The admittedly small and self-selected group of inmates that I provide psychotherapy for on a weekly basis at our local county jail has inspired my curiosity about the mental and emotional health of general inmate populations throughout the United States. Of special interest are persistent reports about growing numbers of inmates coupled with correctional facility overcrowding. In part these swelling numbers are no doubt due to high recidivism rates, and this “revolving door” phenomenon has in recent years generated interest among researchers and officials partly in response to the rising perception of our correctional facilities as the new warehouses for mentally ill, developmentally disadvantaged, and emotionally disturbed individuals.
For example, through conversations with corrections officers I have learned that at least some of these officers believe that many inmates would be better served in a mental health facility, rather than by corrections. They cite a pervasive lack of basic life and social skills among inmates, especially the inability to communicate effectively, plus poor to virtually nonexistent self-regulation of impulses and emotions as just a few deficiencies that correctional facilities are ill-equipped to deal with.
Of my clients at the jail, all have been abused at some point in their lives and are compromised emotionally and/or mentally, with most suffering from comorbid conditions such as bipolar and posttraumatic stress disorders (PTSD), plus substance abuse issues. One man has been diagnosed as a paranoid schizophrenic with obsessive-compulsive disorder (OCD) plus PTSD. Another man has been diagnosed as having schizophrenia, but probably suffers from OCD and PTSD instead.
Although certainly not a comprehensive review of current literature and research, this paper will
examine existent statistical data and information about our inmate populations for a potential
relationship between mental illness and recidivism.
Evidence
The percentage of individuals incarcerated in the United States is increasing. The United States
General Accounting Office (1996) found that between 1980 and 1995, the total number of those
imprisoned at both the state and federal level rose by 242 percent or from 329,000 to approximately 1.1 million inmates nationwide, reflecting an increase of about 770,000 individuals within the span of just 15 years.
These figures necessarily include individuals who have reoffended and been returned to prison. The Bureau of Justice Statistics monitored 272,111 former inmates from 15 states for 3 years after their release from prisons in 1994. Of these individuals, 52% were eventually returned
to prison either for newly committed crimes or for parole violations (Langan&Levin, 2002). Nationally, 53% of all released males, and 39% of all females, were reincarcerated during this time period (Visher&Travis, 2003).
In 1997, approximately 6 to 16% or between 70,000 to 190,000 of all incarcerated individuals were identified as being mentally ill, as compared with only 2% of the general U.S. population (Freeman, 2003; Lovell, et al., 2002). Data concerning specific mental illnesses is incomplete, but rough estimates seem to indicate that inmates with major depression constitute anywhere from 3.5 to 11.4 % of the national inmate population, while schizophrenia is found in about 1.5 to 4.4% of all inmates, and those suffering from bipolar disorder represent between 0.7
to 3.9% of incarcerated individuals (Lurigio, Rollins&Fallon, 2004).
Follow up studies show that about 48% of these individuals were found to have been hospitalized in a psychiatric setting within 18 months of their release, while 64% were rearrested within the same time period (Lovell, et al., 2002). Of note and perhaps indicative of the relative severity of mental illnesses experienced by inmates, Hartwell (2003) found that felons were more likely to be admitted to psychiatric hospitals after being released, while those who had only committed misdemeanors were typically reincarcerated. Inmates that I have interviewed tell me that while in custody they have a right to health care including medications, but this provision ends upon their release.
Reasons for Recidivism
Kubrin and Stewart (2006) examined census data and statistics from the Oregon Department of
Corrections for approximately 5000 prisoners released back into the community during the first half of the year 2000. They found that while individual characteristics such as a history of drug
abuse, prior arrests and incarcerations, as well as a lack of education are important factors in
explaining high recidivism rates, barriers to reintegration coupled with neighborhood environmental issues are also decisive. These external factors include social acceptance or non-acceptance of the ex-offender, the ability to obtain and receive continuing therapy and/or medical treatment, plus accessibility to jobs and housing. In addition, complying with the terms of release may preclude some from employment (Lurigio et al. 2004), as some companies will not allow parolees or probationers to attend appointments with probation or parole officers during working hours.
For individuals released into communities where resources are plentiful and easily procured, recidivism rates appear significantly lower than for those released into disadvantaged areas
(Kubrin & Stewart, 2006; Lurigio et al., 2004). These findings are important because many law
enforcement officers, criminologists, our judicial system, and even the general public often assume that recidivism is primarily influenced by personal choice, traits, and history of criminal
behaviors.
