Sunday, February 10, 2013

The Truth about Mental Illness in Prisons

Review how the mentally ill end up on the streets, in our jails, how the treatment of the mentally ill in prisons is not adequate and what changes in the court system have been made to accommodate the mentally ill.

An overview of the Mentally Ill and Prison Population, research into prisoners reveals that many of our current prisoners are suffering from mental illness. Some of these prisoner are mentally ill and/or previously homeless and an alarming percentage of the population is also suffers from substance abuse disorders. This means some of today’s prisons are our leading institutions to house the mentally ill. Unfortunately prisons are not equipped to deal with mental health issues and many of the correctional officers have only basic understanding of mental illness. This leads many mentally patients receiving poor treatment in prison. Recent changes to the court system have been made to accommodate the mentally ill populations that find themselves in the criminal justice department. 

Previous to the de-institutionalization policy many of our mentally Ill were housed in Mental Institutions. The de-institutionalization policy gave more rights to those suffering from mental illness; including the right to refuse treatment (Martin, 2007). The de-institutionalization policy also relieved the government of the burden of what to do with the Mentally Ill populations. Ultimately the de-institutionalization policy led to the release of the mentally ill patients from institutions all over the country; many of these patients became homeless (Martin, 2007). A 2005 study found that one in six mentally ill individuals was homeless (Martin, 2007). Because of lack of ability, resources, transportation and sometimes desire many of these patients discontinued treatment (Martin, 2007).
From Mentally Ill, Homeless and/or Substance abuser to Prisoner
Many times those with a mental illness will use substances other than prescribed medications (like illegal drugs or alcohol) to help them cope with the symptoms of an underlying illness. Often time’s mental illness (like depression) will set in during a difficult time’s (like in adolescents or early twenties); some of these depressed persons may then turn drugs and alcohol to help them cope and possibly become addicts. Those with mental illness and/ or substance abusers disorders often behave so radically and unpredictably that they jeopardize their living situation and become homeless. While not always true, many of today’s prisoners were homeless before their incarceration and imprisoned for desperate acts of survival.(Nieto, 1999). “Approximately 15% of jail inmates had been homeless in the year prior to their incarceration and 54% of homeless individuals report spending time in a correctional facility at some point in their lives, and studies indicate that homelessness increases the risk for incarceration and incarceration increases the risk for homelessness(National Health Care For The Homeless Council, 2011) “Approximately 20 to 30 percent of the homeless population is suffering from a serious mental illness (Martin, 2007; U.S. Mayor’s Survey, 2003;), and if the term “mental illness” also include clinical depression and substance abuse , that percentage jumps to an astounding 50 to 80 percent(Martin, 2007; North, Eyrich, Pollio, & Spitznagel, 2004; Shern et al., 2000). Eventually and sometimes habitually the homeless, mentally ill, and/or substance abuse users end up in our criminal systems.

The Mentally Ill in Prisons

A good majority of prison populations are mentally ill and/or poly-substance abusers; in 1997 a survey concluded that “the range of jail detainees with co-occurring mental health and substance abuse disorders was between 3-11 percent” (Nieto, 1999). In fact, prison populations are flooded with prisoners suffering from mental illness; “There are more than 200,000—perhaps as many as 300,000—men and women in U.S. jails and prisons suffering from mental disorders, including such serious illnesses as schizophrenia, bipolar disorder, and major depression (Fellner, 2006).” In prisons, prisoners are expected to conform to prison rules and maintain functional, non violent and compliant behaviors. Many of the mentally ill are not able to comply with the demands of prison life, and as a result they end up incarcerated longer and punished frequently for continuing to commit crimes, and break rules in jail. (Fellner, 2006) Statistics from the Federal Bureau of Justice say that “mentally ill prisoners in state and federal prisons as well as local jails are more likely than others to have been involved in a fight or to have been charged with breaking prison rules” and “are more likely to serve maximum sentences” (Fellner, 2006). Prisoners who do not conform to prison rules are punished with solitary confinement and other traumatizing punishments. (Fellner, 2006) Prisoners who break the rules are punished equally despite their mental status at the time. (Fellner, 2006)

Frequently the mentally ill prisoners who are lucky enough to receive psychiatric services in prison are over medicated and under treated with mental health services which can also make rule compliance difficult for mentally ill prisoners. (Fellner, 2006) As a result the mentally ill prisoners who are released from prison often find themselves in similar predicaments to before and re-enter the criminal system as a repeat offenders. In 1991 a study conducted by the Los Angeles County Board of Supervisor’s Task Force on the Incarcerated Mentally Ill, estimated that 90 percent of the mentally ill offenders receiving mental health services in the county jail were repeat offenders (Nieto, 1999).” Many believe that putting the mentally ill in prison is actually detrimental to their mental health because they receive poor mental health management and live in conditions that are not conducive to healthy mental health.

