Mentally Ill and in Jail

1. Mentally Ill and in Jail Joseph J. Harper, LCSW, DCSW, ACSW, MBA, CCHP, CADC Travis J. Nottmeier, MSW, LCSW, CADC October 2013 Tweet us at #NASWIL

2. Objectives: • Review the statistics associated with the topic. • Identify the mental health issues typically identified in the incarcerated population. • Identify the issues associated with the placement of the mentally ill in correctional facilities. • Review concerns associated with the provision of mental health services in correctional settings. Tweet us at #NASWIL

3. Adult correctional authorities supervised about 6,977,700 offenders at yearend 2011, a decrease of 1.4% during the year. • The decline of 98,900 offenders during 2011 marked the third consecutive year of decrease in the correctional population, which includes probationers, parolees, local jail inmates, and prisoners in the custody of state and federal facilities. Correctional Populations in the United States, 2011Correctional Populations in the United States, 2011 Lauren E. Glaze, November 29, 2012    NCJ 239972 Erika Parks Tweet us at #NASWIL

4. At yearend 2011, about 1 in every 50 adults in the U.S. was supervised in the community on probation or parole while about 1 in every 107 adults was incarcerated in prison or jail. The community supervision population (including probationers and parolees, down 1.5%) and the incarcerated population (including local jail inmates and federal and state prisoners, down 1.3%) decreased at about the same rate in 2011. The majority (83%) of the decline in the correctional population during the year was attributed to the decrease in the probation population (down 81,800 offenders). Tweet us at #NASWIL

5. Statistics At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 70,200 in Federal prisons, and 479,900 in local jails. These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates. Mental Health Problems of Prison and Jail Inmates Doris J. James and Lauren E. Glaze BJS Statisticians September 2006, NCJ 213600 Tweet us at #NASWIL

6. Tweet us at #NASWIL

7. National Estimates of Six Psychiatric Disorders among State Prison Inmates and in US Population 1995Source: Prevalence of Communicable Disease Chronic Disease and Mental Illness Among the Inmate Population: in The Health Status of Soon-To-Be-Released Prisoners: A Report to Congress, vol. 1, The National Commission on Correctional Health Care, May 2002.

8. Systemic Problems • Human Rights Watch states that “the high rate of incarceration of mentally ill people is a consequence of under funded, disorganized, and fragmented community mental health services.” • (NASW News, January 2004) Tweet us at #NASWIL

9. “The New Asylums”From Frontline on PBS

10. Comorbid Disorders • Epidemiological Catchment Area (ECA) Survey of late 1980’s indicated that dual disorders are more common among the homeless, prisoners, and mental hospital patients. • ECA survey reflects that 56% of prisoners had alcohol problems, 54% had drug problems, and 56% had another psychiatric disorder (Harvard Mental Health Newsletter, August 2003) • ECA survey “almost all inmates with a mental illness were also substance abusers (Harvard Mental Health Newsletter, August 2003). Tweet us at #NASWIL

11. Substance Abuse • From 1990 t0 2000, drug offenders in state prison increased from 149,700 to 251,000 (Dr. McNeiley, Univ. of Chicago) • Drug Use among state prisoners 1997 (Journal of Correctional Health Care, Vol. 10, 3 Fall 2003). Tweet us at #NASWIL

12. Substance Use Among State & Federal Prisoners(Data from Bureau of Justice Special Report 1997)Tweet us at #NASWIL

13. Systemic Problems • Drug offenders from 1990 to 2000 have increased from 149,700 to 251,000 (Dr. McNeily, University of Chicago). • Currently 2.1 million incarcerated. One in every 75 men in jail or prison. Violent crime is at a 30 year low. 715 inmates for every 100,000 residents. Tweet us at #NASWIL

14. Statistics With Placement * • More than half of all prison and jail inmates nationwide- some 1,255,000 men and women have mental health problems (Bureau of Justice Statistics, 2006) • An estimated one hundred thousand are psychotic on any given day. (American Psychiatric Association, 2000) • Prisoners have rates of mental illness that are two to four times greater than the rates of members of the general public. (Metzner et al., 2006) Tweet us at #NASWIL

15. Prisons were never intended to function as mental health facilities Two distinct policies that have shaped the placement of mentally ill. Deinstitutionalization Punitive approach to anti-crime efforts Corrections systems have not been able to keep up with the exploding prison population much less the mentally ill prisoner Tweet us at #NASWIL Policies with Placement

16. The Physical Conditions of Placement • In the most extreme cases conditions of confinement are horrific. • Extremely restrictive housing acts as an incubator for psychiatric breakdowns • Poorly trained correctional officers have accidentally asphyxiated mentally ill prisoners whom they were trying to restrain. • Society gains little from incarcerating mentally ill offenders in poor environments Tweet us at #NASWIL

17. The Physical Conditions of Placement • Prisoners with mental illnesses have impaired thinking, emotional responses, and ability to cope • More likely to be exploited and victimized • Twice as likely to be injured in a fight. (James & Glaze, 2006) • Higher rates of rule breaking. (Abramsky & Fellner, 2003) Tweet us at #NASWIL

18. The Provision of Mental Health Services • Prisoners receive little or no meaningful treatment • Neglected, accused of malingering, or are treated as disciplinary problems • Even acts of self-mutilation and suicide attempts are too often seen as “malingering” and are punished as rule violations • Accumulate extensive disciplinary histories Tweet us at #NASWIL

