Prisons in the United States have come to be the largest mental heath providers owing to the increase in the number of incarcerated individuals with severe mental illness. Yet, prisons are not meant neither are they designed for this purpose. The prison conditions cannot accommodate the mentally ill because of congestion, violence, inadequate health services and absence of any meaningful activity. These conditions are not proper for individuals whose perception of reality is distorted. As such, the impact of overcrowding, lack of privacy and the hard conditions that are characteristic of prisons is worse for prisoners with mental illness.
The result is that prisoners with mental illnesses are often subjected to abuse and neglect. Beyond this, they may also pose a threat to other inmates in situations where mental illness leads them to violence. Since prisons are not designed for the purpose of taking care of the mentally ill, there is bound to be poor mental health services which further impairs their functional abilities. This is due to inappropriate administering of psychotropic medication. Tension exists in prisons between their mission of ensuring security and considerations for mental health.
The codes of conduct within the prisons, both formal and informal, often reflect on the concerns for security, power and safety manifested in the desire to control. Integrating these goals, rules and codes with the needs of the mentally ill is almost impossible. Statistically, more than three-hundred thousand incarcerated men and women have mental disorder including those severe illnesses like schizophrenia and bipolar disorder. Major depression is also another disorder that this population suffer from. The number of the mentally ill is increasing tremendously.
This come as a result of punitive criminal policies combined with insufficient community mental health services. Mental illness studies in prisons have registered prevalence rates of mental illness among the inmates which exceeds the rate recorded within the community (Diamond et al, 2001). According to Lamberti et al, there is an over representation of individuals suffering from severe mental illness. Their figures stand at between six and fifteen percent for the mentally ill in jails and prisons which contrasts with approximately two point eight percent prevalent rate among the general adult population Lamberti et al, 2001).
Other findings indicate that the number of mentally ill individuals in prisons exceed those in mental health hospitals threefold (Ditton, 1999). This number as compared to those in the general public is between two to four times greater. As much as there exists little historical data, mental health experts agree that the number of inmates with mental illness is alarmingly increasing. Individuals with serious mental illness when left untreated and unstable, especially those languishing in poverty, alcoholism and drug addiction often break the law and enter the criminal justice system.
This failure of the society, manifested in the failure of the mental health system has resulted into criminalization of the mentally ill. It has been noted that if the mentally ill within the communities were to receive adequate services that they so much need, then they would not end up in prison. As such, the mental health system has the responsibility of preventing people with mental disorders from ending up in jail or prison. Other measures by the government which has also contributed to an increase in the number of mentally ill in prisons has been the aggressive and punitive anti-crime policies, encompassing the war on drugs.
These tough approaches which stand out within the United States criminal justice policy have led to a tremendous increase in the number of prisoners in the past three decades. Among this mass includes individuals with mental disorders. The number of mentally ill prisoners have led to prisons being transformed into facilities for the mentally ill. However, prisons cannot provide for the special services that is needed by this population. As is often the case, seriously ill prisoners often confront a dearth of qualified staff who investigate their illnesses, propose treatment plans and monitor their conditions.
The mentally ill are often given treatment which can hardly be referred to as medication. These treatments are often administered poorly with little or no supervision at all. Sometimes they are totally ignored. The diversity of mental health interventions which they so desperately need are lacking, not to mention supportive therapeutic environment necessary for the management of their condition. Such is the life that the mentally ill prisoners live within the confines of the prisons.
With this regard, the mentally ill prisoners are exposed to painful symptoms and their conditions may worsen without adequate and necessary care. Besides the mental health services that may or may not be provided by the prison authorities, the mentally ill are treated equally with all the other prisoners. As such, no special allowances are accorded prisoners with mental disorders. They are required to follow the same rules, bundled into the same facilities, required to follow the same routines and expected to behave the way other prisoners behave.
However, the truth is that mentally ill prisoners are in no capacity to follow prison rules the same way other normal prisoners are supposed to. Inmates who suffer from such conditions like schizophrenia or serious axis I disorders, their perception of reality is seriously distorted which may be described as psychotic. They develop false beliefs, disruptions of consciousness, chaotic thoughts and at times false perception of the environment. Accompanying these are experiences of debilitating fears coupled with severe and uncontrollable mood swings (Lamb et al, 1998).
The effect of this condition is that the mentally ill may resort to keeping to self silently in the cell, mumble or incessantly yell. As such, they may even hear voices commanding them to either commit acts of violence against others or against themselves. Their illnesses may be exhibited through violence, aggression or disruptive behavior. They may all over sudden stop or refuse to abide by the codes and rules such as coming out of the cell, taking showers or standing up for the count.
