In his second year after medical school, psychiatrist James Gilligan found himself short on cash. A job at a teaching hospital in western Massachusetts where he practiced and learned didn’t offer enough for him to support his wife and three children, so he began exploring his options. Gilligan learned he could supplement his income by doing something he had no real interest in: He picked up a shift working as a prison psychiatrist with inmates at a medium-security prison in Norfolk, Massachusetts.
“I wasn’t planning to do this work at all—I had decided to go into psychiatry to treat people more or less like myself,” said Gilligan. “I had been taught up to that point that violent criminals were untreatable sociopaths, that they would manipulate you.”
Yet Gilligan’s new patients defied expectations and welcomed his help.
“Practically everything I’d been taught was at best a half-truth,” said Gilligan. “The people [in the prison] were eager for a chance to talk with somebody who showed an interest in them, who would try to help them understand themselves better.”
For the almost 50 years since Gilligan first set foot in that prison in 1967, he has dedicated his work to people convicted of violent offenses. His work revolves around the ethos that comprehensive rehabilitation, including mental health care, should be available to all offenders and is key to preventing violence.
“It is possible to prevent violence if you want to badly enough,” Gilligan told TakePart. “When you put people in a position where you treat them with respect and support them, even prisoners who have killed multiple people, it works. There’s nobody who I would regard as hopeless.”
Amid the explosive growth of the incarcerated population in the decades that followed Gilligan’s early work in Massachusetts, spurred in part by tough-on-crime rhetoric embraced by both Democrats and Republicans, the gospel Gilligan expounded largely fell on deaf ears. The U.S. prison population has increased by 500 percent since the mid-1970s. With the population peaking in the last several years, bipartisan support for limited reforms has slowly emerged. While some legislators have been stunned by sticker shock at the state level, where corrections expenses have strained budgets, others have called out the enormous racial disparities in the criminal justice system that disproportionately ensnare low-income people of color.
The politically palatable focal point of these calls for change has been low-level, nonviolent offenders, while few have dared to touch the third rail issue of people convicted of violent offenses, who comprise more than half the nation’s state prison population. To Gilligan and others seeking to reduce the number of people in U.S. prisons, this is a missed opportunity.
In the early 1970s, U.S. District Judge W. Arthur Garrity ordered the Massachusetts Department of Corrections to fund the establishment of a team of psychiatrists in the prisons to stem the growing violence behind bars. Garrity’s order followed a spate of suicides and deaths of both prisoners and corrections officers, and it put the chaos in the hands of Gilligan, who was invited to lead a team at Bridgewater State Hospital. Bridgewater is a prison that houses people charged with or convicted of crimes who are awaiting medical evaluation or services. It has been the subject of numerous investigations and lawsuits challenging its treatment of mentally ill inmates in the years before and after Gilligan’s work there. The prison’s population includes people convicted of both violent and nonviolent crimes.
Working with colleagues at Harvard Medical School, his alma mater, and with the support of the court order, Gilligan set up a mental health service at Bridgewater in 1977. The model eventually expanded and was replicated throughout the state’s prisons.
“The Massachusetts prisons were like a war zone,” said Gilligan. “Once we established mental health clinics, we could go for a year at a time without a single fatality in any of the prisons.”
Today, while prison mental health services have become more commonplace, the vast majority of prisons and jails in the U.S. are unable to meet the needs of inmates who have been diagnosed with mental illness, much less the basic therapeutic needs of those who have not been legally designated as mentally ill.
“The most effective way to turn a nonviolent person into a violent one is to send them to prison,” said Gilligan. “Whether or not a person is mentally ill, prisons provoke violence.”
That’s where programs like Gilligan’s have come in.
Because the prison mental health programs in Massachusetts were built on the back of a court order that forced the state to fund them, they were constantly under fire by the Department of Corrections and tough-on-crime politicians who felt they were a poor investment. Gilligan pleaded with judges to keep the programs going, but after 15 years, he lost the fight. The court ceased to uphold the order that created a contract between the Department of Corrections and Harvard Medical School, and the department eliminated the contract.
In the absence of the court’s support, Gilligan resigned as head of the prison’s mental health hospital and moved on to San Francisco, where he got a grant to set up a violence prevention program in the city’s jail based on what he had learned in Massachusetts. Working with a cellblock of 60 men, Gilligan ran intensive programming 12 hours a day, six days a week, all for people convicted of violent crimes. The programs involved group therapy, meetings with crime victims who talked about the impact of violence on their lives, and theater and writing classes.