What has become clear to some researchers though is that arrest and incarceration are often the natural sequelae of untreated mental illness, while recidivism within this population is
exacerbated by homelessness and joblessness (Lurigio et al., 2004; Nelson, 2002). Considering the shortage of easily-accessible psychotherapy in homogeneous lower socio-economic neighborhoods and communities (Lurigio et al., 2004), it is not surprising that these groups are over-represented within inmate populations and thus statistically recidivate more frequently (Mears, Wang, Hay, & Bales, 2008).
Solutions to the Problem
Undoubtedly, the most important correctional aspect regarding inmates with mental illnesses is the availability and acceptance of treatment (Nelson, 2002). However, to facilitate management of mental illness, perceptions within the criminal justice system need to change.
The opinion held by many parole and probation agencies that only 5% of the general inmate
population is afflicted with a mental illness (Lurigio et al., 2004) goes against what limited
statistical information is available. Psychological screening during reception and processing vary
widely from facility to facility, and may consist only of simple questionnaires which are often
unreliable and miss many signs and symptoms that would be observable during a clinical evaluation (Goldberg & Higgins, 2006). Thus, the actual numbers of mentally ill offenders are likely much higher than currently presented, and indeed could change dramatically if each inmate was given an appropriate psychological examination upon first being incarcerated.
Therefore, intensive, cohesive case management is probably the only solution to the problem of
warehousing the mentally ill in correctional facilities, and some communities are moving forward
with innovative collaborative efforts. In Pennsylvania for instance, the Allegheny County
Department of Human Services has implemented a program that begins upon the inmate’s release and continues for as long as necessary. Through this program, mentally ill offenders are provided with a ride from the correctional facility, clothing, bus passes, temporary housing, help applying for food stamps and other entitlement benefits, and arrangements for health care. Recidivism rates for individuals assisted by this program have been cut in half since its inception in 2000, from about 33% to a little over 16% (Yamatani, 2008; Navasky & O’Connor, 2005), and at an annual savings to taxpayers of about $5.3 million (Yamatani, 2008).
Nearly all of my incarcerated clients could be helped by such a program. Our non-profit
organization provides some similar services to inmates, however, adequate funding simply is not
available to provide for the diverse needs of large numbers of inmates. Nor is there much support to date from the department of corrections to form a collaborative alliance.
Case Study
One of my private clients is a young man who has been in and out of jail several times since his mid-teenage years. Recently, he married his high school sweetheart and they live fairly amicably
with her parents. At his wife’s urging, he has completed his GED and is now attending college.
Old wounds compel him towards periodic self-sabotage, and no doubt my client will retain memories of horrific child abuse and privation for the rest of his life, but he being afforded the
opportunity to see the world in a different way with the help of his new family.
Although he now has people that care about him, services such as those provided by the Allegheny County Department of Human Services would still be of enormous help to him, for he has no access to medical care, nor has he been able to find work for the past 8 months. Whether or not he ever reoffends is anyone’s guess, but the chances of him doing so, now that he has virtually 24-hour emotional support, are perhaps less likely.
Much as it may “take a village” to raise a child, similar efforts may be required to help ex-offenders reintegrate with society. The benefits? A productive, tax-paying citizen where once there was an expensively incarcerated individual. I cannot see how we can realistically do otherwise.
References
Federal and State Prisons: Inmate Populations, Costs, and Projection Models (1996). United States General Accounting Office. Retrieved 3/18/2010 from http://www.fas.org/irp/gao/ggd97015.htm
Freeman, R. (2003). Can we close the revolving door? Recidivism v. employment of ex-offenders in the U.S. Paper presented at the New York University Reentry Roundtable, New York.
Goldberg, A., Higgins, B. (2006). Brief mental health screening for corrections intake. Corrections Today, August 2006. Retrieved 3/18/2010 from http://findarticles.com/p/articles/mi_hb6399/is_5_68/ai_n29288993/?tag=c...
Hartwell, S. (2003). Short-term outcomes for offenders with mental illness released from
incarceration. International Journal of Offender Therapy and Comparative Criminology, 47(2).
Kubrin, C., Stewart, E. (2006). Predicting who reoffends: the neglected role of neighborhood
context in recidivism studies. Criminology, 44(1).
