthy and beastly hot cells; left for days covered in feces they have smeared over their bodies; taunted, abused, or ignored by prison staff; given so little water during summer heat waves that they drink from their toilet bowls.In the United States, there are three times more mentally ill people in prisons than in mental health hospitals, and prisoners have rates of mental illness that are two to four times greater than the rates of members of the general public.While there has been extensive documentation of the growing presence of the mentally ill in prison, little has been written about their fate behind bars.We examine the various levels of care available to them, their confinement in long-term segregation facilities, the way prisons respond to their self-mutilation and suicide attempts, and the services they receive upon release from prison.Our research reveals significant advances in mental health care services in some prison systems.

Persons who, with psychiatric care, could fit well into society, are instead locked away, to become wards of the state's penal system.Across the country there are competent and committed mental health professionals who struggle to provide good mental health services to those who need them.They face, however, daunting obstacles - including facilities and rules designed for punishment.They have unique needs for special programs, facilities, and extensive and varied health services.Compared to other prisoners, moreover, prisoners with mental illness also are more likely to be exploited and victimized by other inmates.A prison expert recentlydescribed one prison unit as "medieval…cramped, unventilated, unsanitary…it will make some men mad and mad men madder." Suicidal prisoners are left naked and unattended for days on end in barren, cold observation cells.

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