Mental Health and Incarceration
Among the industrialized nations, the United States ranks at the top for the highest number of adults that are in prison or in jails. In the work of Daniel (2007), the American correctional system held at one point more than 2.2 million individuals that are incarcerated. The numbers of inmates that have mental health concerns or issues are steadily rising in the last 30 years. This is purportedly due to the “deinstutionalization” of the local and state mental health establishment. Correctional and penal facilities have assumed the position of becoming the “default” state mental health facilities, and at an increasing rate, the number of inmate having more acerbic and consistently mentally ill have landed in America’s penal and correctional system instead of getting treatment in the nation’s mental care system (Daniel, 2007, p. 1).
In a study released by the Bureau of Justice Statistics Office in 2006, the agency discovered that more than 50 percent of all inmates in United States correctional facilities had one or two mental health illnesses. Translated into numbers, more than 1.25 million had one form of mental illness or another. However, research information showed that individuals with mental conditions in the criminal justice system were disproportionately high-two to four-compared to individuals without any mental issues. The seriousness of the illnesses within the prison and jail population can be addressed and managed with adequate and sufficient treatment, and could have been avoided from progressing (Horowitz, 2013, p. 1).
These threats to the mental well-being of the individual occur not only in one particular stage of the person’s life; it can occur at all stages of the individual, even before or after birth of the person. Unwanted pregnancies or circumstances that occur during the person’s adolescence years can impact the possibility of the person developing risky mental health tendencies of even the development of mental health issues in their childhood years. Furthermore, insufficient acclimatization to the period of pregnancy can also be factored in as a potential risk factor for developing health risk behaviors (World Health Organization, 2012, pp. 4-5).
In the opinion of Bob Bernstein, executive director at the Bazelon Center for Mental Health, many people that have mental health issues are imprisoned due to the commission of minor criminal acts. Societal issues such as homelessness, obstacles to access to basic mental health care as well as high levels of petty crimes are done due to the need of these people to survive. Bernstein notes that in the last three years, state governments have been forced to cut funds for mental health facilities and services. State governments have cut more than $4 billion dollars from state mental health services. As a result of these budgetary cuts, treatment facilities have resorted to reducing staff numbers and at times had to refuse to admit patients (Horowitz, 2013, p. 1).
Minors with Mental Health
Compared to mental health issues among the adult population, the economic effects of mental health illnesses among the youth and in children have not been thoroughly researched. The expenses related to mental diseases in the childhood years include costs related to medical care, needs for specialized education needs, social services as well as the additional needs for funding that will be allocated to the criminal justice system. There is a number of research activities conducted on the issue, and these conclude that the factors that are considered in terms of expenses are centered mainly on the areas of direct medical expenses and does not factor in the indirect costs that these can inflict upon society (Merikangas, Nakamura, Kessler, 2009, p. 1).
It has been determined that aside from poor adaption to pregnancies and those that occur during the adolescence years have the best chance of increasing the risk of having children that will develop increased potentials for developing at-risk behaviors. In addition, these are the ones that will have a higher chance of developing debilitative physical ailments as well. Here, the elements of poor or inadequate nutrition levels, decreased birth weight, and deficiencies in micro-nutrient intake levels dramatically increase the threats to the development of the brain. In addition, certain detrimental activities on one’s health during pregnancy will have the same outcome. These include smoking, using illegal drugs and alcoholism (World Health, 2012, p. 6).
Conduct ailments are considered as the dominant and consistent of psychiatric conditions present in children. A number of society’s most destructive and costly problems are directly related to the child having conduct issues earlier in life. These behavioral disorders are complicated to analyze and interpret as these conditions are discussed and buttressed in a wide number of contexts. In addition, the motivating or triggering factors tend to be grouped together, and every threat element can be considered as the trigger element that can expose the child for an increased risk for the next stage of progression for the illness.
