The Mentally Ill in Prisons Getting Started Definitions

The Mentally Ill in Prisons

Getting Started Definitions Prison �Function �Minimum, Medium, and Maximum Security �Private Prisons Jail �Function (Gaines, 2006) Mental disorder (NAMI. org)

History Demonology – Believed possession Hippocrates’ (460 -377 B. C. ) Plato (429 -347 B. C. ) Aristotle (384 -322 B. C. ) Greek and Roman thought Therapeutic approach Europe (500 – 1500) The first Mental Hospital Mass Madness Exorcism (Butchner, 2007)

More History Asylums and Shrines (16 th Century. . on) Humanitarian Reform (Late 18 th Century) Moral Management Hygiene Movement (Butchner, 2007)

Changes again in the Twentieth Century • Class Action Litigation � � � Cooper v. Pate (1964) Estelle v. Gamble (1976) Bowring v. Godwin (1977) Bell v. Wolfish (1979) Ruiz v. Estelle (1980) Section 1983 of Title 42 of the U. S. Code Section 1997 of Title 42 of the U. S. Code Civil Rights of Institutionalized Persons Act of 1980 Prison Litigation Reform Act 1996 (Metzner, 2009)

Types of Psychological Disorders Schizophrenia Bipolar disorder Major depressive disorder Non-schizophrenic psychotic disorders Drug Dependence Personality Disorder (Baillargeon, J. , Binswanger, I. , Penn, J. V. , Williams, B. A. , Murray, O. J. , 2008).

A comparison of disorders Men Women Most likely to suffer from: Psychotic disorder Major depressive disorder Personality disorder Post traumatic stress disorder Delusional disorder Psychosis Dementia Substance abuse James & Glaze (2006)

Match the Columns! 1. # of mentally ill in prison A. 1. 25 million 2. # of prison & jail inmates with mental health problems 3. # of mentally ill incarcerated 4. # of inmates with a mental illness B. 16 % C. Nearly 75% D. 71, 619 # of mentally ill patients in psychiatric hospitals in 5. 1950 6. 1994 E. Has quadrupled in the past 6 yrs F. 592, 853 (Human Rights Watch, 2006)

Answers 1 & E- Number of mentally ill in prison has quadrupled in the past 6 years 2 & A- Nearly 1. 25 million prison & jail inmates have mental health problems 3 & B- 16 % of the mentally ill population are incarcerated 4 & C- Nearly 75% of inmates suffer from a mental illness 5 &F, 6 & D-The number of mentally ill patients in psychiatric hospitals in 1950 was 592, 853, and in 1994 was 71, 619 (L. , D. , 2010)

How Many? State prison- 73% women, 55% of men have mental health problems Prisons- 3 times more people with mental illnesses US prison population-4 times the amount of mental illnesses than the general population Mentally ill inmates- 45 & 54 years old (Human Rights Watch, 2006)

Why are the numbers so high in prisons? ? Mentally ill are often poor Homelessness Cost differences Involuntary What are prisons turning into? A cure-all for all of society’s problems Inmates with substance abuse Not enough mental health resources Aufderheide, D. , & Brown, P. (2005)

Ethics and Counseling Psychologists Multiple Roles Assessment Treatment Training Consultation Research Concepts of trust and individual choice collide with prison policies and practices that emphasize control, security, and conformity Scott, N. (1985)

Ethics and Client Welfare Threatened violence and confidentiality Environmental concerns and impact Reporting Drug Abuse Necessary medication Scott, N. (1985)

Ethics The obvious ethical concerns: Beneficence and nonmaleficence; fidelity and responsibility; integrity; justice; and respect for people’s rights and dignity American Association for Correctional Psychology 2005 – American Association for Correctional and Forensic Psychology The Correctional Psychologist Followed APA guidelines 2008 – International Association of Correctional and Forensic Psychology Four more specific ethical guidelines Association for Correctional and Forensic Psychology (2010)

IAFCP’s Ethics Principle A: Recognize individual rights to dignity, respect, self determination, and humane treatment Principle B: Avoid or minimize emotional or physical harm Principle C: Maximize good: Provide and advocate for competent mental health services and research Principle D: Recognize and practice social responsibility Association for Correctional and Forensic Psychology (2010)

Principle D includes: 1. Advocating for and providing optimal psychological or other mental health services of sufficient quality and quantity to meet the professionally identified mental health needs of seriously mentally ill inmates and offenders; 2. Contributing to the staff training needs of the correctional or forensic setting or agency, including identifying and caring for the mentally ill offenders and inmates, and effectively managing suicide risk; 3. Educating policy makers and the public about the mental health, rehabilitation, and community reintegration needs of offenders and inmates; 4. Advocating for research that supports evidence-based foundations for correctional rehabilitation programs, practices, and mental health treatment. Association for Correctional and Forensic Psychology (2010)

Treatment in Prison Today Equation for effective incarceration includes Detailed treatment plan with goals and objectives (discharge plan) Effective drugs Cognitive Behavior Therapy �Learn ways of coping, anger and stress management skills, and other skills to help them manage their illness better. Teaching of Self-Management Skills �Activity therapy, pet therapy, greenhouse therapy, or classes Information passing between treatment facilities and prison pertaining to medical history and diagnosis Caring staff that are properly trained to deal with disorders (Gater, 2006)

Government Federal Required to provide pharmaceuticals and psychotherapy 33 % of federal inmates identified as mentally ill had been convicted of a violent offense, compared to 13 % of other inmates. State Only encourage to provide medication In state facilities, 53 % of mentally ill inmates had been convicted of a violent offense, compared to 46 % of other inmates.

Of the options 34% of state inmates receive highest level of treatment 27% medicated 23% psychotherapy Department of Justice (2006)

Prison Officials Punished for symptoms Confinement Asphyxiation Understaffed Squirrel Cages Daisy Duke Shorts Virgin Islands (Human Rights Watch, 2006)

Other Prisoners Victims to assault, sexual assault, exploitation, & extortion Antipsychotic Medication “Dings” or “Bugs” Material Goods (Human Rights Watch, 2006)

Suicide in lock-up Leading cause of death in lock-up Jail - 47 per 100, 000 Prison – 15 per 100, 000 General population – 11 per 100, 000 Isolation is more likely to increase these types of moods Suicide assessment is not standardized (Cummings, 2009) Best Practices Training programs, screening procedures, communication between staff, documentation, internal resources, and debriefing after a suicide (Lester, 2009)

What’s better? Hospitals $90, 000 -100, 000 More training of staff Better treatment Incarceration $35, 000 3 x higher population Higher suicide risk Treated like a prisoner Staff frustration Nakagawa, S. (2004)

What are the requirements to wind up where? Hospitals Prisons/Jails There are three potential routes to the state hospital: Don’t plea insanity and found guilty Don’t represent enough violence to be civilly committed Not officially stated, the law enforcement community and the courts will incarcerate a mentally ill person because it is the only way to get this individual the treatment they need Civil commitment Inability to assist in one’s own defense to a criminal charge Being found guilty but for insanity Taylor, B. (2008)

The Good and Bad Pros Cons Has been successful People with mental illness often get worse while incarcerated, and tragedies involving victimization and suicide are too common Lowered homicide and violent crime rates Continuing to reform policies and ethics Repeated offenses Qualified care? PBS. (1999)

After Prison 350, 000 mentally ill inmates released Little to No treatment upon release High rate of recidivism (PBS, 2010)

Discussion

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