Mental Health in U.S. Prisons

Introduction

 Mental health and the humane treatment of the individuals serving time inside prisons are two important aspects of the society. Political and human rights advocates consistently look into these particular areas of social life to ensure that the government and those who are responsible are taking every step necessary. This is to ensure that persons with mental illness and in prisons are not subjected to dehumanizing conditions and are provided the necessary care which can enable them to be successfully reintegrated to the society once they get better. Mental health is particularly important inside prisons because of the level of stress present inside these facilities and the presence of many different other factors that can seriously threaten to dislodge the sanity of a person. That is because of the fact that the incarcerations of mentally ill, and the failure to treat those who become mentally ill, are real problems in today’s US’s prisons. “An increasing number of mentally ill inmates continue to enter US prisons and jails. In fact…between 60,000 and 100,000 of the annual jail admissions in the United States are mentally ill…In some states, the number of mentally ill who are incarcerated exceed the number of mentally ill who are institutionalized in state psychiatric hospital facilities (Hensley, 2002, p. 81).” Because of this, it is important to examine the existing problems found inside United States prisons, its repercussions, causes and the possible solutions to these problems so that there is a chance that individuals serving time are protected from acquiring mental illnesses; while those who are mentally ill can be diagnosed and treated properly while inside the prison.

Because of the idea that the prisoners still have the right to be accessible to treatment for mental illness despite their predicament, and the right of the prisoners to be treated for their mental health problems, the US government has ensured that the providing of mental health support system inside prisons is one of the prerequisites for any US prison institution around the country. “Prison systems are typically much larger than hails and sometimes feature separate institutions for inmates of differing security levels, or for inmates who need treatment for their mental health or substance abuse problems (Peters, Matthews, Dvoskin, 2004, p. 707).”

The need for mental health capability inside prison facilities

 Mental health support system, like facilities and equipment, the presence of competitive professionals and the funding to make the treatment and cure sustainable and capable to handle the possible growth in numbers of prisoners who need mental health help, are all necessary features inside the prison because of two reasons. First, because their are numerous mental health related problems found inside prison amongst prisoners and sometimes even among those who are working inside the prison facilities; and second, because there are some parts of the countries which utilizes prison facilities as the depot for stocking, piling and quarantining individuals who have mental health problems and are not suitable anymore to live with their immediate family and should be locked in a treatment facility where professional supervision, cure and treatment are all available. “Confinement institutions of all types (lockups, jails, and prisons) have become the new ‘Bedlams’ of the twenty-first century (Hensley, 2002, p. 81).”

There are many factors why prisoners experience mental health problems. Some of them are afraid to live inside prison houses, in fear of the threat to their life. Some are traumatized by physical assault and sexual abuse. Rape inside prisons results to mental health problems. It is important that mental health specialists detect this problem among the inmates and treat it. Because of fear that those who raped them may get back at them for telling the authorities about what happened, or because of the fear that the rape maybe repeated just so the offender can prove to the victim that he or she is defenseless inside the prison, rape victims inside prisons find it difficult to move forward and report the incident. Because of this, the mental health problem worsens while making the detection of rape victims all the more difficult for mental health workers and professionals. This is something that they should work on because the mental heath repercussions of rape incidences and sexual assaults are lethal and deadly. Most of the time, this is the reason why an inmate wants kill himself or herself inside the prison. “Called the crisis behind bars, suicide is the most serious concern following an inmate sexual assault. Suicide in jails is the second leading cause of death following illnesses/natural causes (Hensley, 2002, p. 81).” But if inmates are not pushed to suicide by the incident, there are still several equally serious threats to mental health after rape or sexual assault of an inmate. “There are several major health issues that can follow inmate sexual assault: suicide; PTSD; and other psychiatric disturbances, including exacerbation of existing mental illnesses and dissociative disorders. Each of these issues represents a major area of concern for correctional medical and mental health staff (Hensley, 2002, p. 81).”

Others are experiencing sadness and anxiety after being detached from family, friends and loved ones. These are just some of the general reasons. There are more specific reasons that happen inside prisons, on a case to case basis. Hensley (2002) believed that “the situation of inmate rape, coupled with the overcrowding, brutality and violence, constitutes a mental health crisis for all inmates, but particularly for the mentally ill (Hensley, 2002, p. 81).” Nonetheless, this establishes the presence of inmates who need mental health support, assistance and care, and the prison system of the government should be capable in providing it.  “In recent years, increasingly greater proportions of jail and prison inmates are homeless, mentally ill, and have substance use disorders and other chronic health problems. For example, between 6% and 12% of jail inmates have severe mental disorder and approximately 10% of jail and prison inmates report mental health problems or a history of residential mental health treatment (Peters, Matthew, Dvoskin, 2004, p. 707).”

