Mental Health and Incarceration

Introduction

This collection of research aims to provide our employer with information relevant to our topic: How people with mental health concerns are at risk of and affected by incarceration. We will focus on key aspects related to this topic such as: why some people with mental health are more at-risk for incarceration, how they are treated in prison, and how mental illness affects them when they are released. The investigation focuses on the Western Culture and looks at potentially useful reliable sources for information under the subject of mental health and incarceration, including an emphasis on mental health prior to the arrest, during sentencing, during their stay in prison and after being released. As an issue that affects the whole of society and so the people within it, it is beneficial to have access to accurate and verifiable information that can allow for a better understanding on the issue and a greater awareness of potential ways to fix the problem.

Definitions

These are some common terms that are commonly used in both the mental health system and the prison system.

  • Conduct Disorder: a psychological disorder diagnosed in childhood that involves a repetitive and persistent pattern in behaviour in which the basic rights of others or major age-appropriate norms are violated. This disorder is usually a precursor to antisocial personality disorder.
  • Antisocial Personality Disorder: a psychological disorder characterized by a pervaisive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.
  • Solitary confinement: a form of punishment used in prisons that isolates the inmate from most human interaction (besides staff) as well as most sensory input from outside the cell.
  • The insanity defense: a defense used by those on trial to claim that they cannot be held to full responsibility for their actions at the time they committed the crime due to their mental health, allowing them to avoid certain charges.
  • Recidivism: involves the rate of relapsing into committing crimes after being released from captivity.
  • Dual Diagnosis: The term dual diagnosis is used to describe the condition of a person considered to be suffering from a mental illness and a substance abuse problem.
  • Chronic homelessness: A person who has been homeless for a year or more.

Pre-Crime Mental Health

What is Mental Health? Why are mental health disorders and crime related?

It is important that we first look at the researched definition of mental health and the connection between mental health disorders and crime, as the reader will be able to link the two together and see that there is a need to pursure the knowledge of someone who has mental health. Mental health refers to an individual's cognitive/emotional well-being. Mental health disorders are medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. To be considered as having a medical mental health disorder the individual must experience an impairment in social functioning for a period longer than 2 weeks. A study of those with psychotic disorders found that those with a mental illness were responsible for only 5% of all violent crimes. An exception to this statistic are individuals with Antisocial Personality Disorder.

Conduct Disorder

Research has told us that mental health can develop from a young age. Children who have conduct disorder at an early age are also more common to run into the law when they go into adolescents and become adults. By looking at this data, this is one aspect that we are able to build the basic framework of people who develop mental health. Children with conduct disorder repeatedly violate the rights and property rights of others and the basic expectations of society. Conduct disorder must have symptoms that last at least 6 months. Conduct disorder is also known as "disruptive behaviour disorder" because of the negative impact it has on the children, their families, their school and their neighbourhood. Conduct disorder is usually linked to Antisocial Personality Disorder in adulthood. The symptoms of conduct disorder can include: aggressive behaviour that harms others, destructive behaviour that destroys property, lying, theft, truancy, early substance abuse and early sexual activity. Conduct disorder is more prevalent in boys than girls. 6-16% of boys will have conduct disorder, 2-9% of girls will have conduct disorder; 40% of children with conduct disorder will develop antisocial personality disorder. Children with conduct disorder will often attain a juvenile record due to theft, vandilism or other criminal activities they may partake in.

Antisocial Personality Disorder

An adult with antisocial personality disorder will normally have symptoms such as: dramatic or erratic behaviours, lack of conforming to laws, repeated deceitfulness, impulsive, irritability or aggression, disregard of personal safety of others, persistent lack of taking responsibility and lack of feeling guilty. Someone who has this disorder cannot be diagnosed until after the age of 18; however, the individual must show the symptoms of ASPD by the age of 15. This disorder occurs in men more than women; 3% of men and 1% of women. The main difference between Antisocial Personality Disorder and Psychopathy is that Psychopathy is not a recognized mental health disorder. Psychopathy is a more severe form of ASPD. Antisocial Personality Disorder (like many disorders) are a product of biological/genetic and environmental factors. The results of an individual having ASPD can be jail time for committing any type of crime (such as murder, theft, fraud, harassment), leading religious cults, severe substance abuse and having severe mood swings (depression, anger, anxiety or even bipolar disorder).