Gilligan and his team tracked the men after their participation in the program and release from jail. For those who spent two months in the program, the likelihood of committing another violent crime after release dropped by 66.7 percent compared with those not in the program, whose violent-crime recidivism rate decreased by 41 percent. Overall, the recidivism rate of participants dropped by 48.3 percent, while the average rate for the control group fell by 34.7 percent. He continued to run the program for 10 years.
“Even though this was just a small pilot study, it showed what you can do if you make the effort,” said Gilligan. “It made the city and the jail safer.”
The program was curtailed after San Francisco Sheriff Michael Hennessey ran for reelection in 2004. Hennessey was known for being a progressive who supported rehabilitation programs, and he was accused during his reelection campaign of being soft on crime. In the aftermath of the election’s turmoil, the reelected Hennessey minimized funding for the program—a change Gilligan attributes to a political survival effort.
The most effective way to turn a nonviolent person into a violent one is to send them to prison. Whether or not a person is mentally ill, prisons provoke violence.
James Gilligan, Psychiatrist and Professor
As criticism of the American criminal justice system grows, calling the country’s mechanism for crime and punishment broken has become a common refrain. With a mounting cry for reform has come a softer but persistent observation that goes something like this: There is nothing broken about our system of policing, courts, and prisons. Rather, it is working exactly as intended—to punish and incapacitate those who violate the rule of law.
“Our criminal justice system has long turned its back on the rehabilitative ideal that informed the founding idea of our system of corrections,” said Scott Hechinger, senior staff attorney with Brooklyn Defender Services, which represents 45,000 indigent defendants in New York City each year.
Perhaps nowhere is that objective better illustrated than in the lack of rehabilitative programs like those Gilligan administered. In spite of Gilligan’s findings that violence is treatable and preventable, the political will to fund such programs is absent. Similar programs are rare, and support for them is subject to the whims of the political climate.
Even victims of violent crime have expressed a desire to prioritize rehabilitation over punishment. A survey released in August by the Alliance for Safety and Justice, a victim-focused criminal justice reform organization, found a majority of crime survivors would want to see more resources invested in prevention and rehabilitation programs. In a survey of 800 crime victims, six out of 10 said they’d like to see a system that doles out shorter sentences and invests in mental health treatment, drug treatment, community supervision, and community service in addition to rehabilitation. This preference was indicated even among respondents who had survived a serious violent crime.
By heralding confinement and punishment over treatment, Gilligan argues, the prison system aggravates violent tendencies.
“Far from reducing violence, punishment is the single most effective way of stimulating violence that we’ve yet discovered,” said Gilligan. “The more severely the prisoners were punished, the more violent they became. This became a vicious cycle.”
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In many prisons, severe punishment takes the form of solitary confinement. In so-called supermax prisons, an American invention intended to house the worst of the worst, prisoners spend up to 23 hours a day isolated in 7-by-12-foot cells, sometimes for years at a time. For these prisoners—even for those who will ultimately be released—supportive programming or rehabilitation is almost nonexistent. In addition to aggravating any existing violent tendencies, research has shown that solitary confinement can provoke mental illness and increase the risk of suicide. Isolation in the absence of rehabilitation also makes it more likely a prisoner will re-offend after release, according to Terry Kupers, a psychiatrist who regularly testifies on jail and prison conditions. In one 2009 study, violent offenders isolated in Florida supermax prisons were found to be more likely to commit another violent offense after their release.
“Simply putting a prisoner in a viable rehab program is going to be the best bet for helping him succeed at going straight when he is released,” said Kupers. “In stark contrast, if he spends significant time in solitary confinement in prison, his risk of recidivism would be very high.”
For people convicted of violent offenses, both the absence of rehabilitative programming and the scarlet letter of their conviction can haunt them long after release.
“Upon release, my clients are marked men and women,” said Hechinger. “Clients with violent convictions have a higher hurdle to overcome because of a designation made by the government and a false narrative disseminated to the public: Violent once, violent forever.”
The data that does exist illustrates the opposite is true: Violent offenders are actually less likely to recidivate than nonviolent offenders and even less likely to commit another violent offense. A 2014 study from the Bureau of Justice Statistics found violent offenders were less likely than property, drug, and public order offenders to commit another crime within five years of their release. The study did not measure access to rehabilitation.
Ronald Day, who spent 15 years in prison for attempted murder, is acutely aware of how a punishment can linger even after time has been served. Day was incarcerated at 21. A high school dropout who grudgingly earned a GED prior to his incarceration at the encouragement of his cousin, he didn’t realize how much he could enjoy the educational process until he began taking classes in prison.
