The Criminal Justice Review: Mentally ill Inmates

The Criminal Justice Review Volume 1. April 2015

Image take n from http://sdmsp.ru/

Taking a closer look at Mentally Ill offenders incarcerated in America’s Prisons

NCCU Edition

TABLE OF CONTENTS

Topic: 

Meet the Writers ………………………………2

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Emerging Technology………………………….3

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Policy Analysis ………………………………..4

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Extent of the Problem…………………………5

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Literature Review…………………………….6-8

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A Closer Look: The Beeler Interview………...9-10

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Opinion Editorial……………………………..11-12

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Facts of Mental Health behind Prison Walls…13

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References……………………………………..14-15

This magazine is created in satisfaction of a requirement of the Senior Seminar CJRU 4600-OL1 AT North Carolina Central University, Department of Criminal Justice. The information contains herein, the opinions, or writings are not to be constructed to be the opinion or policy of an employee, department, division or office of the University.

© No portion of the magazine’s works may be reproduced without the permission of the author.

NCCU Criminal Justice Department’ Whiting Criminal Justice Building; 1801 Fayetteville St; Durham, NC 27707; (919) 530-6100

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MEET THE WRITERS

Emerging Technology: Telehealth By: Jerel McDaniel Mentally ill offenders are a major issue in the Criminal Justice Correctional system and it is growing more and more every day.

According to a 2006 study tan by the Bureau of Justice Statistics (BJS) there are 705,600 mentally ill adults incarcerated in state prisons, 78,800 in federal prisons and 479,900 in local jails. For years jails and prisons have tried to take the place of mental health institutions there has been some progress but there is still work that needs to be done.

There have been tremendous strides to create different forms of technology that that can be used to help mentally ill patients. “Telehealth- using electronic information and telecommu-

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nications technologies to provide long-distance clinical care and consultation, patient and professional health-related education, public health and health administration (New Freedom Commission, n.d)…” Telehealth is a great tool that can be used to help the mentally ill offenders. Its original purpose was to help those who don’t have access to the resources they need due to where they live. But this resource can also be used for inmates because they do lack the appropriate resources needed.

Telehealth is much like Skype offenders will talk with their assigned physician for 30- 45 minutes once a week to give updates and talk with offenders about their progression. “Telehealth technologies can include videoconferencing, store-and-forward data, images or videos, remote patient monitoring, and mHealth (mobile health) applications (New Freedom Commission, n.d).” With partnering with different healthcare professionals within the state the help offender’s need could be at their fingertips.

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Policy Analysis By: Shirbrea Ponder “There have been an increases number of incarcerated men and women with severe mental illnesses. However, U.S prisons are not designed or equipped for mentally ill inmates” (Fellner, 2006). The conditions that prisons are currently experiencing do not fit those who are mentally ill. The conditions are overcrowding violence; isolation and more importantly inadequate health sciences.

There are many individuals who are not diagnosed properly before sentencing. The problem is individuals are sent to prison without the proper treatment plan or medication. This worsens their conditions.

Many prisons are populated with individuals are desperate in need of care and sensitive psychiatric care.

In many cases, prison guards have little training when managing individuals with mental illnesses.

Better mental health services provided to mentally ill offenders in prison can benefit prisoners, prison employees and the community. This policy will improve the life of both prisoners and the prison community.

There are many stigmas and discrimination incidents that can be reduced. “The prevention and proper treatment of mental disorders, together with promoting good health should be the number 1 priority of good prison management” (Beynon & Drew, 2005).

There may be limited resources but steps need to be taken to improve the mental health of prisoners. It should be against the law for someone to be in prison with mental illnesses. The same health that the community receives should be the same that prisoners receive.

Providing health workers with an adequate training or visits outside the prison setting can achieve this. Even when a prisoner needs to see a specialist, there will be a specialist where treatment can be provided. “Training for mental health issues should be provided to all people involved in prisons including prison administrators, prison guards and health workers” (Beynon & Drew, 2005).

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Extent of the Problem By: Shirbrea Ponder

“Kouyoumdjian (2015), it is believed that is prisoners received better health car while behind bars and even after release their health and the community’s health would improve”

This policy will be used to offer treatment to inmates during their sentence and after release.

This can lead to less mental issues, chronic disease and reduced the spread of discusses that are infectious. The staff will be responsible for prescreening inmates for suicide risk. They will also be eligible for separate screenings such as processing, intake and medical screening. In this policy, interim is important for inmates because inmates are given a 45-day supply of medication. Once they are released inmates will receive all the necessary medications until they get the proper medical care.

Regarding post-release follow-up, staff will be required to do a follow-up and make sure that any disapproval receives an appealing process.