Langan, P, Levin, D. (1997). Percent of population under correctional supervision, by gender,
1986-97. Bureau of Justice Statistics Correctional Surveys (The National Probation Data Survey,
National Prisoner Statistics, Survey of Jails, and The National Parole Data Survey). Retrieved
3/18/2010 from http://bjs.ojp.usdoj.gov/content/glance/sheets/cpgendpt.csv
Lovell, D., Gagliardi, G., Peterson, P. (2002). Recidivism and the use of services among persons
with mental illness after release from prison. Psychiatric Services, 53(10).
Lurigio, A., Rollins, A., Fallon, J. (2004). The effects of serious mental illness on offender
reentry. Federal Probation, 68(2).
Mears, D., Wang, X., Hay, C., Bales, W. (2008). Social ecology and recidivism: implications for
prisoner reentry. Criminology, 46(2).
Navasky, M., O'Connor, K. (2005). The new asylums. Frontline Special Reports. Boston: Public
Broadcasting Service WGBH. Retrieved 4/13/2010 from http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/reentry.html
Nelson, S. (2002). Commentary: a second opinion. Psychiatric Services, 53(5).
Salekin, R.T., Rogers, R., Ustad, K.L., Sewell, K.W. (1998). Psychopathy and recidivism among
female inmates. Law and Human Behavior, 22(1).
Snell, T. (1997). Percent of population under correctional supervision, by gender, 1986-97.
Bureau of Justice Statistics Correctional Surveys (The National Probation Data Survey, National
Prisoner Statistics, Survey of Jails, and The National Parole Data Survey). Retrieved 3/18/2010
from http://bjs.ojp.usdoj.gov/content/glance/sheets/cpgendpt.csv
Visher, C.A., Travis, J. (2003). Transitions from prisons to community: understanding individual
pathways. Annual Review of Sociology, 29(1).
Yamatani, H. (2008). Overview report of Allegheny County Jail collaborative evaluation findings.
Center on Race and Social Problems, School of Social Work, University of Pittsburgh. Retrieved
4/13/2010 from http://www.alleghenycounty.us/WorkArea/linkit.aspx?LinkIdentifier=id&Ite...
For example, through conversations with corrections officers I have learned that at least some of these officers believe that many inmates would be better served in a mental health facility, rather than by corrections. They cite a pervasive lack of basic life and social skills among inmates, especially the inability to communicate effectively, plus poor to virtually nonexistent self-regulation of impulses and emotions as just a few deficiencies that correctional facilities are ill-equipped to deal with.
Of my clients at the jail, all have been abused at some point in their lives and are compromised emotionally and/or mentally, with most suffering from comorbid conditions such as bipolar and posttraumatic stress disorders (PTSD), plus substance abuse issues. One man has been diagnosed as a paranoid schizophrenic with obsessive-compulsive disorder (OCD) plus PTSD. Another man has been diagnosed as having schizophrenia, but probably suffers from OCD and PTSD instead.
Although certainly not a comprehensive review of current literature and research, this paper will
examine existent statistical data and information about our inmate populations for a potential
relationship between mental illness and recidivism.
Evidence
The percentage of individuals incarcerated in the United States is increasing. The United States
General Accounting Office (1996) found that between 1980 and 1995, the total number of those
imprisoned at both the state and federal level rose by 242 percent or from 329,000 to approximately 1.1 million inmates nationwide, reflecting an increase of about 770,000 individuals within the span of just 15 years.
These figures necessarily include individuals who have reoffended and been returned to prison. The Bureau of Justice Statistics monitored 272,111 former inmates from 15 states for 3 years after their release from prisons in 1994. Of these individuals, 52% were eventually returned
to prison either for newly committed crimes or for parole violations (Langan&Levin, 2002). Nationally, 53% of all released males, and 39% of all females, were reincarcerated during this time period (Visher&Travis, 2003).
In 1997, approximately 6 to 16% or between 70,000 to 190,000 of all incarcerated individuals were identified as being mentally ill, as compared with only 2% of the general U.S. population (Freeman, 2003; Lovell, et al., 2002). Data concerning specific mental illnesses is incomplete, but rough estimates seem to indicate that inmates with major depression constitute anywhere from 3.5 to 11.4 % of the national inmate population, while schizophrenia is found in about 1.5 to 4.4% of all inmates, and those suffering from bipolar disorder represent between 0.7
to 3.9% of incarcerated individuals (Lurigio, Rollins&Fallon, 2004).
