How the Prison System’s Lack of Mental Health Care Poses a Public Health Risk

It’s fair to say that the United States prison system is one of the most corrupt and harmful in the developed world. Scandinavian prisons, conversely, are the most rehabilitative and the healthiest for both the inmates and the corrections officers. Prison guards in the U.S. system have an average life expectancy of 59 due to the stressful nature of the job and the psychological and health problems it can instigate. American incarceration rates (the highest in the world), poor priorities, and racial, gender-based, and socioeconomic disparities cause significant individual and societal damage, and recidivism rates are appalling for more than one reason, but a huge problem often left unaddressed is how inconducive the system is to recovery from existing mental health conditions and how often it causes them to emerge or worsen.

Credit: ThinkProgress

First, it’s important to note that the U.S. never prioritized mental health care. Advances in science and technology constantly build our understanding of the brain and mental illness, though, enabling significant improvements to the way we treat and view psychiatric disorders. Still, we struggle to emphasize the importance of mental health in most institutions. Until prescription drugs became common and effective in the 1950s and 60s, American mental health care involved involuntary enrollment in state-sponsored psychiatric facilities infamous for neglect, physical abuse, and emotional trauma of patients. Standard conditions in these facilities typically included isolation, beatings, the withholding of food and water, shock therapy, lobotomies and other unethical scientific experiments without consent, and a lack of sanitation. Hundreds of thousands of mentally ill people languished in these treatment centers that didn’t prioritize care, often for the rest of their lives.

Mandatory deinstitutionalization sounded like a blessing, but the U.S. never lost its tendency to hide the mentally ill from the public eye. Rather than send them to institutions, law enforcement simply turned to the criminalization of mental illness, especially addiction. In the year after deinstitutionalization in 1967, the prison population doubledNow, about half of all prison inmates suffer from some disorder, and there are more than three times as many seriously mentally ill people in jails and prisons than in hospitals. Serious mental illness is two to four times higher among prisoners than it is in the general U.S. population, and mentally ill prisoners face substandard conditions compared to other inmates: they are disproportionately subjected to solitary confinement and other punishments as well as more frequent abuse from corrections officers and fellow prisoners. Mentally ill people are 4.5 times more likely to be arrested than others, and facilities in New York, Los Angeles, and Chicago are currently the three biggest “psychiatric facilities” in the country. 

Unsurprisingly, the prison system is anything but conducive to recovery from any psychological problem. Existing conditions can worsen or new ones can emerge due to the isolation from society, constant stress and trepidation, exposure to violence, and feelings of loss or hopelessness associated with prison life and long sentences. Untrained staff, limited medical care and access to medication, and inappropriate facilities, and abuse make recovery highly unlikely and put inmates’ lives in danger.

Despite the clear need, only about a third of state prisoners and a sixth of jail inmates with mental illnesses report receiving treatment while incarcerated. Often, the prison system prioritizes stabilization over true treatment, meaning staff prescribe medication to quell severe behavioral symptoms instead of routine treatment for the underlying illness itself. A person with limited noticeable or disruptive symptoms, such as someone with depression, anxiety, or PTSD, might be denied medication completely. In terms of drug dependency disorders, approximately half of prison and jail inmates suffer from substance abuse, but the U.S. punishes them for their illness rather than rehabilitates them.

Unfortunately — but again, unsurprisingly — inmate suicides are on the rise, spiking by 30 percent from 2013 to 2014. Now, 7 percent of all deaths behind bars are from suicide. It’s even worse for children: minors transferred or sentenced to adult facilities are eight times more likely to commit suicide. They’re also substantially more likely to face sexual assault and abuse from guards and other inmates than are minors in youth facilities.

Credit: National Institute of Mental Health

53 percent of state and 45 percent of federal prison inmates meet criteria for a diagnosis of substance abuse or drug dependence. The lack of addiction treatment, though, is one major failure of the prison system with many downfalls, including delaying the treatment process, returning patients to the general prison population too soon, a lack of positive reinforcement, and a tendency to view addiction as a character flaw rather than a treatable medical condition. The possible resurgence of the failed “War on Drugs” and the dangerous Republican health care bill will likely only worsen incarceration rates and limit access to mental health care throughout the country and, clearly, do nothing to stop drug problems in the U.S.

Poor mental healthcare in the prison system has dangerous consequences such as recidivism. Within five years of release, 76.6 percent of released prisoners are rearrested, most of them nonviolent. For instance, close to 80 percent of nonviolent drug criminals return to jail after their release. 54 percent of mentally ill prisoners will return to jail as well. This instigates a cycle of incarceration and disenfranchisement while accomplishing next to nothing when it comes to drugs.

Since most of the mental health neglect is based on cost concerns and stigmatization, we firstly need to recognize mental illness as a public health issue and emphasize that mental health care, like all healthcare, is a basic human right. If states accept that substance abuse or drug dependency is a disease, they could then properly treat those with drug charges outside of the overly punitive prison system. Some states have plans to offer nonviolent drug arrestees the choice to enter treatment rather than jail. If they refuse, they will be sentenced to serve jail time. This would enable recovery and reduce the prison population, and the plans have received significant support.

Prisons need to focus on “corrections,” and the only way to accomplish this goal is to extensively reform the policies and practices of the entire American prison system. Specifically in regards to mental health, prisons should increase treatment and resources and employ well-trained staff qualified to assess, diagnose, and treat psychological disorders. General prison reform would also reduce the prison population and the public health issue of chronic mental illness. Positive change should include:

To find more information or get involved in prison reform, visit the ACLU, PrisonEducation.com, The Lionheart Foundation, and others on this list from the Center for Prison Reform.

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Emily Rose Thorne
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Emily Rose is a 17-year-old writer and musician from Athens, Georgia. This fall, she will attend Mercer University to double major in Journalism and Political Science. She is currently a staff writer for both Affinity Magazine and Women's Republic as well as an intern at Step Up Magazine and contributor for Rantt. She also frequently posts on Medium, where editors requested to add her as a writer for Politics Means, and on Vocal, where her writing has been selected as a Staff Pick. She has contributed to the Genetic Literacy Project and Sprout Literary Magazine. Contact her at emilyrosethorne6@gmail.com or her website, emilyrosethorne.com.

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