"I didn’t need medication. I needed someone to talk to."
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In the '60s and '70s, deinstitutionalization swept the US. Poorly run state mental hospitals were shut down and set to be replaced with less isolating, community-based programs. It was a promising and ambitious plan that never fully took off—the hospitals closed, the community programs fell by the wayside, and the mentally ill wound up somewhere else: in prisons and jails. But the correctional facilities that moonlighted as America's mental health hospitals weren't—and still aren't—equipped with the staff or resources to help inmates manage their conditions effectively.
How do circumstances like waiting months to see a psychiatrist or not having access to medication impact the people who rely on this care to stay healthy? We asked six former inmates who were managing psychological conditions during their sentence what their experiences with prison mental health services were like. While some spoke about positive and attentive care, others weren't so lucky.
James McLaughlin, 35
Sentence: Five years in Virginia
Diagnosis: Bipolar I
I was diagnosed with Bipolar I a few years before my sentence. My first hospitalization was for a manic episode where I spent 27 days in a mental hospital. Then there were times where I was so deep into depression that I didn't get out of bed for days. When I first got to prison, I was in that depressed state. I just wasn't sure how I was going to be able to do five years—it was a tough pill to swallow.
During my sentence, I didn't receive my medication. No one asked me about my mental health when I came in or about any medications that I would need to take for it. I was OK with that for a while, but about halfway into my sentence, I had a manic episode around Christmas time. My anxiety was very high and I wasn't getting enough sleep. Sleep deprivation is usually what sent my manic state over the edge in the past, and when it happened then, I become really aggressive. A family picture of mine went missing and I came close to getting into it with another inmate. I said, "I'm going to get it now, or someone is going to pay." For that, I was put in solitary confinement for 30 days. I know I set myself up for that.
The first five days in solitary confinement I was so wound up, I was trying to come off that manic episode but I didn't have any medication. It's just lonely in there. I got used to it though; I would read or play cards with myself. After that, I requested medication but I was told that I would need to do something really bad in order to get it. I wasn't as educated about my condition as I am now so I just accepted that answer. I didn't know to ask more questions. I didn't want to end up in the mental institution either if they thought my condition was worsening. I heard horror stories of what it it was like, people yelling and drooling. Thankfully, nothing caused another manic episode for me, so I finished my sentence without one. One thing about prison is that you constantly have to learn to adapt, so I learned how to adapt to being incarcerated and unmedicated.
Tamara Gonzalez, 47
Sentence: One year on Rikers Island in New York City
Diagnosis: Severe depression and anxiety
I experienced my first anxiety attack at Rikers. I had been dealing with mild depression before getting there, but my anxiety started the day I was scheduled to go to court. There were about ten of us waiting in a small cell to get transported from Rikers and we had been there for several hours. We didn't know what was going to happen and if we would even make it to court or not. I started to feel very uncomfortable and started pacing back and forth. I felt like I couldn't breathe. I was nauseous, feeling hot, and I just couldn't stay still. They didn't have water down there either, so one of the other inmates asked an officer for some. I didn't ask to go see a doctor because if I had, I would have missed court. But none of us made it to court anyway; after waiting for eight hours, we learned that they canceled them that day. I realized then that something was happening to me from being incarcerated. You always need to be buzzed in and out or have the keys to get places. I don't like being trapped but I felt like I always was.
I was up all that night pacing and the night correctional officer noticed. He told me when his shift was ending that he would escort me to the doctor. If you're cool with them, they treat you nicely and help you out. If not, I would have had to wait—I got lucky.
Some nights I would get very depressed because I would wonder when I would be able to go home to be with my family. My family would write me but I wouldn't get the letters weeks later because there would be something going on with the mail or your phone calls would get cut. Knowing how they were doing and them not knowing how I was doing made my anxiety [worse].
People were accommodating with mental health needs. I missed my pill call once because I was sleeping but they let me go to the next call. I was seeing a mental health counselor once a week, who asked me how I was feeling and how the medication was working. If you missed your counseling appointment, you had to wait until the next day to go but when it came to medication, they always found a way to fulfill your needs so that you didn't go without it.
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I was scared when I got out, and my anxiety was up there because I was going into the unknown. Being free, reconnecting with my family, looking for work, getting my life back was all a process, and it wasn't that easy. Going to look for a job, I didn't have any training in jail on how to look for a job after being in jail and some people won't hire you because of your background. But I finally found a job in sales and the Women's Prison Project helped me get my life back together. I am still taking medication, and it's helping me. I am going to have to be on it for the rest of my life to be stable.