They are likely to adopt unnatural behaviors like smearing feces on their bodies, self mutilation, knocking their heads on the walls or attempt suicide. In short, the mentally ill within the prisons behave in ways that are forbidden within the prisons. As such, their behaviors are bound to be termed as gross misconduct and hence punishable. The primary goal of prisons is to ensure that the staff and inmates are secure. However, this goal is often difficult to achieve since it is in constant tension with the mentally ill vulnerability.
All aspects of an inmate's conduct are regulated by a complex system of procedures, rules and policies which are very comprehensive and form the basis for the operation of the prisons. It is absolutely paramount to comply with these rules. However, there are few provisions for prisoners whose mental illnesses are likely to lead them to break the prison rules. As much as there is an attempt by some prison systems to incorporate into their disciplinary systems considerations for mental health, the disciplinary system should be urgently reassessed against the backdrop of the increasing number of mentally ill prisoners.
Just like other prisoners, the mentally ill also make use of the prison environment in terms of navigation but their condition make them less able to conform to the codes. Studies have shown that most disciplinary cases involve the mentally ill prisoners. The operation of prison rules can be likened to the criminal justice system's penal code and hence the guards function in various ways like the regular police, attempting to maintain law and order which laying charges upon inmates who whenever they break the laws.
The officers have a great task in determining and deciding how to characterize the nature of misconduct and which rule violation to record in a formal ticket. However, many correctional officers are not sufficiently trained in mental health and hence do not comprehend the nature of mental disorder and how it affects behavior (Munetz et al, 2001). They normally are not in a position to distinguish between the behavior of an inmate who acts out of frustration and disgruntlement or an inmate under the effects and consequences of mental illness.
They often assume that misconduct is either manipulative or volitional. For instance, an officer may have no idea that an inmate banged his head against the wall because he is experiencing severe and uncontrolled hallucinations. As such, he may proceed and issue a ticket. As many medical directors have pointed out, correctional officers refer inmates to the disciplinary process even if the prisoner is experiencing symptoms of mental illness. When it comes to punishing the mentally ill who have acted out, their mental condition is often not taken into account.
There is sufficient evidence to the fact that inmates who are seriously ill mentally are treated with punitive measures so as to control their behavior without any inquiry or regard for the cause or impact of such measures on the inmate's mental situation (Torrey, 1997). The mentally ill prisoners are often punished under the prisons disciplinary system for violation of prison codes whether this violation is as a result of mental illness or not. Infractions are often adjudicated to formal hearing unless they are minor. Theoretically, an individual may be found not guilty in prison disciplinary hearings but this rarely happens in practice.
Instead, the hearings are basically meant for determining the the kind of punishment an inmate should be subjected to. The disciplinary hearings are seen to function like courts in the criminal justice system and hence provide a modicum of due process. They however do not recognize a subjects capacity to participate in the hearings and hence proceeds with the hearing regardless of whether an accused understand the charges or not. These disciplinary hearings do not allow for insanity defense which might appreciate that an individual had no control of his actions at the time of violation.
The hearing officers may also not take into consideration the illness as a factor in determining the sentence. As such, they do not recognize that the prisoner is not in a position to control his behavior due to mental illness. The prison officers are also reluctant to include considerations of illness as a factor in disciplinary hearings. They see this as providing an excuse for the misconduct of prisoners. Many prisons have not structured their codes and rules to accommodate mental illness. The same suctions are applicable to everyone regardless of the mental condition of the prisoner.
The correction culture had made the correction administrators not to develop sensible therapeutic and productive approaches of responding to infractions by the mentally retarded which may facilitate the prisoner's ability to cope with his illness and prison life.
References Diamond, P. M. , Wang, E. W. , Holzer III, C. H. , Thomas, C & Cruser A. (2001) The Prevalence of Mental Illness in Prisons. Administration and Policy in Public Health, Vol. 29, No. 1 Ditton, P. M. (1999) Mental Health and Treatment of Inmates and Probationers. Bureau of Justice Statistics Lamb, R. H. , & Weinberger, E. L.
(1998) Persons with Severe Mental Illness in Jails and Prisons: A Review. American Psychiatric Association Lamberti, S. J. , Weisman, L. R. , Schwarzkopf, B. S. , Price, N. , Ashton. R. M. , & Trompeter, J. (2001) The Mentally Ill in Jails and Prisons: Towards an Integrated Model of Prevention. Psychiatric Quarterly, Vol. 72, No. 1 Munez, R. M. , Grande, P. T. , Chambers, R. M. (2001) The Incarceration of Individuals with Severe Mental Disorder. Community Mental Health Journal, Vol. 37, No. 4 Torrey, E. F. (1997) Out of the shadows: Confronting America's Mental Illness Crisis. John Wiley and Sons, New York