(School/University)
Rehabilitation of mentally ill in prisons and jails: issues and concerns
The California Department of Corrections (CDC) in 2005 added the term “rehabilitation” as a part of the agency’s official title, becoming the California Department of Corrections and Rehabilitation, or the CDCR. However, the change in title did not result in a change of philosophy in the treatment of prisoners in the United States. Though the reintegration of the methodology of rehabilitation officially entered the regime of the CDRC, there is little or no evidence that the methodology has significantly changed (Berkeley- University of California, 2009, p. 277).
Berkebile (2010, p.1) reported that by 2009, California’s penal facilities held more than 40,000 inmates who were mentally ill within its system. With this number, it was said that the state’s penal facilities served more mentally ill individuals than the combined number of the states’ state health facilities and community health centers. However, the increasing number of mentally ill patients in the penal system is not matched by the budget allocated to the care and needs of this sector within the penal system.
The problem is not only present in California alone; the problem is also being seen in many other jurisdictions in the United States. There are studies that show that inmates that are considered as having some form of mental instability is not only suffering from the common bouts of depression or what is commonly termed as the “blues”. It has been found that inmates are suffering from serious mental conditions, and the number of these individuals in the nation’s prison population is rising (Adcock, Hittle, 2014, p. 1). (See figure 1).
In fact, the Los Angeles County Jail has become the largest de facto mental facility in the United States, providing services to more than 3,000 mentally ill inmates at any given time, according to the research of the Sentencing Project (2002). With overcrowded facilities and a decrepit prison health care mechanism, owing to the credit crisis besetting the state, a Federal panel ordered state corrections officials to create a plan to alleviate the “inhuman” conditions in the penal facilities (Berkebile, 2010, p.1). (See figure 3).
Throughout the United States’ prison system, the “truism” is being heard, and heard clearly. The prison system in the country is assuming the role of the “new” mental health service provider from the mental health facilities. In essence, the problem in the penal system is that the prisons and jails are absorbing the “worst” individuals, those that the mental health facilities will readily turn down owing to their overly-violent tendencies (Adcock, Hittle, 2014, p. 1).
The practice of “dumping” mentally ill individuals to the prison facilities is not unique to the United States. In fact, individuals suffering from severe mental instabilities form an inordinate majority in prisons owing to the sole factor that these people cannot, or will not, be accommodated by the mental health facilities in the country. People who commit minor offenses owing to substance abuse or to a minor mental condition are oftentimes sentenced to jail rather than get treatment for their condition (World Health Organization, 2014, p. 1).
Daniel (2007, p. 1) states that in a review of at least 60 studies addressing the conditions of adults in jails and in prisons from 12 Western countries, 3.7 percent of the sample suffered from psychotic illnesses, 10 percent major bouts of depression, and 65 percent of the lot suffering from a form of personality disorders, including at least 47 percent of these suffering from an antisocial personality disorder (See Figure 2).
Even as early as the middle of the 1970s, the approach of rehabilitation was a critical component of the American prison policy. Prisoners were supported to engage in the development of occupational skills and the resolution of a number of psychological issues that can hinder their successful reintegration of the inmate into society. However, with the shift in methodology from rehabilitation to a more punitive approach following the onset of the “war on crime” policy, punishment displaced rehabilitation as the primary policy agenda of the US criminal justice system. As a result, the prison population in the United States skyrocketed, while leaving an insignificant mark on the overall crime rate in the country (Benson, 2003, p. 46).
For a good number of years, the state of the mentally ill in the country’s prison systems was overlooked, ignored and basically “placed in the backburner” of incarceration policies. However, over the past 10 years, a number of prison facilities have acknowledged- at times, upon the stringent orders of the courts, that offering mental health facilities and services for inmates is a requirement and not a “luxury” for the prison system in the United States (Benson, 2003, p. 46).
Costs
In order to accurately gauge the costs of rehabilitation of mentally ill prisoners, the numbers of mentally ill prisoners within a specific system must be noted in order to gauge the nationwide picture given that this instance is not isolated to a single jurisdiction. In the data for the Oklahoma Department of Corrections for 2013, of the ten medications for psychiatric purposes purchased by the agency, seven of the drugs bought were “antipsychotics” and three of these were to counter depression. All in all, the costs of the drugs to the agency amounted to more than $1.3 million, or a 50 percent increase over the amount for the same class of medications in 2010 (Adcock, Hittle, 2014, p. 1). (See figure 4). Medication expenses form a critical, and growing, component of the total mental health care expenditure item in the United States correctional system. On the average, these costs expand about 15 to 20 percent on an annual basis (Daniel, 2007, p. 1).
