How did you find this story? How did you come to focus on Ohio's prison system? Why prisons and not jails?
We became interested in the subject of mentally ill in prison while working on our previous FRONTLINE film A Crime of Insanity, about a paranoid schizophrenic defendant who killed himself inside a New York State prison. During that research, we were shocked to see firsthand the large number of mentally ill defendants in jails or prisons -- and how difficult it was to treat those prisoners inside a system designed primarily for security and punishment.
So we did general research, including many conversations with prison administrators across the country. We knew we wanted to find a single prison system that would allow us to go deep inside -- without restrictions -- so we could document every aspect of prison mental health care, positive and negative. Unrestricted access to any prison system is always difficult, but obtaining permission to film inside a prison mental health unit was really tough. A handful of state systems expressed interest in working with FRONTLINE, but many others refused to let our cameras in -- especially when it became clear that we needed full access.
Over the course of our research, a number of experts in the field suggested we talk to Reginald Wilkinson, the director of the Ohio Department of Rehabilitation and Correction. He is an uncommon voice of reason within the entire corrections world -- and a bold leader. In the early '90s, after a devastating prison riot at their maximum-security prison, a class-action lawsuit was filed by Alphonse Gerhardstein on behalf of Ohio's 12,000 mentally ill prisoners. The lawsuit alleged that prison mental health care was woefully inadequate. Instead of fighting the lawsuit, Ohio prison officials -- Director Wilkinson, in particular -- decided to negotiate a settlement. At the cost of over $70 million, Ohio prison officials then spent a decade overhauling their entire prison mental health system. The before-and-after story in Ohio made them even more interesting to us -- and ensured that the issues we found in Ohio would be illustrative of the problems faced by prison systems throughout the country.
Although we did a good deal of research (and some filming) in the Franklin County Jail in Columbus, Ohio, we ultimately decided, for a number of reasons, to focus on prisons rather than jails. Although jails are handling vast numbers of mentally ill prisoners, most offenders -- even those arrested for minor offenses -- eventually end up in the prison system, so we decided to focus on a single prison system. In addition, most jail inmates have cases pending and we didn't want to affect the outcome of their trials in any way.
From what you know, how does Ohio compare to the rest of the states today?
Today, Ohio's prison mental health care system is considered one of the best in the country. While many states continue to wage never-ending legal battles over prison mental health care, the voluntary changes made in Ohio have become an important new model for prison reform. Of their many reforms, Ohio has set up a system that is trying hard to replicate the community mental health care model. So treatment is available in virtually every one of the 30+ prisons and a system for more intensive treatment is also available. Ohio is one of only 12 states that has a prison psychiatric hospital (Oakwood Correctional Facility) and they have instituted a screening process for mentally ill inmates at every one of their institutions.
What did it take to get access? Were there restrictions on who or what you could film?
Getting access to Ohio's prison system was possible largely thanks to Director Wilkinson, who is proud of the improvements they have made in Ohio's mental health system, and who was also unafraid to let us examine their system -- warts and all -- in order to let the public finally see for themselves the real struggles of dealing with the growing crisis of large numbers of mentally ill prisoners. Wilkinson and his prison staff worked enormously hard to figure out ways to make possible unrestricted access and addressed at the same time all the legal and ethical issues involved in our filming.
It was also a really difficult issue to figure out how to sort through the legal and competency issues regarding informed consent for the mentally ill inmates. After several meetings over the course of nearly two months, Director Wilkinson and prison officials worked out the details of filming and FRONTLINE was granted complete access. Most corrections departments, when confronted with the problems of inmate mental health care, have refused to talk publicly about what's happening inside their prisons. The ODRC, however, has come to believe that their state prison system will be improved by casting more light, not less, on the difficulties they face, so they decided to cooperate fully with FRONTLINE on this project. Throughout the filming, and despite many moments of intense pressure to pull back on our access, Director Wilkinson never wavered and never restricted what we could film.
How many weeks did you film? Did you have to be at the prison every day to capture what you did?
The principal filming at the prisons was only about three weeks -- although there were pick-up days and additional interviews done outside the prison system. We filmed for full days inside the prison and tried to just follow what was going on day to day. But it was a real challenge to figure out how to capture the feel of an observational or vérité-like film with a limited shooting schedule. So we coordinated as much as possible with the prison and mental health staff, but each day also had to stay open to whatever happened inside the prison. For all of us, it was probably the most difficult, exhausting and intense filming we have ever done.
What were the challenges? What don't we get to see in the film? What about problems you confronted as two women in a male prison?
There were many practical challenges each day. Beyond the logistics of filming and capturing sound inside a prison system -- getting the equipment through security each morning, the great distances between each scene we filmed, the unpredictability of inmate movement, etc. -- overall planning and prep was virtually impossible.
Of course, there is a lot of footage that didn't make it into the film. Some of this is posted on the Web site, such as our tapings of the songs of some of the mentally ill prisoners. And, we filmed many treatment sessions or hearings, as well as in-depth interviews with the corrections officers and mental health staff who work daily with these inmates, for example, that did not make it into the final cut because of time constraints.
Surprisingly, as two women in a male prison, we adjusted pretty well, although we each certainly have some very unforgettable memories. But there are many female corrections officers, as well as mental health staff, who work everyday inside the prisons, so the inmates in Ohio are generally used to seeing women inside the cellblocks. We did feel at times that it was easy to get lulled into forgetting you were inside a prison, and if and when that happened, the corrections officers always took extra care to make certain we were never in real danger. There were times, for example, when we would move in very close to talk with inmates at their cells' doors, and occasionally the COs would have to pull us back to warn us that a particular inmate might be unpredictably assaultive.