Sentence: One year on Rikers Island in New York City
Diagnosis: Bipolar depression
I started my sentence in 2001 and a few months in I was experiencing manic episodes. That's how I got my diagnosis. I was placed in mental health housing, where they helped you manage your condition. I saw a therapist once a week and a psychiatrist every other week for a medication assessment. A nurse would come in and made sure everyone got their medication and the guards in the mental health household are trained and knew how to handle these particular inmates—we weren't treated like the other inmates.
The first few weeks while the medication was building in my system, I was severely depressed: I didn't want to get out of bed, I didn't want to eat, I didn't want to do anything—that was the worst part of my sentence. We had access to keep in touch with family but I didn't want to. Once the medication kicked in, I became more sociable.
My condition was good when I left, but they didn't give me any referrals to set me up with a mental health doctor, which I think that they should do—it's one thing that I think they should work on. I would think that I needed to continue to see a therapist or psychiatrist after Rikers, but they don't help you with any sort of discharge plan. All they give you is a Metrocard and whatever money you had in your account—if you come in there homeless, you leave homeless. I didn't have the resources and I didn't know how to search for mental health counselor. I didn't want to ask around either because I didn't want anyone to know that I had a mental health diagnosis—I kept it to myself. I left Rikers in 2002 and I just got back on my medication within the last two years and have been seeing a therapist once a week for the last eight months.
Tim Ryan, 48
Sentence: 14 months in Sheridan Correctional Center, Illinois
Diagnosis: Substance abuse, anxiety, panic disorder
I struggled with a lot of things as a kid: learning disabilities, panic, anxiety, but I choose to mask all that with drugs like cocaine and alcohol. I was sober for a year before I was introduced to heroin in 2001 by a friend's former roommate. I was helping him move and he offered me some to snort. Pretty soon I was engrossed in a $500 a day heroin habit, I had overdosed eight times, and I was doing heroin with my teenage son. My drug use lead to two prison sentences, one in 2008 and another in 2012, where I was in for 14 months.
When I first got to prison, they asked me questions about my mental health, but it was very quick, about two to three minutes. They determined that I qualified to go to Sheridan, which was the only prison at the time in Illinois with a drug treatment program with access to doctors and psychiatrists. If you didn't make it to Sheridan you didn't have any mental health or substance abuse services. I know a lot of people lied to get in there because they have good services and it's close to Chicago. But I don't blame them. It probably ended up helping them in some way.
Before I got to Sheridan, I spent two weeks in a regular prison and it was hell on earth. I was coming off the heroin and alcohol without any medication. Right before my time, I was drinking about a fifth of vodka every day and doing five grams of heroin. I was hot, then cold; I was vomiting and shitting myself; I didn't sleep for the first 30 days. They don't give you any meds for the withdrawal—they looked at it as, "Well, you shouldn't be doing drugs in the first place." In Sheridan, I was in group therapy for two to three hours a day, five days a week for the entirety of my sentence. It was a really supportive environment and you were able to speak your truth. I chose not to take any medication. I just wanted to focus on learning to cope with my condition and work on myself, all while being clear-headed.
I think the hardest part of having a mental health condition is leaving prison—then you are on your own and they don't give you any resources. Prison is very structured: You get meals and you get your medication, but when it's time to go back into the real world, if people don't have the knowledge or help, they just go back to doing what they were doing. I know I was fortunate. My family helped me out, I had a townhouse set up for when I was out, and I knew how to find work. I could leave prison and never look back.
Michelle Stout, 31
Sentence: Over a year in New Jersey
Diagnosis: Bipolar anxiety and depression
When I got to prison, I was dealing with bipolar anxiety and depression, something I had been diagnosed with when I was 13. It took about a month for me to see a psychiatrist, so I wasn't put on medication for the first few weeks I was there, and I really felt my symptoms kicking up a lot during that time.
It was hard to adjust to being in prison. I know a year doesn't seem like a lot, but to me, it felt like a lifetime. I go from really high highs to really low lows and even though I was on medication, the circumstances of prison made it hard to be level. We were able to see a mental health professional but I wouldn't call it counseling. They would just ask how our medication was going and that's it. You had to put in a slip to see them but when you would end up going varied, sometimes it was three days later, sometimes it was two weeks. The whole appointment usually lasted about ten minutes.