Making things worse in the effort to make mental health support system inside prison sufficient for the needs of the prison facility and its prisoners is the shift in paradigm in social action which makes mentally unstable individuals, who are not supposed to be locked up inside a prison facility. They will only be new addition to the prison’s population, forcing the stretching of the resources of the prison facility and making the services, equipment, medicine and treatment time spread more thinly among the growing population that mixes criminals with those who are purely afflicted with mental health problems. “With the closing of state mental hospitals, reductions in public treatment services, and the narrowing scope of private insurance coverage, jail and prisons have increasingly served as ‘public health outposts’ and human service providers of last resort (Peters, Matthew, Dvoskin, 2004, p. 707).”

This move of the government at cutting down costs seemed to have an inhumane and unethical aspect in it. Experts and critics believe that mentally ill members of the society do not deserve to be locked up in prisons, and that, prison systems, facilities, design and amenities are not created for the needs of those who have mental health problems. “Are local jails and state and federal prisons, the most appropriate site for housing and treating people with mental illness in this country? Although the answer is almost certainly no, data suggests that this is what is occurring (McKenzie, Pinger, Kotecki, 2007, p. 330).” The clear impact of this move is that resources are spread thinly, and professionals will have a difficult time attending to the needs of the people inside the prison. It will become a mix of government employees, convicted felons and mentally ill patients, making it hard to create a program that is streamlined for target patience.

Mental health problems developing inside prison facilities

 The development of mental illness among prisoners who are previously perfectly sane and mentally stable is not impossible, considering the situation in some (if not all) of the prisons and jails in the United States. Situations, like stress, living too close with each other, and the lack of sleep among other things, may trigger a mental imbalance and start of a mental health problem. While the same conditions arguable are not conducive to helping those already with mental health problems to get better. “Professor Kay Redfield Jamison has asserted that even if psychological services are provided to mentally ill prisoners, the prison setting hinders treatment. Inmates get deprived of sleep…and isolation can exacerbate their hallucinations or delusions (Urdang, 2002, p. 150).”

Mental health problem prior to prison time

But aside from the fact that some of the prisoners may have developed mental illness because of poor mental health conditions and situations inside prisons and jails where they were locked up, there are also instances wherein with the absence of a competent medical diagnosis prisoners who are sent to jail serve time have undetected mental illnesses. These undetected mental illnesses, sometimes, is the trigger why individuals commit a crime. Since the mental problem is not treated inside or outside the prison, the individual remains in this state, and thus, always susceptible to committing the same crime over and over again. “The president of the National Mental Health Association, Michael Faenza, has observed that the criminal justice system is just a revolving door for a person with mental illness, from the street to jail and back without treatment (Urdang, 2002, p. 150).”

Assessment of mental health treatment performance and capability

 Government agencies report the increase of the number of prisoners over the years. Medical professionals believe that there are also an increase in the need for a more competent, capable and consistent mental health support, treatment and care services so that prisoners are given the chance to come out of incarceration fully capable to rejoin the society and be productive. But if the mental health care inside prisons is not up to par, the inmates are placed in a very vulnerable and susceptible position wherein they can also suffer from mental health problems during and after their stay in prison. “The study found that although mental health services were available in more prisons, the percentage of prisons performing psychiatric testing and assessment had declined. Thus, mental health services became less available to the prison population during that period (McKenzie, Pinger, Kotecki, 2007, p. 330).”

Impact of poor mental health system inside prisons

There are many effects brought about by poor mental health system in place inside US prisons. The most basic and immediate impact is the inability of the government to cure inmates with mental health problems properly and adequately. Another important effect of this situation is that inmates who are starting to show signs that will lead towards a full blown mental health problem are not detected, leaving the inmates to succumb to mental illnesses. These are serious problems because, if the mentally ill and the convicted felons are housed in similar institutions, inmates who are scheduled to be free or has been freed is expected to end up in the same facility in the immediate future. It may either be due to the crime the he or she will commit again because of his or her mental health problems, or simply because the untreated mental health problem worsened beyond the control, care and capability of the persons he or she is living with. This creates a vicious cycle, and if this is the case, there is no hope for prison decongestion and no chance for inmates to start a new life outside the prison. There is no questioning then the statement of Levy and Sidel (2004) that “serious psychiatric cases are recurrent in the prison system (Levy and Sidel, 2004, p. 166).”