Mental Health, Homelessness and Crime

Homelessness is also a major factor for crime and mental health. The numbers of people surveyed who were homeless and also self identified with having a mental health issue were quite high; reporting that 37% of survey takers had been diagnosed and treated for a mental health concern, while 30% of surveyors were concerned they could have a mental health issue. Youth with mental health can feel they were being marginalized more for their appearance than doing any actual physical crime. Many youth with mental health issues report being targeted by the way they dress or thier appearance, making them more likely to come into contact with the police. Dual diagnosis (using substances and being diagnosed with a mental health disorder) is highlighted as a possible risk for incarceration as 41% of people who identified with having a mental health issue also reported using misusing substances in order to cope with their mental health condition
A first offence for a homeless person place them in a cycle of streets and prison. It should also be noted that when people with mental health issues can sometimes be released from prison without their medication or the means to acquire their prescription or access to primary health care and ID, leaving them at a higher risk for rearrest.

Inadequate Mental Health Services

Research indicates that there is inadequate care for street youth who have mental health issues, reporting that only 9% felt like they had appropriate services for their needs. Youth being under served in such a formative time for some mental health concerns can have many negative impacts. The report indicates a high number of youth staying in shelters/ housing programs with employees that are ill equipped to work with people who suffer from mental health issues. If one doesn’t have a strong understanding of mental health concerns, effectively addressing them can be difficult, leading to individuals being discharged for “behavioral issues.” Youth who are forced onto the streets are more likely to cope with illegal activities such as substance use and assaults, leaving them at risk for being detained.

Multiple Diagnosis and Homelessness

48% of those surveyed by a street health survey from Halifax rated their mental health as either fair or poor as opposed to 6% of the general population of Halifax, with 26% reporting hallucinations. These hallucinations can also lead to trouble with the law as many who experience them act aggressively or appear to be out of control, risking arrest. People on the streets are often diagnosed with multiple mental health issues. On a scale of 13 mental health conditions many street involved individuals were identified with multiple diagnosis. In particular, one had been diagnosed with nine. Homeless people with many diagnosis's reported difficulty accessing services because of stigma. The report indicates that homeless encounters with mental health professionals can often leave a negative impressions. These can stay with them or elicit emotional response which negatively influenced their desire to seek treatment or work on getting better. Street involved individuals with mental health are there fore considered less likely to seek help in relation to their mental health or medication leaving them at risk for incarceration or trouble with the law.

  • Community Action on Homelessness. (2009). _Health and Homelessness in Halifax: A Report on the Health Status of Halifax's Homeless Population. _Halifax, NS.

Chronic Homelessness, Mental Health and the Law

Individuals with both mental health and substance use (concurrent disorders) who face prolonged episodes of homelessness face chronic homelessness. Research recorded contacts with the police by those identifying with having mental health concerns as well as substance use issues shows that those who identified being homeless for one year or more had more run-ins with the police. Many of the reasons given for these contacts had to do with mental health and subsequently, substance use. Respondents reported that their mental health was a factor in 48% of the time while 17 % of these contacts were a result of not having/ being able to see a psychiatrist.

  • Patterson, M. L., Somers, J. M., Moniruzzaman, A. (2011). Prolonged and persistent homelessness: multivariable analyses in a cohort experiencing current homelessness and mental illness in Vancouver, British Columbia. Mental Health and Substance Use, 5(2). http://www.tandfonline.com/doi/abs/10.1080/17523281.2011.618143

External Factors and Crime

External factors such as brain injury and drug or alcohol abuse can also impact the mental health of an individual, evident either in the future after the injury or during the substance usage, primarily. From a permanent change in personality and an increased amount of aggression to a temporary loss of judgment, for instance, while under the influence of alcohol, these two factors are major considerations when examining how mental health is related to crime.

Brain Injury

A history of brain injury during childhood has been associated to a higher likelihood of violent acts of crime. This article compares those prisoners who were charged with violent crimes to those whose crimes were nonviolent in a study. While all prisoners seemed to have difficulties in the educational system, the results of the study showed that the prisoners in the violent category had a much higher prevalence of untreated brain injuries in childhood. Sources of this were listed as fights, accidents and punishment from the home. As well, the article examines how injury to specific parts of the brain affected the mental state of the afflicted individual. For example, a mediofrontal and orbitofrontal injury was linked to violent and aggressive behavior, and an orbitofrontal injury alone was linked to feelings of anxiety. It is therefore highly important for brain injuries to not only be treated but also prevented to deter possible violent behavior in the future.

