As noted in the 8/5/2020 post, mental illness disproportionately abounds in our nation’s inmates. Given the evolving rehabilitative lens of modern corrections, the need for psychology professionals to evaluate and treat inmates has skyrocketed. What was once a largely punitive process, many correctional departments have come to recognize the role that illness, both mental and physical, plays in people’s entry to the legal system. Helping inmates stabilize and understand how their illness contributed to their sentence helps not only the person served, but in keeping society safer.
The incarcerated population
What may initially sound like “mentally ill people are dangerous and in need of jail” must be looked at more objectively. But first, let’s be clear. Jails and prisons do contain many incorrigible, sociopathic offenders or people whose way of life is simply damaging and burdensome to societal safety, and they must be removed. The rest contain many lost souls, living on the streets or shelters, being in and out of rehabs and hospitals, and jail is the last stop on the way down. Rembis (2014) notes LA County Jail, New York’s Riker’s Island, and Chicago’s Cook County Jail each individually house more mentally-ill people than any known psychiatric institution.
Jails are often the metaphorical drain sieve of society, catching people before it’s much too late. Another pop culture distortion, TV shows would have us believe jails are mere zoos for the nefarious. However, one of the biggest eye-openers I experienced in nine years of working at a county jail was that a lot of inmates are decent people stuck in bad situations. Many legally-involved citizens have acted out of desperation or gotten involved with the wrong crowd because of their self-medicating substance of choice. Indeed, some are also severely mentally-ill individuals who have been wayward souls since deinstitutionalization and wander, untreated. Unable to care for themselves, they’re left to the devices of their illness. In a manic fit, response to hallucinations, or paranoid reactivity, they have engaged in harmful or damaging activity.
From punishment to rehabilitation
Police have been getting more in tune with assessing if mental illness is at play, and may first bring the person to a hospital. If laws are broken, however, accountability must occur and the incident be examined by the courts. While are mental health courts, some offenses are serious enough that incarceration is necessary.
“Firm but fair” was the motto of the sheriff who ran the jail I worked at. An early visionary, in the 70’s, he recognized that the mental health treatment system was broken and took it as an opportunity to fill the gap. What was available from mental health system, and unfortunately is still the case, there are not sufficient services to provide the significant long-term oversight and intensive care required to make sure people stabilize and learn how to maintain stability. People need to not only feel better, but learn to account for their improvement. That is the heart of corrections- to correct troublesome ways. While not yet the norm, many departments nation-wide have followed suit of the jail I worked in, and offer therapy, psychiatry; separate units for vulnerable, mentally-ill inmates, built-in psychiatric hospital units and aftercare planning.
Researchers have generally noted that mental health care while incarcerated can help reduce recidivism. Some researchers have even suggested that incarceration in and of itself can be stabilizing given the significantly reduced ability to use substances, access to regular meals and a predictable environment (Hoke, 2015). Maintaining the stability upon release is the real challenge. Therefore, there is also a need for clinicians who understand the corrections-to-community life transition, and officials must recognize more mental health programs are essential.
What is takes
Forensic clinicians encounter many of the same situations as community-based settings. However, be sure, it is more of a fast-paced environment and need for specialized skills. Stay tuned for tomorrow’s follow-up post on a day in the life of a forensic mental health clinician.
Hoke, S., (2015). Mental illness and prisoners: concerns for communities and healthcare. The Online Journal of Issues in Nursing, Vol. 20 (1). https://doi/10.3912/OJIN.Vol20No01Man03
Rembis, M. (2014) The New Asylums: Madness and mass incarceration in the neoliberal era. In Ben-Moshe L., Chapman C., Carey A.C. (Eds), Disability incarcerated. Palgrave Macmillan, New York. https://doi.org/10.1057/9781137388476_8