“Community Health services need to be expanded and organized to better serve the poor, the homeless, and those who are substance abusers. To resolve the dilemma between prison security and the needs of mentally ill offenders, we far more commitment, and common sense from public leaders, corrections officials, and the public” (Fellner, 2006).

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FACTS: 

One in four adults -− approximately 61.5 million Americans -− experiences mental illness in a given year (DeMoss, 2015).

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Approximately 2.6 percent of American adults -− 1 million people -− live with bipolar disorder (DeMoss, 2015).

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Approximately 26 percent of homeless adults staying in shelters live with serious mental illness and an estimated 46 percent live with severe mental illness and/or substance use disorders (DeMoss, 2015).

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Approximately 18.1 percent of American adults -− about 42 million people -- live with anxiety disorders, such as panic disorder, obsessivecompulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxiety disorder and phobias (DeMoss, 2015).

Literature Review Mental illness in America has become an increasingly popular topic of discussion. Rather than being placed in hospitals for treatment, mentally ill individuals are being placed in correctional facilities for their actions. Persons with serious mental illness (SMI) such as bi-polar disorder, severe depression, schizophrenia and etc. have trouble within society. Many lack income and stable living arrangements to be able to succeed in the community.

Side effects of their illness can enable them to become a part of the criminal justice system.

One can blame the criminalization of the mentally ill on deinstitutionalization. Deinstitutionalization began in the 1950s, when state mental hospitals began emptying patients and moving them back into the community. “Deinstitutionalization drew enthusiastic support from fiscal conservatives interested primarily in saving funds by shutting state hospitals, as well as from civil rights advocates who believed that mental patients needed to be “liberated,� (Torrey, Kennard, Eslinger, Lamb, & Pavle, 2010). By the 1970s, there was an increase in the number of mentally ill individuals in jails and prisons. According to Adams and Ferrandino (2008), prison inmates tend to have the same disorders as the inmates in the general population. The most common mental illnesses in the inmate population are depression, schizophrenia and bi-polar disorder. In their article, Adams and Ferrandino go into detail about mentally ill offenders in the prison, they try to identify mental health problems and evaluate their needs for treatment.

Adams and Ferrandino speak of the importance of screening and assessment in correctional facilities to detect if an inmate may have a mental illness and the level of risk they may be to themselves and/or others. They also talk about other key issues such as treatment, medication, correctional officer involvement in mental health issues and housing that pertained to mentally ill offenders.

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By: Jessica Morataya While mentally ill offenders are incarcerated, it is important to service their medical needs. Of course with different inmates comes different service needs; for example, mentally ill male offenders greatly differ from mentally ill female offenders. Mentally ill offenders may also have other illnesses or diseases that need medical attention over those mentally ill offenders who only suffer from mental illness. A group of researchers conducted a study on federal mentally ill offenders in prisons to estimate their service needs in correctional facilities. The findings were obtained through a series of exams which included prior mental health service use and past and current diagnosis of serious mental illness.

Through the finding, the researchers were able to notice that although the entire facility needed to treat the mentally ill offenders, there were more chronic offenders with mental illness in three distinct parts of the system: female facilities, medium security facilities and high security facilities.

The researchers suggested an increase in mental health staff at female facilities, medium security facilities and high security facilities because of the higher quantity of mental ill inmates at these facilities (Magaletta, Diamond, Faust, Daggett, & Camp, 2009).

Image taken from kpbs.org

Literature Review By: Jessica Morataya The researchers also suggested correctional facilities elevate their screening, assessment, management, treatment, and services to the mentally ill inmates that are housed at their facilities. Mental health professionals should decide the level of mental health care the mentally ill inmates should receive according to their illness, their symptoms as well as additional factors. Although it can be troublesome to uphold this additional responsibility for correctional facilities, it is important that they understand the importance of the needs and treatment of mentally ill offenders while they are incarcerated. Being criminalized is not helping mentally ill inmates but treatment will aid them in long-term process both while they are incarcerated and while they are out in the community.

Incarcerating mentally ill offenders in correctional facilities can be of a burden to them as well as stress. Housing these inmates in solitary confinement can be even more worrisome and some suggest it can be against the Fifth Amendment: cruel and unusual punishment. According to Metzner and Fellner (2010), the anxiety, lack of social contact and disproportionate days can infuriate the symptoms of mental illness or provoke recurrence. They also stated that suicides occur more frequently in segregation units than elsewhere in prison. Mentally ill inmates who are housed or placed in solitary confinement often require critical care or psychiatric hospitalization. In their article, Metzner and Fellner provide different suggestions for correctional staff which are not limited to mental health practitioners, physicians, health care professionals and psychiatrist. Solitary confinement should have restrictions upon mentally ill inmates; this form of correctional punishment only worsens the mental state of inmates who already suffer from a psychological illness. It can be concluded that at times, the correctional staff in facilities are unaware of certain inmates suffering from a mental illness. This can be due to the inmate not know they have a mental illness, poor screening at correctional facilities, or in-