  • León-Carrión, José, Ramos, F. J. C. (2003). Blows to the head during development can predispose to violent criminal behaviour: Rehabilitation of consequences of head injury is a measure for crime prevention. Brain Injury, 17(3), 207-216. doi: 10.1080/0269905021000010249

Drugs and Alcohol

This article examines the link between drugs and crime and asks the question of which came first, the answer being both. While most of those studied began showing deviant behavior prior to drug use, the remaining either took drugs first or took them simultaneously with deviant behavior. An important point the articles makes that strengthens the association between drugs and crime is that while delinquent behavior alone will often recede as age increases, delinquent behavior that occurs with drug use often does not and continues into adulthood. To add to this, studies across prison populations showed that many, sometimes over half, of all inmates were in need of treatment for drug usage. The article continues on to list many behaviors and attitudes that precede crime and points out alcohol abuse as the main cause of violent behavior.

Sentencing

Being Fit to Stand Trial

There have been many prisoners who were wrongly convicted and sent to prison due to their mental health.The author of the article, An Investigation into the Feasibility of Collecting Data on the Involvement of Adults and Youth with Mental Health Issues in the Criminal Justice System, has written the legal stand point of whether a person is mentally fit to stand trail. This book will be beneficial because along with the historical and current laws it describes what the police should be doing when they arrest a mentally ill suspect and how the suspect should be treated, the courts responsibility to categorize the suspect if they are fit to stand trail to the jury and to consider the mental illness of the suspect while they are in verdict. We will be able to critique if there are any cases that were linked with mental health and if any of those procedures have been violated and hence given a biased decision due to the mental state.

  • Sinha, Maire. An Investigation into the Feasibility of Collecting Data on the Involvement of Adults and Youth with Mental Health Issues in the Criminal Justice System. Ottawa: Statistics Canada, 2009. Print.

Pleading Insanity: Being Acquitted

The book titled, "After the Insanity Defense: When the Acquitted Return to the Community", addresses the problem encountered when potential inmates are released or given shorter sentences under the claim that they were not under their own fully conscious control, or at least not fully aware of what they were doing, due to a severe mental illness of some sort when the illegal act was committed. The issues here that are considered include whether they are fit to join society again after they have been acquitted and whether the society they will be joining again will be supportive or harmful to their mental health. The presence of relational support and a stable occupation, for instance, are suggested to be important factors in helping treatment and preventing recidivism. It also examines any possible misconceptions surrounding mental health and law, and various common characteristics of those who have been found not guilty due to insanity. Young males with criminal histories were shown to be the most likely to recidivate after being acquitted according to the studies addressed by the book. As well, there is a highly informative study on the rate of recidivism for those who were acquitted after an insanity defense. This study considered many facets of the issue, including statistics on the initial charge, if they were charged again after being acquitted and what that charge was, if they were given mental health care, what the main problem was with the individual including their mental health and their relationships in society both before being acquitted and after. Finally, it defines various mental health and behavioural problems and associated life characteristics, such as intellectual development and family functioning, and gives a rating scale to show whether an individual can be considered mentally healthy or afflicted with the mental health or behavioural issue in question and how their life style or environment may be impacting them.

  • Shaw, M. F. (2007). After the Insanity Defense: When the Acquitted Return to the Community. New York: LFB Scholarly Publishing LLC.

Incarceration and Mental Health

Mental Health Issues During Incarceration

This artilce gives substantial figures and data on people who have mental illness and who are in prison. The author splits mental health into two separate categories, recent history and concurrent symptoms of a mental health problem. He believes it is important to look at both because it will impact the mental state of the prisoner when they enter and leave the prison. The author also goes into detail regarding high rates of mental health problems, substance dependence and abuse among state prison and local jails. Three-quarters of female inmates in State prisons who had a mental health problem met criteria for substance dependence and become dependent on drugs. This article emphasizes that the mental state of prisoners can have a significant impact on the prisoners mental health before, during and after prison.

“Psychiatric Services in Jails and Prisons”, a book from the American Psychiatric Association, contains material that would be highly useful for a study on the mental health of those imprisoned. The book neatly outlines the important aspects of prisons when considering the mental health of the inmates. It states what is important for and beneficial to this issue, including mental health care and programs offering education, a way to experience greater acceptance of cultural diversity, and respect of privacy. It also discusses what is deemed to be important for successfully giving psychiatric care, as well as the application of this for situations of high-risk illness, co-occurring disorders and gender or age differences. In order to give appropriate treatment the inmate must be put through a process of screening for information on their needs, current problems and/or their general background. Having a co-occurring disorder or a problem with substance abuse are two important things to consider during processing. This book would be a good reference for information on the inner workings of a prison system dealing with inmate mental health, the processing stages the inmates must complete and what programs and services are available to them to begin progressing toward a healthier mindset and lifestyle.