There have been programs that have been found to be effective in reducing the threat of acquiring behavioral disorders. These programs can be separated by the work that is solely centered on children, those that address the relationship between parents and the children, or in other contexts and parameters. Though child- and parent-oriented prevention archetypes have evidenced limited efficacy, there are new multi-element archetypes that have shown a greater level of efficacy. Interventions designed to reach diverse environments, such as the child, the school, the community as well as the family.
In addition, there is a need to engage “multiple socialization agents” such as the child’s parents, the teachers and the child’s friends and circles for longer periods to shift the developmental curve of the child if he/she lives in “high-risk” circumstances and are presently displaying the initial behavioral problems. Compared to the long term exposure program, short, single environment intervention programs have been shown to evidence limited efficacy and the effects will diminish over time (Greenberg, Domitrovich, Bumgarner, 1999, pp. 4-5).
Though research data of adults proffer the position that depression is linked with lower social classes, there are not enough research data to establish definitive findings for youths and children. Some studies conclude that there is a lack of partnership between the instances of depression and anxiety issues within the context of a social class, there are studies that state the opposite, that there is a critical association between the two, at least for the bottom rungs of the social wealth ladder (Merikangas, Nakamura, Kessler, 2009, p. 1).
Preventing Future Crime
Former inmates released back to society are especially exposed to the threat of a severe regression from the impact of illegal drugs and alcoholism within the initial months after release. During incarceration, these inmates were given either minimal or no mental health treatment or substance abuse except for programs geared for detoxifying the individual. Programs designed to avoid long-term regression were limited to “self-help” organizations, i.e., Alcoholics Anonymous, and other remedial organizations and agencies.
The visible severe symptoms diminish over the first few days after incarceration. After the inmate is released, the person is returned to the same environment that triggered the addiction. Offenders with a known history of illegal drugs and alcohol abuse must be treated with a host of medications, including “anti-craving” drugs and relapse-avoidance measures at least two to four weeks prior to the release of the inmate to society, and this protocol should be continued at least 60 days after the release of the inmate.
Though there are no known treatments for substances such as cocaine, marijuana and other illegal narcotics, there are regimens that involve the use of drugs such as naltrexone and acamprostate that have proven to have a high level of efficacy against opioid and alcohol abuse. Naltrexone is regarded as the optimal drug in the setting of the correction scenario. In addition, this particular drug will generate lesser amounts of debate as the drug does not a high level of potential to be abused and cannot be used for any other purpose (Daniel, 2007, p. 1).
However, even with the identification of these drugs to help combat mental health issues and incarceration, there is still the problem of the cost of incarceration being higher owing to the non use of these alternatives. In a report of the United States Department of Justice, more than 50 percent of the inmates that enters prisons and jails did not receive any form or mental health treatment before these entered the correctional system.
Bernstein of the Bazelon Center avers that the government is investing heavily in funding the operations of the criminal justice system, improving the elements needed to suppress criminality and not investing in the services and facilities that can prevent the mentally ill person from coming into conflict with the law in the first place. Though not all mentally ill inmates commit suicide within prison or relapse, the figures on these inmates harming or killing themselves are too significant to ignore. More than 500 inmates in 2010 killed themselves in the nation’s jails and prison systems. These unnecessary deaths could have been avoided (Horowitz, 2013, p. 1).
Shrinkage of Mental Health Resources
As a result of rising health care expenses, staff requirements, a deficiency in qualified health care practitioners that can be deployed in correctional facilities, an absence in direction and political will, and rising instances of litigation, there are an increasing number of jurisdictions that have privatized their mental and medical health care systems. This instance rose in frequency in the 1980s, and the trend is still on the rise.
However, there are no studies to establish which of the models that are in use by private mental and medical health practitioners that is most effective. In addition, there are no research bases to indicate which of the models being used by private medical practitioners being engaged by state and local jurisdictions are able to render adequate, practical and cost-efficient mental and psychiatric services for inmates.