For us, another enormous challenge in filming was how frequently the inmates were moved through the prison system ... sometimes to the prison psychiatric hospital or to higher- or lower-security prisons. So when we identified an inmate we wanted to focus on, often by the time we began filming the inmate would have been transferred to another facility. That kind of movement made it nearly impossible to figure out which characters to follow and how much to film with each one.
We faced another big challenge in the edit room: How to organize and structure a vast amount of material that was extremely powerful but had no clear or obvious narrative. The idea of "the new asylums" is a huge subject, but like every filmmaker, we had the really difficult job of having to figure out how to shape so many different characters, places, and ideas into a single, coherent and compelling film.
What were the surprises?
I think we were surprised by how much treatment there was inside Ohio's prisons -- and in many cases we were surprised by the quality of care. Yet even with the impressive mental health care system we saw in Ohio, we were still left feeling that improving prison psychiatric care really isn't the answer -- or at least is only part of the answer -- for dealing with this really disturbing national problem.
The other big surprise was the dedication and humanity of many of the officers who work in the mental health units. Contrary to the stereotypes, we met many officers who are making a real difference in the lives of mentally ill prisoners and we saw firsthand what power they have -- for good or bad -- in the daily life of every inmate, but especially inmates who are seriously mentally ill. That world of corrections surprised us and we left the Ohio prisons even more convinced that the work of a good corrections officer is one of the most difficult, demanding, and often thankless jobs in this country.
We were also surprised to see the range of mental illness inside the mental health units. It is easy to see how easily one can become numb to the tragedy of vast numbers of the mentally ill behind bars, but there were many inmates and incidents where we were just overwhelmed by the sadness of it all.
Were there any special issues in filming mentally ill prisoners?
A lot of issues had to be sorted out before we could film them. After much discussion, it was decided that we would get releases to film from the inmates, as well as releases to look at their records. It was also decided that the prison psychiatrist had to evaluate each inmate that we wanted to interview to make certain that, in the treating psychiatrist's opinion, the inmates were competent to agree to be filmed, given the nature of their mental illness. It was a lengthy but enormously important part of our process. In fact, we dedicated a full week to get all the appropriate releases. Sadly, there were also many inmates whom we all agreed were simply too sick or too fragile to approach about the prospect of being filmed.
Interestingly, the inmates reacted very naturally to the cameras. More than anyone else, really. Not surprisingly, we did not have problems finding inmates who wanted to talk and the majority of inmates agreed to sign the film releases. It didn't take long for everyone to get used to our cameras, and overall, staff and inmates were remarkably unfazed at being filmed.
Initially, the corrections officers were more wary about being filmed largely because of how they are typically portrayed "in the media," they say, but also because there are so many lawsuits, or the threat of lawsuits. There was at first some reluctance to speak openly about these issues, and some hesitancy to talk on camera, but eventually, most officers agreed to work with us.
Few Americans have had the experience of being inside a maximum-security prison. What was it like? Was there anything in particular that most affected you?
It's strangely surreal. The maximum-security prison is like a city, really. Vast. Contained. And enormously structured. And intensely disturbing. Routine is everything inside a prison. So every inmate must follow a rigid daily schedule from the moment he wakes up, to the moment he goes to sleep. And when you see how structured everything is, you realize how tough it would be for any inmate -- but especially the mentally ill prisoners -- to function inside and outside of the prison walls.
At the beginning of the film, we get a glimpse of mentally ill people who are struggling [with] living in their communities. How much time did you spend on this part of the story? And can you sum up the situation in the community?
We knew that there was going to be a limited amount of time in the film to fully address what is happening on the streets across America. During research, we did spend a fair amount of time with police in Columbus, Ohio, where many officers can now voluntarily take a training course called Crisis Intervention Training (CIT) to better deal with situations involving the mentally ill people in the community. Anytime a crime involves a mentally ill person, CIT officers can be called to the scene to help with what can often be a dangerous situation with mentally ill offenders.
Many police know the mentally ill offenders really well because they see them repeatedly cycle in and out of the local jails. Officers describe them as "frequent flyers" and are on a first-name basis with many of these repeat offenders. We were all surprised by the degree to which police departments throughout the country have been left to handle this enormous social problem.
Lack of community resources continues to be a disturbing reality. While there are many people in the community trying to provide services and treatment, they seem to be asked to do more and more, with less and less. Our sense from people on the streets was that unless meaningful funding is finally funneled into long-term treatment in the community and release and reentry efforts, the cycle of recidivism among the mentally ill is not likely to change. Unfortunately, when people are released from jails and prisons, there are currently not enough housing options, employment possibilities, and/or long-term treatment centers that could prevent the mentally ill from heading right back to jail or prison.
What's your sense of the amount of movement for change that's out there in the country? Are there people or groups that are working for change?
Prison officials are taking the lead by default, speaking before Congress, developing coalitions, organizing conferences, etc. For the most part, they are being left to handle this issue. In Ohio, Alphonse Gerhardstein, the attorney in Cincinnati who brought the class-action lawsuit, has started a group (Prison Reform Advocacy Center) to assist inmates with grievances. One of the things that really surprised us was that the only thing that seems to force change in the criminal justice system is lawsuits. Also in Ohio, many pilot programs are being developed such as ACT (Assertive Community Treatment) and mental health diversion courts headed by Justice Evelyn Stratton, to try and help transition inmates back into the community or to keep them out of the prison system. But still not enough money is there to support these programs.