“My mom told me I had a good head on my shoulders,” said Day. “But it wasn’t until I went to prison that I was actually able to access a college education.”
Though he is in his fourth year of a Ph.D. program in criminal justice at the John Jay College of Criminal Justice and has rebuilt his life, Day is concerned that the strictly punitive nature of the criminal justice system is out of touch with reality.
“We say we’re a country that believes in science, [and there is] social science research that supports the notion that people do change, people are not incorrigible,” said Day. “To have a system that is purely retributive is a problem.”
To shift away from a punishment-centered system, Day and other advocates point to the rehabilitative value of offering higher education behind bars for violent and nonviolent offenders alike. During his time in prison in upstate New York, Day began taking college courses and earning credits. But his education was cut short in 1994 when President Bill Clinton signed the Violent Crime Control and Law Enforcement Act—which bars prisoners from receiving Pell Grants—inhibiting funding for his education.
Day was left with limited vocational training opportunities and ended up in a drafting class. While designers on the outside had moved on to using computers, Day’s class only had access to “the board and a ruler,” restricting his ability to find a job in the non-prison workforce.
“Building skills and keeping yourself busy in what is a very dehumanizing environment can be beneficial, but it’s sometimes not very useful when people make the transition after their release,” said Day, who completed his degree in public administration after leaving prison.
Hechinger, the public defender, has seen similar problems with his clients, most of whose jobs behind bars have been sweeping, mopping, and cleaning toilets.
“Not because that’s what they would choose to do if they were offered opportunities but because that is the only programming available,” said Hechinger. “As a result, my clients come out with no additional hard skills and ill equipped to reenter society.”
Though the 1994 crime bill that bars prisoners from receiving Pell Grants remains in place, in July 2015 the Obama administration announced it would use its “experimental authority” to launch a program that allows a select number of prisoners (12,000) who are within five years of release to receive funding. The program partnered with 67 colleges and universities across the country to offer classes in prisons and online and launched this summer. Legislation that would fully eliminate the ban on Pell funding was introduced in the House in 2015, and an identical proposal was introduced in the Senate. Both bills await hearings.
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When announcing the program, the administration cited a 2013 RAND Corporation study that found that prisoners who participated in educational programs were 43 percent less likely to re-offend within three years of release than those who didn’t take classes. The RAND study also found that every dollar spent on prison education saved $5 in incarceration costs. The average recidivism rate among all prisoners is problematically high: 68 percent return within three years of release.
Lorenzo Brooks, who served 30 years behind bars, credits his personal transformation to the access he had to higher education in the eight years before the 1994 crime bill passed. Convicted of second-degree murder in 1986, Brooks was sentenced to 20 years to life for stabbing a woman to death during a robbery the year before. At the time of the crime, Brooks was 30 and struggling with a crack cocaine addiction.
While he describes his early years in prison as largely idle, once he began visiting the prison library and taking classes, he noticed a shift.
“The sociology and psychology courses I took gave me insight into crime and criminal thinking,” said Brooks. “I really started seeing myself in what was being said there. It got me thinking about myself, the crime I had committed, and the harm I had caused myself, my family, and my community.”
After earning 73 course credits, Brooks, like Day, was cut off in 1994.
“There’s something about education that humbles a man,” said Brooks. “College education changed my life around.”
He immediately joined the movement to bring back higher education to prisons—something he advocates for today, in the first year of his life outsideprison. (Brooks was incarcerated for 32 years and was denied parole nine times before being released.)
Both Gilligan and Hechinger noted the power of providing education behind bars. Gilligan cites earning a college degree while incarcerated as the most successful means of preventing violence both in prison and afterward. Studies conducted by state corrections departments as well as the federal Bureau of Prisons illustrate the correlation between education and reduced recidivism rates.
“Meaningful academic opportunities are the best marker for rehabilitation and preparation for successful reentry,” said Hechinger.
Rehabilitative programming, educational or otherwise, often runs up against a well-worn rhetoric of punishment that rejects the notion that costly programming should be made available to people convicted of heinous crimes. It’s a tough sell to argue that scarce state and federal funding, already squabbled over, should be earmarked for people convicted of violent crimes. But Gilligan sees no alternative. In San Francisco, his team calculated that the level of re-offending and re-incarceration was so low for participants that the intensive program saved taxpayers $4 for every $1 spent on it.
“It’s an investment that pays itself off,” said Gilligan. “The question is not can we afford to have a program like this in our prisons and jails but can we afford not to. Right now, we’re wasting money and wasting human lives. We’re making the community less safe.”