  • American Psychiatric Association. (2000). Psychiatric Services in Jails and Prisons. United States: American Psychiatric Association.

General Treatment In the Prison System

The book titled “Punishment and Madness: Governing Prisoners with Mental Health Problems” by Toby Seddon discusses the issue of the mentally ill being held in prisons instead of being placed in treatment facilities where the problem can be resolved from its beginnings. It looks at how the incarcerated mentally ill are perceived and the repercussions of this perception, as well as how the changes in society over the years has promoted this perceptional bias. Each chapter in the book addresses a new period in history and the changes that came from that period and how they impacted the perceptions and treatment of the incarcerated mentally ill. While the crime committed may be serious enough to receive a jail sentence, the inmate’s mental health which will undoubtedly impact their stay in the system should also come into consideration. These prisoners might benefit from treatment instead of just being incarcerated, impacting not only the prisoners themselves but staff and other inmates as well. With the perception that mentally ill prisoners can receive treatment to prevent future acts of deviance both in and out of the prison system, the health of society as a whole can be increased. Throughout the book there are also various charts depicting statistics on the subject that give more emphasis and understanding toward the author’s main idea at particular points, emphasizing the number of prisoners that have been transferred into mental health facilities over the years. As well, much of the research found in the book comes directly from the author, leaving less of a possibility of a misinterpretation of results. It is a great source when looking to follow the development, whether negative or positive, of the prison system.

  • Seddon, Toby. (2007). Punishment and Madness: Governing Prisoners with Mental Health Problems. USA and Canada: Routledge-Cavendish.

Solitary Confinement

This article considers how prisoners with mental health issues are faced with difficulties equal to those faced by the more healthy inmates though they may be far less mentally capable of dealing with them. A major problem with the treatment of inmates, and especially of the mentally ill, is solitary confinement. Solitary confinement prevents the socialization that can allow inmates to exchange ideas and knowledge, express sentiments and find needed understanding in others. It plays upon the fears of isolation and deprivation of an inmate’s ability to find comfort or support in others. The promotion of these negative feeling states does nothing beneficial in helping those with mental illness; instead, solitary confinement may exacerbate the symptoms and intensify the attitudes which are looking down on by prison officials. This article would be greatly appreciated when considering the causes, repercussions and mediations of these issues.

  • Metzner, J. L., and Fellner, J. (2010, March 1). Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics. Journal of the American Academy of Psychiatry and the Law Online, 38(1), 104-108. Retrieved from http://www.jaapl.org/content/38/1/104.long

Effects of Solitary Confinement

Table 2: Psychopathological Effects of Prolonged Isolation
Haney / Issues in solitary & supermax confinement p 133

Symptom - % Presence Among Pelican Bay SHU Prisoners
Ruminations - 88
Irrational anger - 88
Oversensitivity to stimuli - 86
Confused thought process - 84
Social withdrawal - 83
Chronic depression - 77
Emotional flatness - 73
Mood, emotional swings - 71
Overall deterioration - 67
Talking to self - 63
Violent fantasies - 61
Perceptual distortions - 44
Hallucinations - 41
Suicidal thoughts - 27
NOTE: SHU = security housing unit

These numbers clearly state the effects solitary confinement can have on an inmate due to being isolated both from others and from most environmental stimuli. As a form of punishment, it has an overall negative affect on mental health, possibly exacerbating already present psychological issues and increases the likelihood of violent tendencies.

  • Haney, C. (2003). Mental Health Issues in Long-Term Solitary and Supermax Confinement. Crime & Delinquency, 49(1), 124-156. doi:10.1177/0011128702239239

Prison Alternatives

The distinction between “guilty but mentally ill” and “not guilty by reason of insanity” is discussed, the former shown as being an attempt to prevent an over-usage of an insanity defense by the system. Due to the conflicts between the verdicts as well as the sentencing issues associated with them, such as false claims on the insanity defense, the trial process has failed to prevent prisons from taking in the mentally ill without ever allowing them access to treatment. The article continues to explain how inmates are released without provisions, they are without money, insurance, and health care options, increasing the possibility of a return to incarceration. It criticizes the quality of mental health care that prisoners are offered, as well as the failure of mental health care to treat nearly half of those who are in need. Diversion programs, which have been increasing in their numbers, are suggested to prevent crimes from being committed by an inmate after they are released. The methods of these programs vary but all have the health of the inmate in consideration, using social workers, crisis centers, community oriented services and even family interaction.

  • Schaefer, N. J. (2003), "Alternative to Prison" Programs for the Mentally Ill Offender. Journal of Offender Rehabilitation, 38(2), 41-55.
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