 | Mental Illness and the Criminal Justice System |
 Copyright 2004, Men Stopping Violence Inc.
Today, some 283,800 inmates are identified as having a mental illness. This represents 16% of the inmate populations of state and local jails. Jails have effectively become America’s new mental institutions; they house a larger volume of mentally ill people than all other programs combined. However, these inmates rarely receive the treatment that they need and have a right to. The criminal justice system is overpopulated and under equipped to deal with those with psychotic disorders requiring mental health care services.
Background
The shift in residency of the mentally ill from hospitals to the criminal justice system is the result of de-institutionalization, which occurred, in the early 1900’s. The impetus began in the 1970’s to eliminate the infamous mental institutions. These “warehouses” of the past were known for their sparse living conditions, brutal treatment of patients, and harsh medical procedures and treatments such as electroshock therapy. Concern for the civil rights of mentally ill persons, a desire to cut costs, and hope that new medications could replace supervised care spurred the movement to close the institutions. A majority of the de-institutionalized mentally ill had anosognosia, a condition that made them unable or unwilling to recognize their illness. In the civil rights conscious state of the era, they were allowed to make their own decisions regarding their need for treatment. Not surprisingly, many went off their medication and lost touch with mental health care centers.
Without family or a means to earn money for rent, many turned to a life on the streets. They were then arrested on minor charges by the police, under social pressure to “do something” about the homeless population. Approximately one third of homeless people have a psychological disorder.
Implications for the Mentally Ill Inmate
A common disorder to develop in prison is depression, a byproduct of institutionalization. In the context of a total institution, inmates are systematically broken down and manipulated by the staff. Their lives are completely supervised, homogenized, and organized. In the process, inmates tend to learn behaviors counter productive to their survival in the outside world. Some of these behaviors may include, “aggressiveness and intimidation of others or, conversely, extreme passivity, manipulative behavior and reluctance to discuss problems with authority figures. These behaviors create barriers to engagement in mental health services and treatment.” (Barr)
A result of the effect of prison life on inmates is the alarmingly high rate of suicides. Suicide is the leading cause of death in inmates, accounting for over half of the deaths occurring while inmates are in custody. Almost all who attempt suicide have a major psychiatric disorder. More than half of the victims were experiencing hallucinations at the time of the attempt. These deaths are tragic because mental disorders are highly treatable with 60-80% success rates.
Implications for Society
The overflow of the mentally ill has overloaded the prison system. The American Correctional Association recommends that jails should operate at 90% capacity. All jails were at 85% capacity in 1985, and were up to 111% capacity in 1987. The overcrowded conditions disrupt the efficiency and function of the prison system. Room for booking and close observation areas upon admission is at a scarce. Even if a mentally ill inmate is correctly recognized as in need of further observation or treatment, on-sight mental health professionals are scarce; there may not be anyone on duty at odd hours. Admittance screening is rushed and many mentally ill inmates who should receive treatment instead slip through the cracks of the system and enter into the general population. The original social goal of society to provide these individuals with more humane mental health care is lost.
Half of mentally ill inmates report three or more prior incarcerations . The long-term costs quickly add up. While the direct cost of mental health services was $69 billion in 1990, the estimated hidden costs of loss of productivity and long term health care cost were an additional $78.6 billion.
Why You Should Get Involved
Our society has attached a glaring stigma to mental illness, which makes
it difficult for individuals to ask for or receive help. The perception that mentally ill people are violent is a common one. In reality, studies have shown that they commit violent acts no more often than a random sample of their peers, if they do not abuse alcohol or drugs. The small percentage of mentally ill people who do represent a significant risk to themselves or others should not be ignored though. These people do belong in a correctional facility. However, many are arrested on minor charges and for non-violent crimes. In fact, 29% of jails in one survey reported holding mentally ill persons against whom no charges were ever pressed. They are jailed because more appropriate community based programs do not have the funding or space to deal with them.
Mental illness is stigmatized across every culture, every gender, and every geographic region of America. These individuals are feared and avoided as perpetrators of violence, an undeserved reputation. People need to realize that psychological disorders are a disease. They can be diagnosed and treated as such with high rates of success. Living with mental illness is a terrifying experience. It can be a confusing and disorienting time of their lives. On their own, those with mental illness often end up jobless and on the street. They need our help to set them on the path to mental health. We cannot morally afford to toss them into the prison system, to hide them in a dark corner of the American conscious. Out of sight, out of mind.
A large number of prison inmates today suffer from psychotic disorders that are severe enough to warrant mental health care. Numerous court cases have established that mentally ill inmates have the constitutional right to these services. However, more often than not, inmates are denied these needed services. Most prison administrators report that they do not have the resources or ability to respond to the needs of mentally ill offenders. They describe their programs as “grossly understaffed” and “in urgent need” of help from mental health organizations to develop appropriate programs. In effect, today’s prisons and jails are shouldering the responsibility for the mentally ill which used to reside with community based hospitals and institutions.
