According to the Prison Policy Initiative, 37% of inmates in state and federal prisons, and 44% of individuals in locally-run jails have a mental illness, but 66% of people in federal prisons report no mental health care provision. This is a complex issue with no easy solution, but if one of the goals of incarceration is rehabilitation or even the prevention of recidivism, it’s critical to spread awareness and increase advocacy for mental healthcare in prisons. Especially when CBT and mindfulness-based approaches are modestly effective to treat depression and anxiety in prison, care should be promoted.
Mental Health Care During Incarceration
Even when mental health treatment is offered, it can be challenging to implement given the punitive culture that can exist in carceral settings. Since prison administration is likely to prioritize security while healthcare providers are often bound to promote quality of life, these competing interests can be difficult to balance in terms of mental health treatment. Despite these challenges, a 2021 study assessed North Carolina’s use of Therapeutic Diversion Units, and found that they were associated with better outcomes regarding infractions, mental health, and self-harm.
Mental Illness Often Gets Criminalized
Neuroscientist and clinical social worker Renetta Weaver, LCSW-C, says, “Inmates face increased risk for mental health issues such as depression, anxiety, and post-traumatic stress disorder (PTSD)." Weaver explains, “Inmates face many disconnecting conditions such as social isolation from loved ones, constant noise which disrupts mental peace, lack of control which prevents self-determination and barriers to mental health care which produces feelings of rejection and neglect.” While these conditions are generally treated with empathy, Weaver notes that incarcerated individuals are often seen and treated as less than human. Weaver explains, “From a neuroscience and mental health perspective, these conditions that inmates face are known to cause uncertainty and are perceived by our brain as threats to emotional and physical safety.” These perceived threats are the same criteria that cause trauma and sometimes lead to PTSD in people who are at war, according to Weaver. “As a result, inmates are being discharged from prison back into society with a loss hope, learned helplessness and feelings of despair,” she says. Weaver notes that suicidality has increased among inmates and is higher than the non-incarcerated population, as she explains, “The prison system was originally designed to segregate and punish deviants who broke the law.” Historically, law breaking was seen and treated under the behavioral model, but Weaver notes that the reasons why people engage in such behaviour are being looked at differently, as they are often symptoms of mental illness. Weaver explains, “In the early part of my career, I was a juvenile probation officer and I worked in Pre-Trial Release at Baltimore City Jail. In my experience, I found that the legal system often punished people for crimes related to untreated mental illness and/or substance abuse.” After recognizing this, Weaver found it difficult to stand before a judge and recommend incarceration. Consequently, she developed treatment plans to support her clients in the community until her supervisor said that she could not work in their office, and was encouraged to pursue social work instead. Weaver highlights, “I wish the public knew that many inmates are individuals with untreated mental illness and often manage their symptoms with addictive use of alcohol and drugs.” Unfortunately, these factors can lead to behaviors that are seen as resistant or aggressive, which can result in arrests. “While on some level they can be seen as breaking the law, a lot of these behaviors are connected to the same mental illness that is managed and treated by therapists,” she says. Weaver explains that law enforcement and mental health professionals are both responding to the same person through a different lens, which begs the question, “Can we hold inmates accountable for their behavior but also give them access to mental health and substance abuse treatment?” Treatment is not always enough to prevent recidivism, according to Weaver. “There has to be a bridge of support that leads from incarceration to rehabilitation that extends to aftercare in the community. In fact, I wish the public knew that funding preventative programs was less costly mentally and financially than it is to incarcerate someone,” she says. Weaver explains that the carceral setting can have mental health impacts of making inmates more hypervigilant and reactive. “Instead, preventative programs work to address people’s untreated trauma,” she says.
Corrections At Odds with Rehabilitation
Psychotherapist, National Certified Counselor, and Certified Advanced Alcohol and Other Drug Counselor Matt Glowiak, PhD, LCPC, says, “Some of the symptoms of various mental health and addictive disorders are ones that align with what society views as antisocial or criminal.” Glowiak explains that this is especially true when individuals may react impulsively, harm others, or partake in more self-serving behaviors, which can include personality disorders, psychotic disorders, PTSD, substance use and processing type disorders. Especially when mental health issues go untreated, Glowiak notes there is an increased likelihood that one may ultimately become incarcerated. “It is important to delineate corrections from rehabilitation,” he says. Glowiak highlights, “Corrections are merely locking someone away as punishment for bad deeds. Rehabilitation, on the other hand, is working with someone to overcome personal challenges.” There are many cases in which individuals without previous mental health or addiction challenges are met with them in prison, according to Glowiak. “Human beings thrive off freedom and choices,” he says. Glowiak explains, “Consider someone wrongfully convicted or having committed a minor crime being sent to prison—taken away from family, friends, home, work, and most everything else cherished in life.” Without freedom, Glowiak notes there may be significant distress. “Essentially, prison is an unnatural mental mind trap that can lead even the most mentally stable of individuals toward mental health crises,” he says. Glowiak highlights, “When those with previous conditions continue to go untreated while others develop conditions in prison, there is a perfect storm for mental health issues among inmates.” Although prisons do often have social workers on site, Glowiak notes that case management is more of the focus of their work, rather than clinical mental health treatment, so major issues go unresolved. Glowiak explains that inmates may be considered “outcasts of society,” so they are often left behind, which can exacerbate issues. “Many would rather forget them than help them out of a difficult situation,” he says. When inmates are finally released back into the real world, Glowiak notes they may lack the coping skills and other life essentials needed to succeed. “Without rehabilitation, they re-engage in criminal behavior and find themselves back in prison—repeating the cycle,” he says. Glowiak highlights, “There are numerous individuals in prison who suffer from mental health and addiction issues. Many estimates conclude that this is more so the case than the exception. Time in prison without appropriate remediation does little more than serve as a time-out.” While in prison, without the appropriate support, Glowiak notes that inmates may find their maladaptive thoughts, feelings, and behaviors intensify like a pressure cooker waiting to explode upon their release. Glowiak explains, “When this happens, society must consider whether this is the fault of the individual or our own. As a mental health professional, I tend to blame the system more than the inmates themselves.”