The Governments Problem with Mental Illness in Prison

The cost of imprisoning mentally ill prisoners is significant! In California it is estimated that the “annual associated costs to police and sheriff’s departments to handle mentally ill offenders including transfers and escort costs, arrest and booking, and detention are estimated to $605 million in total” (Nieto, 1999). Treating the underlying mental illness and/or substance abuse issues that causes dysfunctional behavior that result in their imprisonment is the preferred method for reducing the cost and burden of the mentally ill on prisons. However many of the mentally ill are medication resistant or become resistant to taking the medications; some refuse to believe they are ill even when presented with overwhelming evidence, and as a result don’t believe they need medications. A person like this in prison could decompose and withdraw in prison and find themselves in constant trouble for misconduct in jail. ( Nieto, 1999) This presents a challenge for the court, and government whom would much prefer rehabilitate the offender so he or she may return to civilized living situations and socialization than pay thousands of dollars for this mentally ill person to be neglected in jail.

The Current Solution to Mental Illness in Prisons

A recent addition to our public court system is the Mental Health Court. The Mental Health Court is designed to prevent the mentally ill from receiving hard prison time, and when all possible aim to give treatment to the offender. This collaborative effort to keep the mentally ill out of prison and in treatment allows the court a better measure of control when sentencing the mentally ill. “Mental health courts employ incentives and sanctions tailored to the circumstances and needs of each participant to motivate him or her to engage in treatment and comply with the terms of participation.” (Almquist & Dodd, 2009) Incentives including “individual praise and applause, program completion certificates, and fewer court appearances” encourage Mental Health Court participants to engage and stay in treatment often longer than they would have if they had been incarcerated. (Almquist & Dodd, 2009) Allowing the mentally ill to serve time in psychiatric units, community service when applicable, and outpatient treatment programs they not only avoid the significant cost of imprisonment, but they can also reduce the rate of repeat offenders, and give the mentally ill a reason to comply with treatment. Some of the services offered by the mental health court are referrals to transportation services, housing, vocational training, group skills training, and substance abuse management. (Almquist & Dodd, 2009) One of the main focuses of Mental Health Court is to keep the mentally ill out of jail and in treatment, so the services are varied based on need; thus the services provided can depend on type of case and resources available to the court. (Almquist & Dodd, 2009)

How Does This Help the Mentally Ill Person’s Charged With Crimes

Compared to the previous services offered to prisoners these services are an improvement because once in prison only prisoners with a "serious medical need" have a right to appropriate medical care, this includes persons with serious mental illness as well. (National Alliance on Mental Illness, 1993) Because not all mentally ill patients act out in a manner that would warrant attention some prisoners who were mentally ill often times could go years in prison without proper treatment. (National Alliance on Mental Illness, 1993) Additionally their right to treatment does not qualify them for very much, at times it just what is needed to reduce symptomatic behaviors. (National Alliance on Mental Illness, 1993) The number one reason this is helpful to mentally ill persons who have been arrested is because it helps them get help with their mental illness and when possible they avoid jail time and/or confinement in less than tolerable conditions like prison. Because the Mental Health Court’s focus is treating the illness, when jail time can’t be avoided it is often mandated at facilities that are equipped to treat the mentally ill instead of prisons (Almquist & Dodd, 2009).When jail time can be avoided the mentally ill patients are thus spared a lengthy sentence in exchange for treatment compliance (Almquist & Dodd, 2009). By mandating treatment courts can reduce cost for imprisonment, reduce prison over population rates, and improve the quality of life for the mentally ill (Almquist & Dodd, 2009).
Does Research Support The Development Of More Mental Health Services To Prisoners?
Because research indicates that these services will reduce re-incarceration of the mentally ill and ultimately improve the quality of life for the mentally ill the findings support the establishment of more mental health programs to the imprisoned mentally ill. (Almquist & Dodd, 2009) However, this program alone is not enough to help mentally ill prisoners who are already in prison and need services desperately. Prisoners already in prisoners should be offered a similar program would be a great first step to making sure all mentally ill prisoners are helped equally.

How Can We Improve These Services to Better Serve The Mentally Ill Prisoners?

These services could better services could possibly better help the mentally ill population if mental health screenings were offered to persons arrested and before they are bailed. This would help because it would bring attention to mental health concerns before the case is heard in court, possibly even help those who are unaware they have a mental illness or that do not have access to mental health care. This would reveal problems especially in teen offenders before their problems become so unmanageable that they become homeless and or imprisoned.