Mental illness is surprisingly common in prison populations around the world. While incarcerated individuals already face many challenges, those with mental health conditions often struggle even more inside the criminal justice system. Understanding the scope of this issue and implementing reforms is crucial to improving outcomes for these vulnerable individuals and communities overall.
The Prevalence of Mental Illness in Prisons
Studies consistently show high rates of mental health conditions among incarcerated people. In the United States, over 50% of those in jail and prison have a mental health diagnosis. The most common conditions are major depressive disorder, bipolar disorder, and post-traumatic stress disorder (PTSD). Substance use disorders also frequently co-occur.
Comparable numbers are seen globally. A systematic review found that over 25% of prisoners worldwide had depression or anxiety. Rates of psychotic disorders like schizophrenia tend to be three to five times higher than general populations as well.
Several factors drive these high rates of mental illness:
- Childhood trauma and adversity – Many incarcerated individuals experienced violence, abuse, poverty, loss of loved ones, or other trauma as children. These adverse childhood experiences (ACEs) increase risks for mental health conditions later in life.
- Substance use – Problematic drug and alcohol use often goes hand in hand with mental illness. Individuals may “self-medicate” to cope with untreated psychiatric symptoms.
- Lack of community resources – Limited access to mental health services, housing, education, and employment can precipitate criminal justice involvement.
- Criminalization – People with untreated mental illness may exhibit behaviors that attract law enforcement attention. Police frequently serve as first responders to those in crisis.
Mental health disorders are both a cause and consequence of incarceration. Prisons must grapple with this complex public health issue that spans communities, generations, and social services systems.
Barriers to Care Behind Bars
The prison environment poses numerous challenges for addressing mental health needs:
Inadequate Screening and Treatment
- Most facilities rely on quick intake screenings to identify mental health conditions. Lengthier diagnostic assessments are rarely offered.
- Psychiatric services and medications are limited. Counseling sessions may be brief and infrequent.
- Group therapy classes tend to have a corrections rather than therapeutic focus.
- Staff shortages, budget constraints, and administrative hurdles also limit care.
Adverse Conditions of Confinement
- Crowding, violence, isolation, lack of privacy, restricted movement, and sensory deprivation can worsen mental health.
- Use of disciplinary segregation and physical/chemical restraints is countertherapeutic.
- Prison culture encourages toughness and discourages “weakness,” preventing inmates from seeking help.
Disruption of Existing Care
- Inmates lose contact with previous healthcare providers and supports in the community.
- Transition planning and continuity of care upon release is minimal.
- Medically vulnerable individuals have higher recidivism rates.
Discrimination and Exploitation
- Inmates with mental disorders are more likely to be exploited or victimized by others.
- Mental illness is often seen as a sign of weakness, and inmates strive to hide symptoms and “do their own time.”
- Prison staff may dismiss symptoms as “malingering” or regard these individuals as troublemakers.
Lack of Coordination and Oversight
- No single entity is responsible for managing inmates’ mental health. Medical, security, and administrative staff have different priorities.
- Fragmentation across healthcare, courts, corrections, and community systems hinders continuity of care.
- Many facilities do not comprehensively track mental health data. Standards and regulations for mental health services are vague in many jurisdictions.
Improving Mental Health Outcomes in Prisons
Advocates have identified several strategies for addressing these systemic shortcomings:
Increase Preventive and Supportive Services
Expanding mental health courts, crisis intervention teams, assisted outpatient treatment, transitional programs, and supported housing could divert more people away from the criminal justice system. Stronger social safety nets could also address risk factors like poverty, homelessness, and unemployment.
Implement Screening, Diagnosis, and Treatment Protocols
Evidence-based tools should be used for mental health assessments at intake and periodically after. Individualized treatment plans should be developed and integrated with programming and behavioral management. Incentives can encourage participation.
Provide Targeted Programming
Cognitive-behavioral therapy, trauma recovery, anger management, life skills, medication management, and peer support groups should be offered. Accommodations like lower bunks or single cells may be warranted. Staff should pursue non-punitive approaches for symptomatic behaviors.
Hire Specialized Mental Health Staff
Psychiatrists, psychologists, social workers, counselors, and nurses are needed on-site at facilities. Telehealth can supplement direct care. All staff should receive mental health crisis intervention training. Oversight bodies should enforce adequate staffing levels.
Review Use of Segregation and Restraints
Solitary confinement, physical restraints, and pepper spray exacerbate psychiatric problems and should be used sparingly, if at all. Any use should trigger review by mental health staff.
