There are currently 2.3 million people in American prisons and jails – a number that has quadrupled over the past 25 years, according to a report published in March 2015 by the Urban Institute. Of these 2.3 million inmates, more than half live with some kind of mental health problem, according to a report published in 2006 by the Bureau of Justice Statistics (BJS). In fact, the Urban Institute report found that the largest jails and prisons in America hold more people with mental illnesses than many inpatient psychiatric facilities. So what does mental health in prisoners look like, and how are mental health problems in prison different from everyday life?
The BJS report explained that the most common kinds of mental illnesses in prisons include depressive disorder (over 20 percent of inmates); manic depression bipolar disorder or mania (12 percent); post-traumatic stress disorder (7 percent); and schizophrenia or some other psychotic disorder (5 percent). According to the BJS, 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of all jail inmates have a mental health problem. While all federal prisons and most state prisons provide mental health services to inmates as a matter of policy, only one in three state prisoners and only one in six jail inmates have received mental health treatment since their admission. Ignoring a mental health issue is dangerous for those outside the prison system, but in prisoners it can increase the likelihood of recidivism or a person’s relapse into criminal behavior after being released from prison or jail.
The BJS report found that inmates with mental health problems are more likely to be incarcerated again than inmates without. Several different studies have found that recidivism rates among inmates with mental health problems can be decreased with community-based programs that offer continuity of care. The Urban Institute report argues that if mentally ill inmates do not receive the proper support and guidance prior to their release into the community, they are more likely to fall back into the cycle of arrest and incarceration. The most common type of treatment reported for mental illnesses was prescribing medication (15 percent in 2004, up from 12 percent in 1997). As citizens with mental health issues are increasingly incarcerated, the prison system has had to face new struggles in providing care and treatment.
One of the biggest challenges is the overcrowding in prisons across the nation. An extreme case of overcrowding took place in Califorina in the 2000s. The 2011 Supreme Court Case Brown v. Plata found that over the course of 2006, “a preventable or possibly preventable death occurred … once every five to six days” in California’s prison system. Overcrowding, which has occurred to a lesser degree in many other prisons, makes already scarce resources even scarcer, making it even harder to provide adequate care to inmates. Compounding this issue, prison conditions often only make mental health issues worse due to the forced inactivity and the fear of victimization, which especially affects older inmates, according to the Urban Institute report.
The Justice Center conducted a study in 2006 that examined recidivism rates among mentally ill inmates under the Mental Health Services Continuum Program (MHSCP). The program included two components: a pre-release assessment by a social worker and attendance at a post-release Parole Outpatient Clinic. The social worker would send the assessment to the inmate’s parole officer, who would then oversee the inmate’s post-release attendance at the outpatient clinic. The study found that while a pre-release assessment alone didn’t significantly affect a person’s odds of re-incarceration, the pre-release assessment was associated with a higher rate of treatment at the clinic. Attendance at the clinic, in turn, was associated with a decrease in recidivism over 12 months after release. By providing a continuity of care for ex-convicts after they have been released into society, the correctional facility decreased the likelihood that mentally ill inmates would end up in prison yet again.
While the prison system must recognize this rise in mentally ill inmates and attempt to treat them while they are incarcerated, it is also important to follow up with the inmates once they are released into the civilian world. The MHSCP is taking steps in the right direction to decrease recidivism by assessing inmates before their release, and providing care once they are removed from the counter-productive environment of prison life.
The Urban Institute; http://www.urban.org/research/publication/processing-and-treatment-mentally-ill-persons-criminal-justice-system/view/full_report
Bureau of Justice Statistics; http://www.bjs.gov/index.cfm?ty=tp&tid=131
New York Times; http://www.nytimes.com/2011/05/24/us/24scotus.html
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