In prison, I had to learn on my own how not to be in my head. You have a lot of time on your hands there so I had to find ways to not overthink or worry about things because it would make both my anxiety and depression worse. Something that helped me take my mind off the stress was coloring. One of the other inmates let me use her colored pencils and she had a bunch of adult coloring books, so it was nice that she was able to share with me because I didn't have family coming to see me or someone to put money in my account. It's one thing that I can say really relaxed me and calmed me down.
The whole time I was there, no one came to visit me, I didn't speak to anyone, and I didn't receive any letters—that definitely impacted my depression. My mother wouldn't answer any of my calls. To know that someone else's mother or kids or sister was coming, kind of bothered me. Those days were hard and even though I was on medication, I would get really sad.
Entrice Valdez, 46
Sentence: Eight years in Rikers Island and Albany, New York
Diagnosis: Bipolar disorder, manic depression, and anxiety
I had been selling drugs for ten years before I finally got caught. I was charged with possession of cocaine with the intent to sell. I was first taken to Rikers and had a difficult time coping with being there because it's so hectic. I started getting in a lot of trouble and acting out. I didn't trust anyone so I wouldn't talk to anyone, and when someone crossed me, I would get into fights. They finally evaluated me and said I had all those conditions, which I never knew I had in my life. I was shocked, I was like, "This can't be true. How come no one noticed this before?" But during my initial appointment, they just diagnosed me, they didn't give me a chance to explain my history or talk about how I was feeling.
I would take the three medications they gave me but not a regular basis because they had too many side effects. They were making me bloated, I gained weight, and for me, they weren't helping me psychologically. I felt like a statue and I didn't like the feeling. I just took them when I thought I needed them, like when I felt on edge or like I was going to explode. They didn't care that I wasn't taking it as prescribed, they didn't seem to care about anyone. As long as you weren't trying to attack anyone or hurt anyone, they didn't ask questions. The psychiatrists didn't come around very often, sometimes it was once a week or once a month. Five months out of the six I was at Rikers, I spent in solitary confinement. Honestly, for me, it wasn't that bad. There, I didn't have to worry about anyone, I just had to worry about myself. No one really came by to ask how you were doing, though. They just dropped off the medication and kept it moving.
When I got to Albany, I was a little more relaxed. There was more open space so I could move around more, walk, think, jog—it was a lot different because I wasn't confined to one spot. For the most part, I didn't take my medication because I felt like I didn't need it, though once in a while I would take my anti-anxiety ones. Being away from home for that long probably gave me the most anxiety. I just wanted to be with my family, be able to talk to them and hold them. I had a good support system, though, and people visited me once a month.
Now, I see a therapist once a week and I don't need to be on medication. Actually, when I went to the psychiatrist he said I only had anxiety. Maybe things changed, but I feel like when I was at Rikers, they just wanted to give me anything to make me quiet.
Sentence: 16 months in Pennsylvania
Diagnosis: Depression, anxiety, PTSD
I was put on suicide watch when I first got to prison. I was arrested and I was upset and crying when they took me in. I never said I wanted to kill myself but because I couldn't stop crying, they put me there. It was my first time in prison, so I was scared, you know? They took all my clothes and I had to sleep naked on a metal bed. I had my period at that time too, but they didn't provide us with any pads or tampons, we had to let the blood flow on us until we showered, 72 hours later. After that was up, on Monday, a psychiatrist came to my cell door, asked me if I was suicidal and I said no. He prescribed me some medication to calm me down, told me I have PTSD, anxiety, and depression. They gave me my clothes back, and I was out. But I didn't see him or any sort of mental health counselor again after that during my sentence. I just took the medicine that they provided me with.
With the medicine, all I did was sleep until they gave me my next dose. I started to feel like the medicine made me really angry. I put in a request to see the psychiatrist about changing my medicine but they told me he had bigger problems to deal with than mine. I didn't want to take it, but they told me if I stopped, I would go to solitary confinement. I ended up going there about 36 times. A lot of it was due to the correctional officers. The officers would really take advantage of you if they knew you had mental conditions—they would pick on you, laugh at you, call you slow, call you retarded. I know I have anxiety, but when they called me that, I would fight back. One time, I got into a fight with three officers and was put into solitary for 60 days. I couldn't have any visits, no phone calls, nothing. I felt alone, I felt scared, I felt like no one wanted to know where I was coming from. I know I have these conditions, but I didn't need medication, I needed someone to talk to.
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