19. The Standards set by courts and human rights • Federal court rulings made it clear that correctional authorities could not simply ignore the mental health needs of prisoners • The eighth amendment to the Constitution of the United States. “Deliberately indifferent” • International Covenant on Civil and Political Rights (1966) • Human Rights Watch “prisons are not equipped to handle mental illness and, more often than not, resort to punishment to control those afflicted, aggravating their illness.” (NASW News, January 2004) • Litigation Reform Act of 1995 has hampered these rights. (1995) Tweet us at #NASWIL

20. The Mental health professional obstacles to provide services • Competent and committed mental health professionals struggle to provide good services • Too limited resources • Officials who resent or begrudge their work • Lack of decent pay and recognition Tweet us at #NASWIL

21. What does the provision of mental health services offer? • Helping individual prisoners regain health and improve coping skills • Encourage the development of more effective internal controls • Promote safety and order within the prison community • Enhance community safety when offenders are released Tweet us at #NASWIL

22. What do provisions currently lack? • A sufficient number of qualified mental health professionals • Peer review and quality assurance programs. Paper to practice • Lack of specialized facilities • Mental health staff have very limited administrative authority Tweet us at #NASWIL

23. What do provisions lack? • Needed private counseling, group therapy, or structured activities • Training to non-mental health staff to recognize these prisoners and needs • limiting treatment to the most acutely ill • Mental health staff limit their attention to only a few Tweet us at #NASWIL

24. Systemic Problems • American Correctional Association indicates that funding for mental health professionals (particularly social workers) was reduced in the 1980’s and 1990’s as the focus of corrections became punitive. (NASW NEWS, January 2004) Tweet us at #NASWIL

25. The root of the Mentally ill and in Jail • Can we afford to continue expanding prison populations? • Radical changes to community mental health, as well as poverty and homelessness • Public commitment, compassion, and common sense. Tweet us at #NASWIL

26. Policy Statement From: Social WorkSpeaksSocial Work in the Criminal Justice System In2006,therewere2,245,189individuals incarceratedinlocal,state,andfederalcorrectionalfacilitiesin theUnitedStates(Sabol,Minton,&Harrison,2007).TheUnitedStates hasthehighestincarcerationrateintheworld, andtherateincreased700percentbetween 1970and2005(Public.SafetyPerformance Project,2007).Inaddition,upto60percentof incarceratedindividualswhoarereleasedwill bereincarceratedwithintwoyears(Langan& Levin,2002). Tweet us at #NASWIL

27. Mental Health Correctional facilities have become the treat­ment facility of last resort for individuals who have been failed by other systems. The dismantling of the psychiatric hospital system and the fragmentation of community mental health systems has shifted the care of those with chronic mental health issues to the correc­tional system. Substantial numbers of offend­ers have mental health disorders that have not been diagnosed or treated. Many of these individuals have comorbid substance abuse issues. Weedon (2005) reported there are five times more persons with mental illnesses in jails than in state psychiatric hospitals. Conservative estimates propose that 10 percent of offenders have a mental illness (Norton, 2005), with rates of mental health problems in incarcerated indi­viduals reported as high as 64 percent Qames & Glaze, 2006). Tweet us at #NASWIL

28. As Showalter and Hunsinger (2007) stated, "in essence our prisons are full of people extremely short on resources and long on problems" (p. 366). Social workers trained in the cor­rections field are uniquely qualified to provide services addressing all the problem areas. Yet little has been written about delivery of services in this field, and schools of social work rarely address correctional social work and criminal justice. Incarceration needs to be closely ana­lyzed. Tweet us at #NASWIL

29. POLICY STATEMENT • NASW recognizes the importance of provid­ing quality social work interventions to the incarcerated population. The provision of an ade­quate level of professional social work services could reduce the rates of recidivism, reentry, and incarceration for the betterment of the individual as well as society. Thus, NASW supports: • ongoing advocacy to address issues sur­rounding and leading to disproportionate rates of incarceration for individuals of racial or ethnic minorities, juveniles, women, and undocu­mented individuals; • increased use of professional forensic social workers to provide culturally competent treat­ment and intervention for the growing popula­tion of incarcerated individuals, including mental health and substance abuse services; • Tweet us at #NASWIL

30. safe, humane, and equitable treatment for all incarcerated individuals, including cessa­tion of sexual abuse, sexual harassment, and differential sentencing and treatment; • access to quality health care, medications, nutrition, treatment, rehabilitation programs and support for incarcerated individuals includ­ ing resisting all forms of discrimination based on diagnosis in delivery of medical care; • appropriate educational and vocational opportunities to assist incarcerated individuals with transitioning back into their communities; • access to affordable and adequate housing to assist incarcerated individuals with transi­tioning back into their communities; • establishment of best practice standards for professional social work in criminal justice settings; • specialized training on the unique applica­tion of social work skills and values in a cor­rectional environment for social workers prac­ticing in criminal justice settings; • research to identify effective alternatives to incarceration, such as diversion programs. • Tweet us at #NASWIL

31. expansion of prevention , screening, and treatment efforts, including issues such as sub­ stance abuse and dependence, mental illness, sexually transmitted disease, blood and airborne pathogens, confidential testing, and domestic violence; • increased funding for community-based options, especially for those individuals with substance dependence or serious mental ill­ ness who may be better rehabilitated by these services; • identification of and response to the special needs of any individual under the supervision of the criminal justice system, including, but not limited to, racial, sexual, and gender minorities; juveniles; women (including pregnant women); the elderly; and those with impairments; • advocacy and social work leadership to es­tablish national policy on criminal justice, issues in collaboration with other organizations. • Tweet us at #NASWIL