What Should Be Done
The federal district courts have formulated six components of a minimally adequate mental health treatment program
What You Can Do
The following is a sample letter that you can print off and send to any of the persons on the list below. Or, use your own creative voice to get involved. You can make a difference.
A large number of prison inmates today suffer from psychotic disorders that are severe enough to warrant mental health care. However, less that a third of these individuals receive the care that they have a constitutional right to. I find it abhorrent that, instead of seeking to rehabilitate these inmates, prison conditions drive them further into their illness, even to the point of suicide.
Rehabilitating and treating the incarcerated mentally ill benefits everyone. The inmates can become productive members of society once again. The overcrowded prison system saves money and space by not having to deal with repeat offenders. Short-term costs are offset by the long term savings in health care.
Please work to ensure that the mentally ill receive the help they need. The Correctional Mental Health Associates recommend that prisons employ at least the following staff to provide adequate care:
Sincerely,
Your Name Here
You can send your comments and concerns to these agencies:
Federal Bureau of Prisons Central Office
National Criminal Justice Reference Service
U.S. Department of Justice
Correctional Staff Perceptions of Disordered Offenders
There has been little research on the perceptions of correctional officers toward mentally disordered offenders. However, the authors of a recent study believe that officer perceptions are extremely relevant to the management of inmate mental health.
Correctional officers are in a position to identify offenders in need of mental health services and often to help some of these individuals. In addition, the prison environment has been shown to play an important role in the mental health of inmates. Correctional officers, who are a significant part of the prison environment, may well be able to reduce inmate stress.
The study evaluated the perceptions of correctional officers toward mentally disordered inmates in order to gather information that could prove valuable in the planning of officer-training programs. The authors emphasized that correctional officers perceived mentally ill offenders less favorably than mentally ill patients, other inmates, and the population in general.
The participants in the study were drawn from a potential sample of approximately 85 correctional officers employed at a maximum security prison center in Vancouver, Canada. Some of the officers could not be contacted because of shift changes or vacation leave. However, all of the 78 officers contacted agreed to participate in the study.
The participants were asked to rate mentally disordered offenders, mentally ill patients, other prisoners and most people in terms of 18 items.
In addition, the study assessed officers’ interest in receiving more training to deal with mentally disordered patients. The officers were shown four statements about training and were asked to rate their feelings about each one on a scale ranging from “strongly agree” to “strongly disagree.”
The officers also rated their feeling about their professional contact with inmates. A seven point scale measured the degree to which they felt in control, successful, active, helpful, effective, powerful and confident when dealing with inmates.
Demographic information gathered from the officers revealed no significant links between attitudes and the individual variables. The variables examined included age, sex, education, length of employment as a correctional officer, and the perceived amount of contact with mentally disordered prisoners.
The average age of the sample was 32 years, average education was some college, and average number of years in corrections was 6.6. On a scale of 1 to 5 (in which 5 represented frequent contact), the average level of perceived contact with mentally ill persons during the previous three months was 3.7.
According to results from the ratings, there were extreme differences between the officers’ perceptions of people in general and the other three categories (prisoners, mentally disordered prisoners, and mentally ill patients). The “most people” group was viewed the most favorably, and no further analysis was conducted on officers’ perceptions of this group.
Comparisons of the other three groups showed that mentally disordered prisoners were regarded as less predictable, less rational and more mysterious than other prisoners. However, prisoners in general were seen as more manipulative than mentally disordered prisoners.
A second comparison revealed that mentally disordered prisoners were perceived as more dangerous than mentally ill patients. Finally, mentally ill patients were seen as less bad and less manipulative than prisoners but also as more irrational and unpredictable.
The correctional officers as a group indicated strong concerns about working with mentally ill offenders. Ninety percent felt that it added stress to their job. Eighty-nine percent thought that mentally disordered offenders should be kept in facilities separate from the rest of the population. Almost all of the officers were interested in additional training to deal with mentally disordered offenders. In contrast, they reported that they generally felt confident in dealing with the rest of the inmate population.
One item which discriminated officer perceptions of mentally ill offenders and mental patients was “dangerousness.” The perception, or misperception, of the uniform dangerousness of mentally ill offenders would be an important issue for training programs to focus on.
The study clearly indicates that correctional officers have concerns about mentally disordered offenders and would like to improve the ways in which they deal with these offenders.
In the final analysis, it is important to note that, although the participants in this study were trained under the most current programs, they still felt unprepared to deal with the mentally ill. Future research should examine training programs in order to identity the source of gaps in understanding. The perceptions and needs of the people working most directly with mentally disturbed individuals should be addressed.
Studies on whether the presence of mentally disordered inmates is stressful for the rest of the prison population might also be an interesting area of research. In such studies, samples would have to be selected very carefully in order to avoid misclassification of offenders.
Kropp, P. Randall, Cox, David N. , Roesch, Ronald, & Eaves, Derek (1989).
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