Mental Health and the Criminal Justice System

As of June 2000, 1,394 of the country's 1,558 state public and private adult correctional facilities reported providing mental health services to their inmates (Beck, p. 1). Parts of treatment include prescreening or psychiatric assessments, psychotropic medications, assisting inmates in obtaining community health services, and providing 24-hour care or therapy/counseling (Beck, p. 1). The number of mentally ill offenders being incarcerated is growing - by midyear of 1998, the population had reached 283,800 (BJS survey, p. 1). While this number grows, the treatment available to these offenders should be evaluated. Other treatments may be beneficial to some of these individuals, and could help ease the overcrowding in prisons and jails.

A natural component of incarceration is cell confinement. Some mentally ill offenders tend to turn to self-induced cell confinement, in an effort to avoid trouble (Kupers, p. 28). As Kupers states, social isolation and sensory deprivation tends to worsen psychotic conditions, and often times if offenders are able to survive in their cell alone their condition may not be declared disabling and will therefore not receive aggressive treatment (p. 28). If these individuals must be incarcerated, they should be given opportunities for group activities that allow them to feel safe and comfortable in leaving their cell. Those imposing restrictive confinement on themselves should be monitored more closely, and given social support to avoid the social isolation and sensory deprivation that can be so damaging.

In fact, social support has been shown to offer benefits to mentally ill offenders. In a longitudinal study of 27 mentally ill prisoners in Ohio, some benefit of social support was demonstrated (Jacoby). Researchers found that social support during prison and after release was "consistently, significantly, and positively associated with a wide range of subjective and objective quality of life outcomes" (p. 499). While social support did not seem to have any effect on recidivism or rehospitalization, it did have an impact on the quality of life for the tested individuals, which is an improvement over the quality of life for those who impose restrictive confinement on themselves.

Although prison systems do tend to offer inpatient units or psychiatric wards, they tend to be small in comparison to the needs of overcrowded prisons (Kupers, p. 75). This could mean the staff is pressured to discharge patients quickly, or that there is a backlog of patients waiting for a bed in the psychiatric ward (Kupers, p. 76). Offering a larger psych ward could help alleviate the strain on this aspect of the prison system.

Something similar to the Garner Correctional Institution in Connecticut may help alleviate this strain in other states. Nearly all of this institution is intended to care for seriously mentally ill inmates (Connecticut, p. 39). Plans for this institution called for adding custody and mental health staff, making the total mental health staff 82 (Connecticut, p. 40). While corralling mentally ill offenders in to one facility may seem harsh, it could actually be beneficial. If those who must be incarcerated are placed in an institution that specializes in caring for mentally ill offenders, they may get a more thorough treatment than if they were in a traditional prison.

Another popular treatment for mentally ill offenders is the use of medication. Without education, the patient may not understand their illness or the need for medication (Kupers, p. 79). Consequently, according to Kupers, the patient is likely to stop taking medication and a risk of relapse becomes high (p. 79). Obviously if someone is not taking required medication, they will not be getting the help they need.

Some things can be done to allow medication to become a more beneficial option. First, if mentally ill offenders are educated about their illness, and are capable of understanding the explanation, they may be more likely to continue taking medication. Secondly, court-ordered outpatient treatment may be preferable - it could help solve the problem of pill refusal (BJS survey, p. 2). "It could also lower the rate of law enforcement or corrections response to an inmate who has not been properly medicated" (BJS survey, p. 2).

Post release planning is also a part of treatment for mentally ill offenders. Upon release, offenders are often given a specific amount of the drug they are supposed to take, and are given info on a local treatment center. Little guidance can make post release adjustment difficult for even the most stable ex-felon (Kupers, p. 87). With the recidivism rate over 80 percent for ex-prisoners suffering from serious mental disorders three years after release, it is clear that this type of offender needs a little more guidance upon release (Kupers, p.87).

An outpatient program such as OPTIONS may be beneficial in easing the transition to life in society. The program focuses on things that will aid participants in negotiating daily life, such as: cognitive-behavioral therapy, individual and group psychotherapy, medication, skills training and self-care activities (Skancke, p. 71). The real-world knowledge, social support/skills, and therapy options offered in this type of program would give offenders a place to turn to if they find the transition to "real life" difficult.

Court diversions would be beneficial to mentally ill offenders that don't really need to be in prison. Probation services could employ the skills and experience of applied psychologists, including accompanying probation staff in attendance at court to assist in a variety of tasks, including offender assessment (Crighton, p. 33). If offenders are assessed by psychologists, perhaps the screening process would be more rigorous, and more offenders would be diverted into programs that will help them, rather than being sent to prison, unless mandatory sentencing interferes.

All things considered, treatments available for mentally ill offenders could use a little improvement to further benefit the offenders. Having any sort of treatment program at all is a good start, but some existing programs, such as distributing medication in prison, need to be approached a little differently. Adding some new programs, such as the Garner Correctional Institution may be helpful to mentally ill offenders as well.

References

Beck, Allen J., Maruschak, Laura M. (2001). Mental health treatment in state prisons, 2000. Bureau of Justice Statistics special report.

BJS Survey tracks prevalence of mentally ill behind bars. (March 10, 2006). Corrections Professional, volume 11 issue 12. Retrieved April 6, 2006 from LexisNexis.

Connecticut prison will increase treatment of mentally ill inmates. (November 8, 2004). Managed Care Weekly, p. 39. Retrieved April 6, 2006 from Infotrac OneFile.

Crighton, David, Graham, Towl (eds). (2005). Psychology in probation services. Malden, MA: Blackwell Publishing.

Jacoby, Joseph E., Kozie-Peak, Brenda. (1997). The benefits of social support for mentally ill offenders: prison-to-community transitions.

Behavioral Sciences and the Law, volume 15, pages 483-501.

Kupers, Terry A. (1999). Prison madness: The mental health crisis behind bars and what we must do about it. San Fransisco: Jossey-Bass Publishers.

Skancke, Jennifer (ed). (2005). Alternatives to prisons. Farmington Hills, MI: Greenhaven Press.