In this light, there are questions that must be posed as well as addressed in order to effectively deal with the issue of deteriorating mental health services and decreasing funding allocations to the nation’s correction systems. One, it must be asked whether the structure of the nation’s rehabilitative divisions is compatible to offer extensive and thorough psychiatric programs, given that the prison population will increase, and many of these “entrants” will be suffering from some form of mental instability. Second, are the states ready to allocate adequate financial resources in order to meet the requirements of the inmates with mental illness as well as substance abuse issues (Daniel, 2007, p. 1)?
In addition, the problem may be exacerbated if the issue is left in the “hands” of the prison administration alone. The dispensation of these medications can result in the development of severe problems within the confines of the prison system. Research has shown that prisoners are vulnerable to not getting their medicines if these are being transferred to other facilities or when the stocks are used up; this can result in the inmates going on without their medication for a minimum period of one month, or can be even extended for longer periods of time. In addition, though many corrections department has an approved formulary, some mental health professionals can specify medications not found in the agencies’ formularies if the inmate does not show any improvement in his/her condition (Adcock, Hittle, 2014, p.1).
With regards to resource utilization vis-à-vis effectiveness of treatment regimens, it is given that there are a host of treatments that have been proven to be effective in countering the deleterious effects of mental illness among inmates. However, the main problem here is that given that with budget cuts, much of these resources are routinely wasted. Majority of the funds that are still available are often spent in cost-inefficient, impotent services that can only serve a small, insignificant number of inmates.
Here, it must be noted that there have been two positions arrived at. One, that prison facilities are the wrong places to send mentally ill individuals, and two, the current criminal system is ill-equipped to handle individuals with mental illness; prison authorities must consider other options than incarceration. To restate, the position of the criminal justice system in the United States, or in any other country for that matter, is angled on the deterrence and punishment of criminals instead of caring and rehabilitation.
Laws can be enacted to facilitate the transfer of mentally unstable prisoners to state mental care facilities at any stage of the criminal justice process. For individuals with mental illness or substance abuse issues, laws and policies can be introduced that will divert these individuals before these are sent to prison. This in turn will result in facilitating the treatment of these individuals as well as reducing the prison population, and decreasing the amount spent by corrections agencies on psychotropic medications (World Health Organization, 2014, p.1).
Medication regimens designed to prevent relapsing with “relapse-prevention” medication at least two to four weeks before the individual is released from detention, and the regimen must be pursued anywhere from 30 to 60 days after the inmate is released (Daniel, 2007, p.1).
In addition, follow up services must be conducted at the community level. Economic or clinical-wise, former inmates released into the community must be given follow up services; these services has been shown to reduce re-arrest rates, or at the very least, lengthen the periods before these are re-arrested (Pomerantz, 2014, p.1).
References
Adcock, C., Hittle, S (2014). “Prison meds reveal disorders severe for mentally ill inmates”. Retrieved 18 March 2014 from <http://oklahomawatch.org/2014/02/01/prison-meds-reveal-disorders-severe-for-mentally-ill-inmates/>
Benson, E. (2003). Rehabilitate or punish? Psychologists are not only providing treatment to prisoners; they’re also contributing to the debate over the nature of prison itself. Monitor Volume 34 number 7
Berkebile, L.M. (2010). “Prison reform and the incarcerated mentally ill: a preliminary case study of California”. Retrieved 18 March 2014 from <http://aladinrc.wrlc.org/bitstream/handle/1961/9864/Berkbile,Lauren-Fall2710.pdf?sequence=1>
Berkeley- University of California (2009). Mental illness in prison: inmate rehabilitation and correctional officers in crisis. Berkeley Journal of Criminal Law Volume 14 Issue 1 article 10 pp. 277-301
Daniel, A.E. (2007). Care of the mentally challenged in prisons: challenges and solutions. Journal of the American Academy of Psychiatry and the Law Online Volume 35 issue 4 pp. 406-410
Pomerantz, J. M. (2014). “Treatment of mentally ill in prisons and jails: follow up care needed”. Retrieved 18 March 2014 from <http://www.medscape.com/viewarticle/458600>
World Health Organization (2014) “Mental health and prisons”. Retrieved 18 March 2014 from <http://www.who.int/mental_health/policy/development/MH&PrisonsFactsheet.pdf>
Appendices
(Figure 1: Source: Adcock, Shittle, 2014)
Figure 2: Source: Our Health Policy Matters (2014).
Figure 3: Cuts of state mental health facilities. Source: Governing, 2014
Figure 4: Source: Adcock, Hittle, 2014