Follow up studies show that about 48% of these individuals were found to have been hospitalized in a psychiatric setting within 18 months of their release, while 64% were rearrested within the same time period (Lovell, et al., 2002). Of note and perhaps indicative of the relative severity of mental illnesses experienced by inmates, Hartwell (2003) found that felons were more likely to be admitted to psychiatric hospitals after being released, while those who had only committed misdemeanors were typically reincarcerated. Inmates that I have interviewed tell me that while in custody they have a right to health care including medications, but this provision ends upon their release.
Reasons for Recidivism
Kubrin and Stewart (2006) examined census data and statistics from the Oregon Department of
Corrections for approximately 5000 prisoners released back into the community during the first half of the year 2000. They found that while individual characteristics such as a history of drug
abuse, prior arrests and incarcerations, as well as a lack of education are important factors in
explaining high recidivism rates, barriers to reintegration coupled with neighborhood environmental issues are also decisive. These external factors include social acceptance or non-acceptance of the ex-offender, the ability to obtain and receive continuing therapy and/or medical treatment, plus accessibility to jobs and housing. In addition, complying with the terms of release may preclude some from employment (Lurigio et al. 2004), as some companies will not allow parolees or probationers to attend appointments with probation or parole officers during working hours.
For individuals released into communities where resources are plentiful and easily procured, recidivism rates appear significantly lower than for those released into disadvantaged areas
(Kubrin & Stewart, 2006; Lurigio et al., 2004). These findings are important because many law
enforcement officers, criminologists, our judicial system, and even the general public often assume that recidivism is primarily influenced by personal choice, traits, and history of criminal
behaviors.
What has become clear to some researchers though is that arrest and incarceration are often the natural sequelae of untreated mental illness, while recidivism within this population is
exacerbated by homelessness and joblessness (Lurigio et al., 2004; Nelson, 2002). Considering the shortage of easily-accessible psychotherapy in homogeneous lower socio-economic neighborhoods and communities (Lurigio et al., 2004), it is not surprising that these groups are over-represented within inmate populations and thus statistically recidivate more frequently (Mears, Wang, Hay, & Bales, 2008).
Solutions to the Problem
Undoubtedly, the most important correctional aspect regarding inmates with mental illnesses is the availability and acceptance of treatment (Nelson, 2002). However, to facilitate management of mental illness, perceptions within the criminal justice system need to change.
The opinion held by many parole and probation agencies that only 5% of the general inmate
population is afflicted with a mental illness (Lurigio et al., 2004) goes against what limited
statistical information is available. Psychological screening during reception and processing vary
widely from facility to facility, and may consist only of simple questionnaires which are often
unreliable and miss many signs and symptoms that would be observable during a clinical evaluation (Goldberg & Higgins, 2006). Thus, the actual numbers of mentally ill offenders are likely much higher than currently presented, and indeed could change dramatically if each inmate was given an appropriate psychological examination upon first being incarcerated.
Therefore, intensive, cohesive case management is probably the only solution to the problem of
warehousing the mentally ill in correctional facilities, and some communities are moving forward
with innovative collaborative efforts. In Pennsylvania for instance, the Allegheny County
Department of Human Services has implemented a program that begins upon the inmate’s release and continues for as long as necessary. Through this program, mentally ill offenders are provided with a ride from the correctional facility, clothing, bus passes, temporary housing, help applying for food stamps and other entitlement benefits, and arrangements for health care. Recidivism rates for individuals assisted by this program have been cut in half since its inception in 2000, from about 33% to a little over 16% (Yamatani, 2008; Navasky & O’Connor, 2005), and at an annual savings to taxpayers of about $5.3 million (Yamatani, 2008).
Nearly all of my incarcerated clients could be helped by such a program. Our non-profit
organization provides some similar services to inmates, however, adequate funding simply is not
available to provide for the diverse needs of large numbers of inmates. Nor is there much support to date from the department of corrections to form a collaborative alliance.
Case Study
One of my private clients is a young man who has been in and out of jail several times since his mid-teenage years. Recently, he married his high school sweetheart and they live fairly amicably
with her parents. At his wife’s urging, he has completed his GED and is now attending college.