Coordinate Care and Plan for Reentry
Correctional healthcare systems should share treatment records with community providers. Reentry plans should connect inmates to mental health and social services upon release.
Track Data and Implement Standards
Uniform tracking of mental health statistics and compliance reviews would increase transparency and accountability for providing adequate care.
Case Examples of Crimes Committed by Those with Mental Illness
Here are a few examples of high-profile crimes committed by individuals later deemed to have mental disorders:
Case 1: James Holmes
- Crime: Killed 12 people and injured 70 in a mass shooting at a movie theater in Aurora, Colorado in 2012. He was convicted on 165 counts of murder, attempted murder, and other charges.
- Diagnoses: Schizophrenia, delusional disorder
- Quote on Conviction: “We are very grateful that justice is served and James Holmes will never be released from prison. He is an evil killer that thought nothing of shooting innocent people.” – Statement from victims’ families
Case 2: Eddie Ray Routh
- Crime: Murdered former Navy SEAL Chris Kyle and his friend Chad Littlefield at a shooting range in Texas in 2013. Found guilty of capital murder.
- Diagnoses: Psychosis, schizophrenia
- Quote on Conviction: “I believe we had not just one but two American heroes who had their lives taken from them. Despite the fact that Eddie Routh killed them, Chris died doing what filled him with passion — helping a veteran.” – Taya Kyle, Chris Kyle’s widow
Case 3: Kori Ali Muhammad
- Crime: Killed 4 people in a racially motivated shooting spree in Fresno, California in 2017. Sentenced to life without parole.
- Diagnoses: Schizophrenia, paranoid delusions
- Quote on Conviction: “You can’t run from your own wickedness. You have set in motion that which you will never be able to stop.” – Fresno Police Chief Jerry Dyer
Case 4: Jared Loughner
- Crime: Killed 6 people and injured 13 others, including Congresswoman Gabrielle Giffords, in a 2011 shooting in Tucson, Arizona. Pleaded guilty and sentenced to life in prison.
- Diagnoses: Paranoid schizophrenia
- Quote on Conviction: “He will never have the opportunity to pick up a gun and hurt anyone else ever again…Mental illness and criminal behavior crossed paths with disastrous results.” – Mark Kelly, Giffords’ husband
Case 5: John Hinckley Jr.
- Crime: Attempted to assassinate President Ronald Reagan in 1981. Found not guilty by reason of insanity.
- Diagnoses: Major depression, erotomania
- Quote on Conviction: “Hinckley will remain in institutional care, but he will live under court supervision in a gated community, outside the security fence… He remains profoundly mentally ill.” – Federal judge final ruling, 2016
Frequently Asked Questions
How many incarcerated individuals have mental illness?
Studies estimate at least 20-50% of incarcerated individuals have a mental health condition such as depression, bipolar disorder, schizophrenia, PTSD, or anxiety. Rates are even higher when including substance use disorders.
What are the effects of incarceration on mental health?
Prison environments can worsen mental health due to adverse conditions like isolation, lack of privacy, restricted movement, violence, and minimal treatment options. Disruption of community supports and reentry difficulties also impact conditions.
Do prisons provide adequate mental healthcare?
No, most prisons have limited mental health staffing and treatment resources. Standards and oversight are minimal. Assessment, therapy, and coordination with outside providers are frequently inadequate to meet needs. Harsh conditions often exacerbate symptoms.
Are people with mental illness treated differently in prison?
Yes, inmates with mental disorders report higher rates of victimization and discrimination from both staff and fellow prisoners. Symptoms may be ignored or punished. Many are reluctant to seek help due to stigma.
How could mental health outcomes be improved in prisons?
Experts recommend more preventive services, screening and treatment protocols, targeted programming, specialized staff, reduced segregation/restraints, care coordination, reentry planning, and better tracking of mental health data. Legal standards must also be bolstered to ensure humane treatment.
Conclusion
Mental illness affects a substantial portion of correctional populations, reflecting deeper societal problems with trauma, inequality, inadequate healthcare, and the criminalization of behaviors related to psychiatric disabilities.
While no simple solutions exist, a multi-pronged strategy is needed to divert vulnerable individuals from incarceration when possible, improve diagnosis and treatment behind bars, coordinate care between institutions and communities, reduce risk of victimization, and strengthen oversight to enforce constitutional protections against cruel and unusual punishment.
Compassion and humanity must be the guiding principles, even in the confines of a cell. Only by tackling this mental health crisis behind bars can we build a more just and humane system that upholds the dignity and potential of all.