Ill Documented Essay


An inmate on max assault status and 23-hour lock down talks to himself in his cell. Max assault status is issued to inmates who have attacked officers or treatment staff. The inmates have been known to throw a mixture of feces and urine, spit, hit, kick, punch or cut. Photos by Jenn Ackerman.

What happens to someone suffering from mental illness after they commit a crime? Are they treated for their illness during their incarceration? Is their treatment sufficient or will they be sent back to the streets without the necessary help to prevent future damage?

With the mass shootings in Newtown, Conn., Aurora, Colo., and countless others before, the treatment of mental illness has become a highly debated national issue. The conversation has largely been about prevention, treating the mentally ill before they commit a crime. But what happens after the crime is committed? What is the prison system like for the mentally ill and the people responsible for managing them?

Minneapolis photographer Jenn Ackerman set out to find out the answers to these questions. For her project Trapped, she spent months in the Correctional Psychiatric Treatment Unit (CPTU) of the Kentucky State Reformatory to learn about the experiences of the mentally ill confined in the prison system.

According to Ackerman, nearly 25 percent of prisoners in Kentucky suffer from schizophrenia, bipolar disorder and other equally serious mental health problems. Larry Chandler, the warden at the Kentucky State Reformatory in La Grange told Ackermann, “We are the surrogate mental hospitals now.”

“I saw them cry. I saw them hit themselves so hard in the head that they bled. I saw them throw their feces at the officers. …For most of these men, they have been outcasts of society and rarely heard. So they had a chance to share their story and have someone listen that actually cared,” Ackerman describes in her artist statement.

Art Beat recently spoke with Ackerman about her experience:

Art Beat: What sparked your interest in this project?

Jenn Ackerman: The project really started when I read an article. I don’t remember what the article was about honestly, but there was a sentence that mentioned that there was an increase in the mentally ill in prisons, and so of course that led to questions and to weeks of research and then I had to do this project. People need to understand what’s going on and people need to see it and feel it. My belief is that when you feel something you can’t forget it and so my approach was to make people feel something from these images in order that they can’t forget it. So after weeks of research, I put a proposal together and started contacting prisons in the U.S. that were attempting to meet the needs of the mentally ill.


A man on suicide watch lays without a blanket. “Isolation works in our favor sometimes, but more often than not it works against us,” says Dr. Stephanie Roby, psychologist in CPTU.

Art Beat: What was your experience in the prison? What are you trying to make the viewers feel?

I felt sorrow, compassion, and that’s what I wanted people to feel. It wasn’t that I was scared of these men and I didn’t want people to walk away scared; I wanted them to walk away saddened by the fact that these men had ended up in prison. It was a really sad experience for me and one where I felt helpless in a way and that emboldened me more. I need to do this even more than I thought originally. I need to help these men, not necessarily the ones in Kentucky, but the people that are ending up in prison with mental illness. I need to help the situation.

Art Beat: You say in your artist statement that “The system designed for security is now trapped with treating mental illness and the mentally ill are often trapped inside the system with nowhere else to go.” What do you mean?

Jenn Ackerman: At first, I went into the prisons with the intention of showing what the inmates were dealing with and then I realized that it’s actually two-sided. The prison system is designed to keep people secure within the boundaries of a prison. They’re not designed to be a hospital and they now have to do both, which means they are not doing either really well. They are not getting as much funding as they would need in order to treat these men and they don’t have the capacity to do so. They’re correctional officers, not nurses; they are not there to treat the inmates, but that’s what they are learning. They have to be trained to help treat people with mental illness.


Correctional officers clean the room of an inmate, searching for possible weapons, after the inmate cut himself with a spork earlier that morning.

On the other side of the equation, a lot of the men that I met received treatment before they ended up in prison. I would say 97-98 percent had already received treatment, which was not very successful at the time. They would be put into a hospital setting, but at the time they would only be able to stay in a psychiatric treatment facility for 72 hours. With someone with mental illness, that is definitely not enough to maintain their meds and get them stabilized, so they often went back on the streets and got off the meds. Some of these men did some pretty heinous things, but often they were just delinquents. They would steal something at a convenience store and then they would be put into jail overnight and they wouldn’t understand what was going on and they would hit an officer and that would get them into the system. Once they get into the prison system, it’s really hard for them to get out because a lot of them are not aware of what was going on, they don’t understand the rules. A lot of these men were not able to follow the rules of society and now to follow the rules of the prison system is really difficult.


The men in CPTU are a fading memory for many. The mentally ill often get trapped int he system with nowhere else to go. Here, a man stands in the middle of his room for most of the day staring at the 4 walls surrounding him.

Art Beat: What about the correctional officers? Can you speak about their experience?