Old wounds compel him towards periodic self-sabotage, and no doubt my client will retain memories of horrific child abuse and privation for the rest of his life, but he being afforded the
opportunity to see the world in a different way with the help of his new family.
Although he now has people that care about him, services such as those provided by the Allegheny County Department of Human Services would still be of enormous help to him, for he has no access to medical care, nor has he been able to find work for the past 8 months. Whether or not he ever reoffends is anyone’s guess, but the chances of him doing so, now that he has virtually 24-hour emotional support, are perhaps less likely.
Much as it may “take a village” to raise a child, similar efforts may be required to help ex-offenders reintegrate with society. The benefits? A productive, tax-paying citizen where once there was an expensively incarcerated individual. I cannot see how we can realistically do otherwise.
References
Federal and State Prisons: Inmate Populations, Costs, and Projection Models (1996). United States General Accounting Office. Retrieved 3/18/2010 from http://www.fas.org/irp/gao/ggd97015.htm
Freeman, R. (2003). Can we close the revolving door? Recidivism v. employment of ex-offenders in the U.S. Paper presented at the New York University Reentry Roundtable, New York.
Goldberg, A., Higgins, B. (2006). Brief mental health screening for corrections intake. Corrections Today, August 2006. Retrieved 3/18/2010 from http://findarticles.com/p/articles/mi_hb6399/is_5_68/ai_n29288993/?tag=c...
Hartwell, S. (2003). Short-term outcomes for offenders with mental illness released from
incarceration. International Journal of Offender Therapy and Comparative Criminology, 47(2).
Kubrin, C., Stewart, E. (2006). Predicting who reoffends: the neglected role of neighborhood
context in recidivism studies. Criminology, 44(1).
Langan, P, Levin, D. (1997). Percent of population under correctional supervision, by gender,
1986-97. Bureau of Justice Statistics Correctional Surveys (The National Probation Data Survey,
National Prisoner Statistics, Survey of Jails, and The National Parole Data Survey). Retrieved
3/18/2010 from http://bjs.ojp.usdoj.gov/content/glance/sheets/cpgendpt.csv
Lovell, D., Gagliardi, G., Peterson, P. (2002). Recidivism and the use of services among persons
with mental illness after release from prison. Psychiatric Services, 53(10).
Lurigio, A., Rollins, A., Fallon, J. (2004). The effects of serious mental illness on offender
reentry. Federal Probation, 68(2).
Mears, D., Wang, X., Hay, C., Bales, W. (2008). Social ecology and recidivism: implications for
prisoner reentry. Criminology, 46(2).
Navasky, M., O'Connor, K. (2005). The new asylums. Frontline Special Reports. Boston: Public
Broadcasting Service WGBH. Retrieved 4/13/2010 from http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/reentry.html
Nelson, S. (2002). Commentary: a second opinion. Psychiatric Services, 53(5).
Salekin, R.T., Rogers, R., Ustad, K.L., Sewell, K.W. (1998). Psychopathy and recidivism among
female inmates. Law and Human Behavior, 22(1).
Snell, T. (1997). Percent of population under correctional supervision, by gender, 1986-97.
Bureau of Justice Statistics Correctional Surveys (The National Probation Data Survey, National
Prisoner Statistics, Survey of Jails, and The National Parole Data Survey). Retrieved 3/18/2010
from http://bjs.ojp.usdoj.gov/content/glance/sheets/cpgendpt.csv
Visher, C.A., Travis, J. (2003). Transitions from prisons to community: understanding individual
pathways. Annual Review of Sociology, 29(1).
Yamatani, H. (2008). Overview report of Allegheny County Jail collaborative evaluation findings.
Center on Race and Social Problems, School of Social Work, University of Pittsburgh. Retrieved
4/13/2010 from http://www.alleghenycounty.us/WorkArea/linkit.aspx?LinkIdentifier=id&Ite...
I can think of many people, besides the mentally ill, that would benefit from such treatments. In our society, we've adopted an "every man for himself" kind of attitude, so it's hard to support programs to provide such assistance when other people are left to fend for themselves. This is especially true when one sees individuals that have "played by the rules" and done everything right, only to be deprived of everything they've worked for by those that simply take advantage.
While I realize that it isn't your intent to discuss the larger social aspect of this, and I certainly don't want to hijack this post to consider such social problems, it does seem clear that it will be hard to gain much enthusiastic support when our entire society shows so little respect and value for its citizens in general.