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Mental health, just as much as physical health, is a mainstay of life.Indeed, it is beyond any serious dispute that mental health is a need as essential to a meaningful human existence as other basic physical demands our bodies may make for shelter, warmth, or sanitation. Prisons are tense and overcrowded facilities in which all prisoners struggle to maintain their self-respect and emotional equilibrium despite violence, exploitation, extortion, and lack of privacy; stark limitations on family and community contacts; and a paucity of opportunities for meaningful education, work, or other productive activities.They huddle silently in their cells, mumble incoherently, or yell incessantly.They refuse to obey orders or lash out without apparent provocation.We identify the mentally ill in prison – their numbers, the nature of their illnesses, and the reasons for their incarceration. We review their access to mental health services and the treatment they receive.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 also indicates the persistence in many prisons of deep-rooted patterns of neglect, mistreatment, and even cavalier disregard for the well-being of vulnerable and sick human beings.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.

Persons who, with psychiatric care, could fit well into society, are instead locked away, to become wards of the state's penal system. Yet across the nation, many prison mental health services are woefully deficient, crippled by understaffing, insufficient facilities, and limited programs.Without the necessary care, mentally ill prisoners suffer painful symptoms and their conditions can deteriorate.They are afflicted with delusions and hallucinations, debilitating fears, extreme and uncontrollable mood swings.They face, however, daunting obstacles – including facilities and rules designed for punishment.The current fiscal crisis in states across the country also threatens the gains that have been made.

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