Access to mental health in the prison system in the United States is abysmal. There are about 1.2 million people suffering from mental illness sitting in jails and prisons each year—about half of the total prison population in the United States—with little to no access to the care they need. To make matters worse, with less and less patients being admitted into true psychiatric facilities, the spill-over often winds up in the criminal justice system. Currently, there are ten times as many mentally ill individuals in jails and prisons than in state psychiatric institutions.
Part of the issue can be drawn back to the deinstitutionalization movement of the 1960s, in which new government policies moved mental health patients from state-run “insane asylums” to community health centers funded by the federal government. This was intended as a way to give the patients better care (and also cut government budgets), but it wound up severely limiting the care that mentally ill patients were able to receive. According to one report, the number of state psychiatric beds declined from a high of about 550,000 beds in 1960 to 40,000 today. So, the United Sates has gone from institutionalizing people, often in subhuman conditions, with mental illnesses to incarcerating them at shocking rates. As a 2016 Slate article aptly put it, “America’s prisons have become warehouses for the severely mentally ill.”
Over the past decade in particular, the United States has been incarcerating increasing numbers of individuals with mental health conditions. Very often their first offenses are very low-level, such as loitering, trespassing, or jaywalking. Once they’re incarcerated, their loss of personal liberties is combined with a preclusion of community integration and the community-based health treatment that they would be able to receive on the outside. A 2014 study found that “more than 50% of inmates who were medicated for mental health conditions at admission did not receive pharmacotherapy in prison.” Inmates with more overtly apparent conditions, such as schizophrenia, were more likely to receive their medication while those with presenting less overt conditions, such as depression, were less likely to receive their treatment. Moreover, of those who were taking medication for a mental health condition in prison, over 60% used no other form of treatment, such as talk therapy.
The result of the lack of treatment given to those with mental health conditions in jails and prisons, besides being utterly unethical and an abuse of human rights, is that there is a much higher chance of recidivism and higher health care cost to the tax-payer once those affected are released. The Sentencing Project found that states with less access to mental health care also have the highest rates of incarcerations. Six out of the ten states with the least access to mental health care also have the highest rates of incarceration. They include Alabama, Arkansas, Mississippi, Texas, Georgia, and Florida.
Furthermore, the World Health Organization has long held that prisons are bad for mental health. Any symptoms that are exhibited before admission will most likely be exacerbated once they are incarcerated. Features such as overcrowding, various forms of violence, enforced solitude, lack of meaningful activity, lack of privacy, and isolation from social networks are just a few characteristics of prison life that can have a negative effect on mental health. The high rate of suicides in prisons (representing 7% of all deaths in prison) is an unfortunate side effect of this.
Mental Health America developed a list of four solutions aside from incarceration to handle and prevent criminal activity from those suffering from mental illness. The first is to invest in real diversion. Currently, there has been a rise in diversion programs, such as mental health courts, in the United States. These require that a person first plead guilty to a crime before being able to receive adequate help from mental health treatment providers. The results of these programs are questionable at best. According the Mental Health America, a far better solution is to explore the use of pre-booking diversions, wherein a person who exhibits symptoms of mental illness and commits a low-level offense such as jaywalking, be diverted by the police to options like treatment or peer run crisis respite models.
Other solutions are to invest in services and start early. Investing in treatment such as Assertive Community Treatment and Multisystemic Therapy has shown strong evidence in reducing days of incarceration and would reduce the likelihood that the person would will ever face incarceration in their lifetime. It has also been proven that supporting our schools leads to less juvenile incarcerations. Students who have been suspended or expelled are more likely to end up in the juvenile justice system, and kids who have been in the juvenile justice system are more likely to end up incarcerated later in life. Programs like Behavioral Intervention and Supports, screening, and community based resources can help keep kids connected to their communities and out of the criminal justice system.
In prisons, given the unfortunate increasing prevalence of inmates with mental health conditions and the ever-decreasing correctional budgets, innovative thinking that puts and emphasis on effective mental health treatment is required. According to the American Journal of Public Health, “specialized therapeutic communities, mental health courts, telemedicine (to provide access to psychiatric specialists without prisoners leaving the facility), integrated family counseling, and cognitive-behavioral therapies may be used as complementary to pharmacotherapy in prison settings to reduce already elevated levels of reoffending.”
Finally, we must ensure continuity of care. For those entering into the criminal justice system, insurance is often taken away from them and their access to treatment completely changes. Once they are released, especially if they begin receiving treatment in prison, their treatment is often taken away; this is particularly dangerous if their treatment includes medication. We must have a plan to ensure people receive the appropriate care and access to community-based services once they are released. Mental health reform in the criminal justice system will not happen overnight, but taking steps to these solutions will ensure that it gets better, not worse.
“Access to Mental Health Care and Incarceration.” Mental Health America, 14 Nov. 2017, www.mentalhealthamerica.net/issues/access-mental-health-care-and-incarceration.
Gonzalez, Jennifer M. Reingle, and Nadine M. Connell. “Mental Health of Prisoners: Identifying Barriers to Mental Health Treatment and Medication Continuity.” American Journal of Public Health, American Public Health Association, Dec. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4232131/.
Lithwick, Dahlia. “Prisons Have Become Warehouses for the Mentally Ill.” Slate Magazine, 5 Jan. 2016, www.slate.com/articles/news_and_politics/jurisprudence/2016/01/prisons_have_become_warehouses_for_the_mentally_ill.html.
“Mental Health and Prisons.” Information Sheet – World Health Organization, www.who.int/mental_health/policy/mh_in_prison.pdf.
“Position Statement 56: Mental Health Treatment in Correctional Facilities.” Mental Health America, 16 Mar. 2015, www.mentalhealthamerica.net/positions/correctional-facility-treatment.http://www.mentalhealthamerica.net/positions/correctional-facility-treatment