It is believed that private mental health services are largely driven by the need to generate profit, and this motivation may imperil ethical standards and policies. Profit-centered facilities generally are known to leave critical positions unfilled and often advocate for less expensive methodologies for the patients. This practice will inevitably place the inmates being treated at risk. Nevertheless, the private mental health service sector is still the optimal choice given the severe “limp” of the public sector in recruiting highly-qualified personnel (Daniel, 2007, p. 1).
On the plane of social and environmental factors, critical indicators as well as results of mental illness include obstacles to access of even primary services and amenities, social ostracization, bigotry and conflicts and calamities. Policies applied within the states can help in addressing these shortcomings and help in building social equality, protection for the poverty-stricken in the state, and social inclusion.
With the societal stigma that people with mental disabilities are accorded, anti-bigotry campaigns, including calls for more responsible and accountable reporting from the media regarding people with mental illnesses, can play a significant role in reforming the perceptions of the public regarding people with mental illness. These shifts in the macro-societal level regarding attitudes and perceptions as well as in the philosophies in crafting policies are easier said than done. There must be a strong political will exercised by key policy makers in government. Furthermore, policy makers at the national level must be able to allocate significant financial resources to improve mental health services (World Health, 2012, p. 12).
In addition, there is a lack of funds to properly equip corrections to accurately identify, and if there is an actual case, to effectively handle the inmate with the condition. Corrections officers aver that there is indeed a significant hindrance in treating the mentally unstable in a corrections setting than treating the mentally ill in a normal population scenario. A familiar problem in treating inmates noted by prison officials is that the inmates are either attempting to address their conditions by themselves or abandoning any treatment for their conditions.
In a prison or corrections facility scenario, there are no designated staff members that will look after the monitor the intake of the inmates of their medications. Generally, corrections officers are given no more than a few hours of training regarding mental illness among inmates on an annual basis, and this is inadequate even among corrections officers. In one scenario, one inmate with mental illness viciously stabbed himself with a razor. The inmate was prescribed medication for treating the inmate’s particular condition; however, the inmate stopped taking the medications shortly before the suicide. When the officers arrived at the suicide’s cell, these did not even know how to apply pressure on the wounds of the inmate. Unfortunately, while the officers struggled with their confusion, the inmate died due to the massive loss of blood.
In the opinion of Donn Rowe, the president of the New York State Correctional Officers and Police Benevolent Association, inmates with mental illness place a large unnecessary burden on the correctional system. In a report of the Bazelon Center, costs for “case management” of mentally ill individuals cost more than $2,165 per person annually. More aggressive programs tend to cost more than $9,000 per person. Compared to these low figures, “normal” inmates cost state coffers more than $34,000. However, even with these obvious financial benefits, mental health services are grossly underutilized (Horowitz, 2013, p. 1).
References
Daniel, A.E. (2007). Care of the mentally-ill in prisons: challenges and solutions. Journal of the American Academy of Psychiatry and the Law Online Volume 35 number 4 pp. 406-410
Greenberg, M.T., Domitrovich, C., Bumbarger, B. (1999). “Preventing mental disorders in school-age children: a review o the effectiveness of prevention programs.” Retrieved 17 September 2014 from <http://prevention.psu.edu/pubs/documents/MentalDisordersExecSumm.pdf
Horowitz, A. (2013). “Mental illness soars in prisons, jails while inmates suffer.” Retrieved 17 September 2014 from <http://www.huffingtonpost.com/2013/02/04/mental-illness-prisons-jails-inmates_n_2610062.html
Merikangas, K.R., Nakamura, E.F., Kessler, R.C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience Volume 11 issue 1 pp. 7-20
World Health Organization (2012). “Risk to mental health: an overview of vulnerabilities and risk factors.” Retrieved 17 September 2014 from <http://www.who.int/mental_health/mhgap/risks_to_mental_health_EN_27_08_12.pdf
