Mental health disorders occur at high rates all over the world with an estimated 450 million people suffering from a mental or behavioral disorder at the global level. With that being said, numerous surveys show that there’s a disproportionately high prevalence of psychiatric conditions in the prison population.
Many of these conditions are present before the individual is sent to prison and they’re aggravated by the high levels of stress associated with being incarcerated. This stems from a pervasive belief that all people with mental health conditions represent a danger to the general population so they need to be removed, an intolerance to unusual behavior resulting from a lack of information which leads to fear, a lack of or limited access to appropriate services and a lack of emphasis on treatment and rehabilitation in the criminal justice system.
How Prisons Affect the Mental Health of Inmates
Being in prison is associated with overcrowding, violence, loss of privacy, autonomy, and control, forced isolation, lack of access to former social networks, lack of access to meaningful social interaction, uncertainty regarding future prospects such as the ability to find employment and build a legitimate career which can offer the inmates the possibility to provide for their families, suboptimal access to health services, especially mental health services.
All these factors further deteriorate the mental health of inmates already suffering from mental health challenges and lead to developing mental health conditions even in the inmates who were previously unaffected. These conditions are meant to “punish” the individual into making a prosocial decision after release but many studies have shown that the long-term impact of chronic stress on the brain makes this goal less likely, basically having a counter-productive effect.
Chronic stress over a prolonged period of time makes the amygdala hyperactive, therefore makes the individual more prone to strong reactions such as anger outbursts, damages the structure of the hippocampus which leads to cognitive impairment, as well as having a negative impact on the optimal functioning of the prefrontal cortex which is responsible for impulse control and decision making.
All this makes the inmates neurologically less likely to make prosocial decisions upon release, even without taking into consideration socio-economical factors that affect recidivism rates.
Studies also show that suicide rates are much higher among inmates compared to the general population, proving that the current measures to reduce suicide rates such as temporarily placing the person under suicide watch are not effective.
Suicide watch means even more restrictive conditions. Their usual clothes and linen are taken away, they’re checked on every 15 minutes by a guard who takes notes on what they’re doing, they’re kept in isolation for 23 hours a day with no access to a shower, their meals change so that they no longer need to use utensils and after a few days they’re reevaluated to see if they’re no longer suicidal. Given the conditions, it makes sense that at least some of them will pretend to be feeling better so they can get back the freedom they lost.
The Situation in the United States
Correctional facilities in the United States are grappling with the fact that they’ve become the nation’s primary mental health providers, despite being ill-equipped for such a position. An inmate search will reveal tens of thousands of cases in which the individual convicted was previously diagnosed but didn’t have access to treatment and they ended up being incarcerated for a manifestation of their symptoms. People with mental health conditions make up about half of the US prison population.
It’s estimated that 50% of Americans with serious mental illness will be arrested at some point in their lives and 25% of the fatal police shooting from 2016 involved a mentally ill person, the same percentage for 2017.
When they do end up in the criminal justice system, they’re less likely to make bail and get longer sentences. They’re also more likely to be placed in solitary confinement, have lower chances to make parole and higher chances of committing suicide.
Although the situation is increasingly obvious in almost every correctional facility nation-wide, very little is noted in public debate. In Michigan, about 1 in 2 people in county jails suffer from a mental illness and for state jails, it’s 1 in 4. About $4 million were spent on psychiatric medication for inmates in state prisons. In Iowa 1 in 4 inmates is diagnosed with a chronic mental illness.
The percentage of prisoners with mental health conditions seems to be increasing. If we take New York’s Rikers Island jail as an example, in 2010 the ratio was 30%, it rose to 40% in 2014 and in 2017 it was 43%.
The inadequate prison conditions in the United States are so well known that on the 5th of February 2018, the United Kingdom’s High Court refused to extradite British-Finnish activist Lauri Love who was wanted on hacking charges, arguing that allowing him to be put in an American jail would be “oppressive” as the poor conditions are inadequate for preventing suicide. Since Lauri Love has Asperger’s Syndrome and severe depression, the court reasoned that it was highly likely he would be put on suicide watch and therefore in solitary confinement and he wouldn’t have access to mental health services. The court also considered the substantially longer sentence he would get in the United States compared to the UK.
Why It’s Important to Address the Issue of Mental Health in the Prison Population
First of all, when it comes to the inmates themselves, promoting a greater understanding of the challenges people with mental disorders face improves the individual’s chances of being accepted in the community after release and, as a result, reduced the rate of recidivism.
Both prisoners and their families should be educated in regards to the nature of mental health disorders and their effects, as well as how to access services that can help them mitigate their symptoms. This information will help the family better understand and empathize with their loved one and they’ll be more willing and better able to offer the necessary support as to allow the person to readjust to life outside prison.
Likewise, the prison staff should receive better training on how to handle inmates with a mental health condition as to not aggravate their symptoms through their behavior. A better understanding of psychiatric conditions will help the staff protect their own mental health since the stressful environment and inadequate attempts at managing the inmates increase their levels of fear and stress. If our aim is to reduce crime and recidivism rates, access to mental health services in prison should be at least equal to the general population and should not be considered separate from public health.
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