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According to Lafortune (2010), for at least 20 years, significant proportions of offenders with mental illnesses are not being detected at admission, and are therefore not being treated. Lafortune conducted a study to examine current screening practices in short -term correctional facilities. Although there was a large amount of missing data from this study, it indicated that correctional workers did not have time and/or good working conditions to fully complete the assessments. The study also found that women were more likely to be found with mental health problems compared to men. Lafortune stated “certain offender are at greater risk of not being diagnosed than others: those suffering from depressive disorders, those who are older, or those from ethnic groups and cultural minorities� (Lafortune, 2010, p. 94). Findings also revealed that male offenders who a mental health problem had been detected received shorter sentences, but the women who were detected of having mental health problems did not receive shorter sentences. Overall, the findings from the study concluded that screening and assessment to detect mental health problems in correctional facilities have been more complex for certain mental illnesses over others. This makes it tougher to treat these mental illnesses.

Detecting offenders for mental health problems in indeed very important for not only the offender but also the correctional system, however, is it not uncommon to hear of persons having mental illness and substance abuse disorder.

Persons with psychiatric and co-occurring substance abuse disorders are reported to have poorer overall prognosis than individuals with single disorders. The presence of co-occurring disorders is associated with multiple negative outcomes, including higher rates of psychotic symptoms, depression and suicidality, violence, rehospitalization and homelessness. (Baillargeon, Hoge, & Penn,

Image taken from kpbs.org

By: Jessica Morataya Released offenders with substance abuse disorder co-occurring mental health problems often times have trouble coming back into the community. With no source of income, no health insurance and little to no family support they turn to shelters for help and beg for money. If shelters are over-capacitated, they are forced to sleep under bridges, in public parks or even in abandoned homes. There was a study conducted at a Texas prison facility to compare the number of times inmates with substance abuse disorder co-occurring a major psychiatric disorder was incarcerated versus inmates with only a single disorder. The study showed that inmates with co-occurring substance abuse disorders had significantly higher risks of multiple incarcerations over a 6-year period compared to inmates with a major psychiatric disorder alone or a substance use disorder alone (Baillargeon, Hoge, & Penn, 2010).

In other words, offenders who are severely mentally ill and are substance abusers have a higher chance of recidivating over offenders who only suffer from either a major mental illness or substance abuse disorder. Substance abuse can also lead to poor compliance with psychotic medications and can result in psychotic symptoms and further involvement with the criminal justice system (Baillargeon, Hoge, & Penn, 2010, p. 372). There are many different factors that lead to the conclusion of this study including mental health and rehabilitative programs for released offenders in the community. If more community-based treatment facilities that were skilled in treating both mental illnesses and substance abuse, the chances of the recidivism rate for these dual diagnosis offenders would decrease.

Mental ill offenders are constantly getting caught up in the criminal justice system. They are receiving punishment over treatment for their illness and it has had a negative impact on both the offender and the system. There are many different factors associated with mentally ill offenders in prisons such as solitary confinement, screening and assessment, substance abuse and their medical needs. It can be noted that mental ill offenders need to be is hospitals to be able to receive the proper treatment they need to be able to function properly in society or they will become repeat offenders. Jails/prisons are not properly equipped with staff and treatment to house mentally ill offenders. Their actions can be seen as absurd, insubordinate, and strange. Solitary confinement is often a place they are housed because of their psychotic and outlandish behavior, but solitary confinement only makes their behavior worse. It is important to understand and comprehend mental illnesses so that coping with mentally ill offenders can increase and become more sufficient.

Inside a Level 4 inmate's cell at the R.J. Donovan Correctional Facility. (Angela Carone/KPBS) Image taken from kpbs.org

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Professor Arthur Beeler has an outstanding background working with offenders with mental illness. He started working at the federal bureau prison for 40 years, prior to that he was a volunteer probation officer, where he worked his way up to being the complex warden of the federal complex prison of Burtner in North Carolina. He served as a warden in 7 different prisons prior to retirement. Today he currently works in the Division of Public Safety where he serves as a Chair, Task Force looking at the provision of mental health in North Carolina prisons. Specifically, he reviews mental health practices for the mentally ill offenders who are confined to restrictive housing. He works with a team, who makes recommendations to the Director of Prisons. I chose to interview Mr Beeler, because over the years he has shown a great passion and sympathy towards the field of mental illness. As an instructor at North Carolina Central University, he has taught students the importance of inmates with mental illness inmates and addresses the field of corrections. During my 30 minute interview with Professor Beeler, I could tell that is very passionate about inmates with mental illness.

A Closer Look: The Beeler Interview By: Delia Kpenosen

Q:

Do you think correctional officers are well trained to serve mentally ill inmates?