Jenn Ackerman: It’s not an easy job for them. I saw the level of compassion that they needed, the level of trust that they had to have with these men, who are very volatile. They are a very volatile community of inmates and the officers really cared and that really surprised me. The first day that I was there, I saw them do a cell entry, which means they broke down the door, handcuffed an inmate, and strapped him in a chair. I was so taken back and upset by the situation and I was so frustrated with the officers because I was like, “What are you doing? Why are you hurting them?” That afternoon, they explained to me, “Look, Jenn, he was trying to commit suicide. He had been trying to hurt himself all day.” I realized at that moment that they have such a tricky position to play because they are not only trying to keep them secure, they are really trying to keep them from hurting themselves. If that means being hit on and spit on, then they are willing to take that. It definitely takes a certain type of individual; not every correctional officer can handle that level of compassion day after day after day. There is a high level of turnover in that unit for that reason alone. It takes a lot of patience and humor to get through that and not every officer comes into a prison expecting to have that kind of job and need those kinds of traits.


An inmate is cuffed and returned to his cell after acting out earlier that day. A spit mask is used to prevent him from spitting at the doctors and correctional officers. “Our priority is security. That mandates that we have certain security measures that cant be breached. But security can’t be a stranglehold on progress,” says Larry Chandler, warden of Kentucky State Reformatory.

Art Beat: How did you gain the access and trust you needed to tell this story?

Jenn Ackerman: One of the things I really strive for is access and trust in all of my projects, no matter what. I realized that in order for me to be the photographer that I am, I have to have that. That’s what I told the warden. He was an amazing component to this. He believed in educating the public and at the time, his prison was really struggling with what to do with this population. When I first approached him, I gave him my spiel and told him I needed that level of access and asked him if he was willing to do that and I just put it out on the table and told him exactly what I needed and what I was planning to do. He believed in the story and he believed that people needed to know about a population that is rarely talked about in prison.


The officers restrained an inmate after he banged his fist and head on his cell door for six hours and threatening to kill himself.

The inmates were skeptical of course of someone coming with a camera. But after days of talking to them and explaining my intention and showing them that I was willing to put down my camera and the questions I was asking them — I wasn’t really asking them about their crime and I think that also helped. I didn’t really think it was necessary to the story and I think that showed them that I really did care about their condition in prison and their experience of mental illness. That’s pretty much all I asked them, “what are you experiencing, do you hear voices, tell me about what goes on through your mind during the day?” Those kinds of questions. I think that helped to reinforce the story that I was really trying to tell and I think over time, everybody within that prison, including the doctors and the correctional officers, knew that this is a story that no one really talked about and they were really willing to talk to me about it.

To see more of Jenn Ackermann’s photographs, view the slideshow below:

In a 5–4 decision on Monday, the Supreme Court ruled in favor of an indigent Alabama death row prisoner who had no dedicated mental health expert to help explain his condition to the court that sentenced him to die. The task before the court in McWilliams v. Dunn was to determine what kind of expert psychiatric assistance an indigent defendant deserves at trial. The court—with Justice Anthony Kennedy weighing in with the liberal wing—ruled very narrowly but in a way that suggests that five justices are pretty certain that a defendant receiving almost no expert help in explaining at trial a serious mental health issue is problematic, if not unconstitutional. The ruling could have an impact on two Arkansas death row inmates—Bruce Earl Ward and Don Davis—whose executions had originally been set for April 17 before being halted over similar questions. The death penalty may still be dying in America. But we continue to have no idea what to do about mentally ill defendants in court.

Dahlia Lithwick

Dahlia Lithwick writes about the courts and the law for Slate and hosts the podcast Amicus.

In 1984, James McWilliams was convicted and sentenced to death for the rape and murder of Patricia Reynolds during a robbery at a Tuscaloosa, Alabama, convenience store. A three-member state “Lunacy Commission” examined McWilliams at a state hospital and concluded he was competent to stand trial. But McWilliams had no expert witness testify on his behalf at trial or help in the preparation of his defense, despite the fact that two days before his sentencing hearing a court-appointed psychologist concluded that McWilliams had “organic brain dysfunction.” His lawyer also only received 1,200 pages of critical prison records the day before sentencing. They revealed that McWilliams was being treated with strong psychotropic drugs. His defense counsel pleaded with the sentencing judge for time and an expert to help him understand all the new material, which as a layman he could not understand or explain. The judge gave him three hours, no expert, then concluded that the accused was “feigning, faking and malingering.” McWilliams was sentenced to death. On appeal, McWilliams argued that the trial court denied him the right to meaningful expert assistance as guaranteed by the 1985 case Ake v. Oklahoma. In Ake, the Supreme Court established that when an indigent defendant’s sanity becomes a major issue at trial, “the State must, at a minimum, assure the defendant access to a competent psychiatrist who will conduct an appropriate examination and assist in evaluation, preparation, and presentation of the defense.”  