Even in prisons where there are mental health facilities and professionals working, the threat of not being able to fully cure a mentally ill inmate or not being able to release an inmate is present if the mental health assistance program is broken or weak. Mental health problems usually trigger people to display aggressive or violent behavior, or even the inability to be cohesive and straight thinking. If the inmates who not are cured well (or have not been cured at all) display this symptoms because they are not healthy mentally, the government may think that they are still a threat to the society, forcing them to extend the jail time or prison time of a particular convict, each day spent there making the mental health situation of the inmate become worse and worse. “Mental illness may preclude inmates’ compliance with their prescribed medication schedules. Without these medications, inmates with mental illness may be incapable of good behavior, a prerequisite to parole or release. In fact, they may become candidates for placement in more isolated and restrictive prison units (McKenzie, Pinger, Kotecki, 2007, p. 330).”

Hope for mental health help

 Despite the fact that existing culture and the current position of the government in these issues renders inmates helpless, there are still some courses of action that people, especially inmates, can take to help themselves. One of the possible avenues is through lawful means. “One increasing approach to remedying deficits in jail mental health services has been the class action suit. This mechanism has been much more common for redress of abuses in state mental hospitals (Steadman, McCarty, Morrissey, 1998, p.119),” pointing out to the case of the 1971 class suit in an Ohio jail wherein the court ruled in favor of the inmates and in favor of putting a mental health support and assistance feature in the prison to help inmates in need. It was an action that highlighted the power and ability of the people if they chose to get involved (Arrigo, 1996, p. 88). Ever since that landmark case, major cities are all complied by court orders to guarantee the placing of a capable and competent system (including men and material) inside prisons so that the mental health needs of the inmates are attended to and treated well. All the people needs to do is to be vigilant, since “despite court orders to improve mental health services, no systematic work has been conducted to assess whether such orders have been acted upon, and if so, no empirically sufficient evidence exists exploring the impact of such presumably improved psychiatric services (Arrigo, 1996, p. 88).” There should be also vigilance and action versus the belief of some sectors of the society that prisoners are not deserving of humane health care. “For some people, the ideal of improvement seems frivolous; they see correctional facilities as warehouses for undesirable elements and programs to improve inmates’ physical and mental health, literacy and employability as a waste of public funds (Allender, Spradley, 2004, p. 869).”

Conclusion

The data and figures involved in the discussion of mental health and prison is a serious matter.  “According to a 2006 Department of Justice report, more than half of all prison and jail inmates have mental health problems. This includes 705,600 inmates in state prisons, 70,200 in federal prisons and 64% of jail inmates. Furthermore, approximately 24% of jail inmates, 15% of state prisoners and 10% of federal prisoners reported at least one symptom that meets the criteria for a psychotic disorder (McKenzie, Pinger, Kotecki, 2007, p. 330).” Levy and Sidel (2004) contributes to the growing list of data, noting that “approximately 500,000 inmates have a major psychiatric disorder (Levy and Sidel, 2004, p. 166).” With this put to light, many serious questions surface. Is there insufficient sources, materials and professional support inside prison to answer the need for mental health assistance and care among prisoners and inmates? Is the current prison setting or the culture inside US prison the source of mental health problem? Are these factors moreover, contributed to the worsening of the mental health of the inmates? Is the government marginalizing the mental health needs, both of the mentally-ill individuals and prisoners who have mental health problems?

Most importantly, what should be done immediately, and in the long term, so that these problems are remedied and prevented from worsening? According to Levy and Sidel (2004), “Mental health problems are another hallmark of US prison populations (Levy and Sidel, 2004, p. 166).” In light of more evidences about the problem, the people can’t help but ask if the government continue to live up to its billing or will drastic measures be taken so that this situation is corrected? Will the government services in US prisons be forever a patch of notoriety in humane civil service? As what Jewkes (2004) was trying to point when saying that “since their inception, prison healthcare services have been criticized for a lack of quality, suitability, scope and accountability. Prisoners present with a variety of health-related problems, which they commonly experience at greater rates of prevalence than the general public (Jewkes, 2004, p. 393).” People should not stop taking actions to ensure that this practice does not continue and the situation worsen, since inmates also have some rights that people and the government, has to protect.

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