The Mentally Ill in Prisons

1. The Mentally Ill in Prisons

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

3. 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)

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

5. 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)

6. 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).

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

8. Match the Columns! • 1. # of mentally ill in prison • 2. # of prison & jail inmates with mental health problems • 3. # of mentally ill incarcerated • 4. # of inmates with a mental illness • # of mentally ill patients in psychiatric hospitals in • 5. 1950 • 6. 1994 • A. 1.25 million • B. 16 % • C. Nearly 75% • D. 71,619 • E. Has quadrupled in the past 6 yrs • F. 592, 853 (Human Rights Watch, 2006)

9. 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)

10. 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)

11. 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)

12. 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)

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

14. 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)

15. 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)

16. 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)

17. 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)

18. State 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. • 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.

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

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

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

22. 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)

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

24. Prisons/Jails What are the requirements to wind up where? Hospitals There are three potential routes to the state hospital: Civil commitment Inability to assist in one’s own defense to a criminal charge Being found guilty but for insanity • 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 Taylor, B. (2008)

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

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

27. Discussion

28. (2010). A Crime of Insanity. In PBS. Retrieved November 28, 2010, from http://www.pbs.org/wgbh/pages/frontline/shows/crime/jailed/. • (2010). Jailing the Mentally Ill. In American Public Media. Retrieved November 29, 2010, from http://americanradioworks.publicradio.org/features/mentally_ill/poll/stats.html • Aufderheide, D., & Brown, P. (2005). Crisis in Corrections: The Mentally Ill In America's Prisons. Corrections Today, 67(1), 30-33. Retrieved from Academic Search Complete database. • Baillargeon, J., Binswanger, I., Penn, J. V., Williams, B. A., Murray, O. J. (2008). Psychiatric Disorders and Repeat Incarcerations: The Revolving Prison Door. In The American Journal of Psychiatry . Retrieved November 23, 2010, from http://ajp.psychiatryonline.org/cgi/content/full/166/1/103. • Ball, D. W. (2008). Mentally ill prisoners in the california department of corrections and rehabilitation: strategies for improving treatment and reducing recidivism. • Butcher, J.; Mineka, S.; Hooley, J. (2007) Abnormal Psychology. (Ed.). Boston, MA.: Pearson Education, In • Cordner, G. (2006). People with mental illness. Problem-oriented Guides for Police Problem-Specific, 40. Retrieved from: www.cops.usdoj.gov. • Croft, H.. (March 29, 2010). Guilty of Mental Illness. In America's Mental Health Channel. Retrieved November 22, 2010, from http://www.healthyplace.com/thought-disorders/articles/guilty-of-mental-illness/menu-id-64/. • Cummings, D.L. & Thompson, M.N. Suicidal or manipulative? The role of mental health counselors in overcoming a false dichotomy in identifying and treating self-harming inmates. Journal of Mental Health Counseling, 31, 201-212. • Fellner, J. (2010). A corrections quandary: mental illness and prison rules. • Gaines, L. & Miller, R. (2006) Criminal Justice in Action. The Core. (Ed.). Belmont, CA.: Thomson/Wadsworth • Hartenstein, M. . (July 8, 2010). ACLU demands Louisiana prison stop locking suicidal prisoners in 'squirrel cages,' humiliating them. In NY Daily News. Retrieved November 23, 2010, from http://www.nydailynews.com/news/national/2010/07/08/2010-07- 08_aclu_demands_louisana_prison_stop_locking_ suicidal_prisoners_in_squirrel_cages_h.html.

29. References • International Association for Correctional and Forensic Psychology (2010) Criminal justice and behavior, 37(7), 749-808. doi: 10.1177/0093854810368253 • Jacobson, S. (July 23, 2010). Bedlam: mentally ill trapped in bulging county jail. In The Payson Roundup. Retrieved November 23, 2010, from http://www.paysonroundup.com/news/2010/jul/23/bedlam-mentally-ill-trapped-bulging-county-jail/. • James, D. & Glaze, L. (2006). Mental health problems of prison and jail inmates. Bureau of Justice Statistics Special Report • L, D. (2010). Individuals with Mental Illnesses in Jail and Prison. In Bazelon Center for Mental Health Law. Retrieved November 29, 2010, from http://www.bazelon.org/LinkClick.aspx?fil eticket=zvzRLXFf3cU%3D&tabid=246. • Metzner, J. (2009). Monitoring a correctional mental health care system: The role of the mental health expert. Behavioral Sciences & the Law, 27(5), 727-741. doi:10.1002/bsl.879. • Nakagawa, S. (2004). Prisons as the new mental hospitals. Justice Matters, 12. Retrieved onNovember 26, 2009 from www.safetyandjustice.org. • (November 30, 2007). ACLU Urges Court to Fine Virgin Islands Officials for Indefinitely Detaining Innocent Mentally Ill Inmates. In American Civil Liberations Union. Retrieved November 29, 2010, from http://www.aclu.org/prisoners-rights/aclu-urges-court-fine-virgin-islands-officials- indefinitely-detaining-innocent-ment. • (October 21, 2003). VII. Difficulties Mentally Ill Prisoners Face Coping in Prison. In Human Rights Watch. Retrieved November 29, 2010, from http://www.hrw.org/en/node/12252/section/8. • PBS. (1999). A crime of insanity: the jailed and imprisoned mentally ill. Retrieved from: http://www.pbs.org/wgbh/pages/frontline/shows/crime/jailed/ • Scott, N. (1985). Counseling prisoners: Ethical issues, dilemmas, and cautions. Journal of Counseling & Development, 64(4), 272-273. Retrieved from PsycINFO database. http://www.safetyandjustice.org/story/237. • (September 5, 2006). U.S. Number of Mentally Ill in Prisons Quadrupled. In Human Rights Watch. Retrieved November 22, 2010, from http://www.hrw.org/en/news/2006/09/05/us-number-mentally-ill-prisons-quadrupled. • Taylor, B. (2008). Mentally ill in prisons and jails. State of Oregon. Retrieved from: www.leg.state.or.us. • Windmill, H. (September 29, 2010). The High Prevalence of Mental Illness in Prisoners. In Suite101. Retrieved November 28, 2010, from http://www.suite101.com/content/the-high-prevalence-of- mental-illness-in-prisoners-a291556.