James McWilliams—on death row for more than 30 years—will get another look.

In an opinion authored by Justice Stephen Breyer, the court concluded Monday that McWilliams did not receive such assistanceand sent the case back to the 11th U.S. Circuit Court of Appeals to determine whether that kind of help would have made a difference at sentencing. The majority did not rule on the broader constitutional question of whether Ake meant that indigent defendants have the right to have meaningful assistance and participation from these expert mental health witnesses.

Breyer—writing for Justices Kennedy, Ruth Bader Ginsburg, Sonia Sotomayor, and Elena Kagan—found that even though Ake was decided after the McWilliams conviction, that conviction could be revisited under existing death penalty law if it was “contrary to, or involved an unreasonable application of, clearly established Federal law.” That is typically a very big lift, but the court found that the bar was met. So McWilliams—on death row for more than 30 years—will get another look.

Breyer first noted in his opinion that McWilliams was indeed indigent and indeed suffered from a mental condition that was relevant to his punishment. Breyer rejected Alabama’s claims that McWilliams’ lawyer had a volunteer expert he never called and the claim that his lawyer never asked for an expert.

Breyer then found that Ake clearly held that a defendant must receive the aid of a mental health expert who can “assist in evaluation, preparation, and presentation of the defense” and noted that most states now provide defendants with their own experts who do just that. The only question, then, was whether Alabama did enough to meet that standard. Breyer found that an independent expert dumping a report on a defense counsel’s desk prior to a sentencing hearing without any assistance in understanding it was not enough. He ruled that while Alabama met the examination requirement of Ake, it failed completely to provide an expert to help out with the evaluation, preparation, and presentationprongs of the case. He concluded that this sort of assistance might have made a difference at sentencing for James McWilliams.

Justice Samuel Alito—writing in dissent on behalf of Chief Justice John Roberts and Justices Clarence Thomas and Neil Gorsuch—was clearly annoyed by this ruling. He was angry that the majority ducked the larger question of whether the decision in Ake clearly established that an indigent defendant whose mental health was a significant factor in a case is “entitled to the assistance of a psychiatric expert who is a member of the defense team instead of a neutral expert.” Alito called this duckage “a most unseemly maneuver.” After excoriating the majority for deciding the case narrowly, Alito argued that in any case, Ake was ambiguous about what kind of psychiatric help a defendant must receive. Further, he wrote that ruling clearly stated that an indigent defendant does not have a constitutional right to “choose a psychiatrist of his personal liking or … receive funds to hire his own.” Alitoinsisted that the court in Ake held only that a defendant is entitled to have “access” to “one competent psychiatrist” and concluded that “Ake is ambiguous, perhaps deliberately so.” He concluded that the majority’s decision to rule only on the facts of the case and not the broader issue is “acutely unfair to Alabama,” which briefed only the broader question. He argued that the state was not given a fair chance to respond to this narrow question, and so the ruling would come as “nasty surprise” to the state.

At least now Alabama will know how McWilliams’ lawyer felt.

Alito finally argued that the lack of expert help was a “harmless error” that wouldn’t have made a difference in the sentencing anyhow.

Alito made the narrowness of the ruling a key bone of contention, but the passage of time and state statutes that now afford the kinds of assistance required in this case will eventually obviate the need to decide this broader question. So, perhaps simply correcting the injustice done to McWilliams is enough. But what is lost as a result is a focus on the massive disparity between the resources available to prosecutors and those available to indigent defendants. That’s a divide that continues to expand. I asked Stephen Bright, McWilliams lawyer at the Supreme Court, why the disparity in resources matters so much. He said, via email:

It’s not fair for the prosecution to be able to hire any expert it wants and as many experts as it wants while the defense is not even allowed to consult with an expert. The adversarial process cannot function properly if the prosecution can retain mental health experts, but the defense is not even allowed to consult with [one]. Today there is great reliance on experts in many areas of the law. A mental health expert who can assist in the evaluation, preparation, and presentation of the defense is indispensable in a case which is decided by expert testimony.

It seems to me that latter bit is also somewhat lost in these dueling opinions: the acute crisis in the mental health of defendants and prisoners. As I noted at the time of oral arguments, a recent Bureau of Justice Statistics report estimated that 64 percent of local jail inmates, 56 percent of state prisoners, and 45 percent of federal prisoners have serious mental health illnesses. Mental health diagnoses cannot merely be a “check the box” enterprise for the justice system. Rigorous analysis and explanation is necessary. That the court is fighting over whether only McWilliams deserved better or whether all indigent defendants deserve better is pretty much reflective of the problem itself: Mental illness isn’t simple; brain science is ever more complicated, and whether the courts go big or go small on that question doesn’t make the desperate need for the justice system to acknowledge all that go away.

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