Iowa Is A National Disgrace in Its Mistreatment of the Mentally Ill

Iowa

Background

The largest state psychiatric hospital at Mount Pleasant holds only 78 patients, and all four state hospitals together total only 231 patients. The Polk County Jail in Des Moines, with 2,500 inmates, has more seriously mentally ill individuals than all four state hospitals together. Similarly, the state prisons at Fort Dodge, Newton, Anamosa, Clarinda, and Mount Pleasant – all of which hold more than 1,000 prisoners – each have more individuals with serious mental illness than the largest state hospital does. In 2011, when the Black Hawk County sheriff reported that “60 percent of the inmates in his jail are mentally ill . . . twice the national average,” it was at first thought to be an aberration (Eastern Iowa News Now, Apr. 3, 2011). But in Iowa, such a number is not an aberration. In 2014, the Linn County sheriff reported that three-fourths of his jail population “is on some sort of psychotropic medication” at any given time (The Gazette, Mar. 4, 2014). Among the inmates of the state prisons, “more than 25 percent are diagnosed with serious mental illnesses, such as schizophrenia or bipolar disorder,” according to the director of the Iowa Department of Corrections (Des Moines Register, Feb. 25, 2014).

Doug Newby puts a human face on mental health services in Iowa. Diagnosed with severe schizophrenia, he was arrested for “urinating on a friend’s porch.” During his three months in the Wapello County Jail, he was confined to a small cell by himself because of his outbursts. “He rarely left the cell, where he remained naked and incoherent much of the time. . . . He often kept his mouth full of loose tea leaves or orange peels which he let fall to the floor when [the corrections officer] tried to give him medication.” The jail attempted to get him transferred to a state hospital, “but administrators there refused to take him, saying he was too difficult to control.” As Newby’s court-appointed lawyer summarized it: “He was too crazy for the mental health unit” (Des Moines Register, June 29, 2013).

This is what happens in a state that is among the stingiest in state mental health expenditures per capita and among the states making the least effort at jail diversion programs. The re-incarceration rate among mentally ill males in the state prisons is twice the rate of non–mentally ill prisoners, and among females, three times as high (Des Moines Register, July 30, 2011). Headlines such as “State Pays Woman Who Blinded Herself in Prison” (Des Moines Register, May 28, 2009) have become more frequent. Court awards are costly, and the incarceration of mentally ill prisoners is far more expensive than it is for other prisoners. The Iowa legislature is mistaken in thinking it is saving money by not treating seriously mentally ill people.

Current Laws Governing Treatment in Prisons and Jails

Prisons

The Iowa Department of Corrections (IA DOC) civilly commits inmates in need of treatment to its licensed forensic psychiatric hospital. Involuntary treatment procedures are determined according to statutes governing Department of Human Services involuntary commitment and treatment.

Jails

State law does not prohibit Iowa county jails from administering medication involuntarily on a nonemergency basis. Therefore, county jails could use a Washington v. Harper administrative proceeding to authorize involuntary medication for an inmate who is suffering from a mental disorder, is gravely disabled, or poses a likelihood of serious harm to himself or others. Based on survey information, Iowa jails petition for a court order to involuntary commit inmates in need of treatment to a psychiatric hospital. It is difficult to have inmates committed to state psychiatric hospitals due to a shortage of beds.

Note: By statute, the hospital serves inmates from both IA DOC prisons and county jails. However, there is no evidence that this happens.