A: I think correctional officers training are getting better now however, we still have a long way to go. prison and jails were never designed to serves people with mental illness but with the deinstitutionalization of mental health hospital within the 1960’s and 1970’s and some other issues, many people who were released from the mental health hospitals were placed into the community without funding. As a result of that this caused people to commit more crime and be incarcerated. As of today about 20% of the prison population today is now seriously mentally ill.

Q: As a warden do you believe that inmates with mental illness should be treated with special care from the general population?

A: I believe that inmates with mental illness should have individualized treatment plan and people with mental illness should be treated by those individualized plan. However this treatment breaks the prison because people who are not mentally ill believe that the mentally ill are being favored of which of course is not the case but it’s that rule dilemma of whether people with mental illness should be treated differently from people who are incarcerated for crime who are known as “criminals without having mental illness “. The bottom line here is that there should be individualized treatment and we have to carry on with that plan however one big issue is that there’s not enough staff and resources to do that.

Q: Being that inmate with mental illness have to be separated from the general population what is the cost of housing mentally ill inmates?

A: There are different data’s and statistics that show the cost of Mr. Arthur Beeler Image taken from nccu.edu

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housing inmates with mental illness, however based on my recent research, the state of Texas department of criminal justice recently said it cost $22,000 dollars a year to house an offender. At the same Texas department of criminal justice it cost about $50,000 dollars a year to house an offender with mental illness. This cost of housing varies according to the state.

A Closer Look: Continued…...

By: Delia Kpenosen

Q: Do inmates will mental illness receive ALL treatments they need while incarcerated

A: No I know for a fact they do not receive all the treatments

Mr. Arthur Beeler Image taken from nccu.edu

Q:

they need, going back to the resources a large component of offenders have substance abuse problems, the correlation between this two problems are significant and there is just not enough diagnosis programs out there to treat both the mentally ill and the substance abuse. People who are mentally ill often end up in isolation or housed by themselves either for protection or there no place to place them in general population and it’s not fair to the mentally ill and the society, but that the way reality is. He further explains that we have to be able to provide them with treatment and after care which is the huge component that the criminal justice system is missing because once they leave we have to provide them with after care if not they are liable to come back for the same offense or if not even worse

Do you think the correctional system should come up with a new policy to better help inmates with mental illness? (If yes) what should this new policy be, how will you

Q: Does Rehabilitation and counseling of inmates with mental

A: Yes the three largest metal health prisons

A: He stated yes he believes it plays a positive role because if

in the Unites States are L.A county jail, cook county jail, and Rickers Island, which is a shame on the criminal justice system but because of that jailers and prison wardens have to develop policies to deal with mental illness. Based on my experience my new policy would be taking into consideration of all policies and the fact that these people are mentally ill and to provide some sort of allowance to diagnose their mental illness however this does not mean that they are not held accountable. it means they get the assistance they need when dealing with the situation they don’t necessarily understand by making sure they get the education needed you evaluate this policy based on the mentally ill offenders and how they can stay in general population and get the services they need, are not placed in isolation and being managed humane style of an

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illness play a positive role? an individual is lucky enough to get into a good program where there are caring professionals who know how to treat mental illness it can make all the difference in the world. He stated that there are a few of these programs available however there as just not enough of them

Q: When considering the ethical standards of mental ill in prison how do you handle the conflict between the two?

A: There is a conflict between the two; in fact there have been a conflict since the start of process criminalizing some who is “sick”. Yes they have committed a crime and there is this entire ethical dilemma that occurs with that. As a prison administrator for 30 years “ I realize that “I can’t change everything, but I have to change what I can “ in other words you deal with what you have and try to ensure that inmates with mental illness get all the treatment they can

Opinion Editorial By: Zakia Knight

The Bureau of Justice Statistics (BJS) reported in 2005 that 62.2% of mentally ill inmates had been formally charged with breaking the rules since admission, compared to 51.9% of the general population (Adams & Ferrandino, Managing Mentally Ill Inmates in Prisons, 2008). At the same time, the mentally ill are more vulnerable to assault, sexual assault, exploitation, and extortion from other inmates. 36% reported being involved in a fight since admission, for example, compared to 25% of other inmates (Adams & Ferrandino, Managing Mentally Ill Inmates in Prisons, 2008). With statics showing the mentally ill are more receptive to engaging in additional criminal like activity upon admission, and are highly likely to become victims, action should be taken to ensure their safety and rehabilitation. The obvious action that should be taken is to implement a separation of institutes for the mentally ill and those who do not have mental illnesses, thus, reincorporating the deinstitutionalization process.

Image taken from theatlantic.com

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Image taken from democraticunderground.com Mentally ill inmates can find niches or specialized environments in prison in which they function better (Toch, 1992). The thought here is, by taking advantage of these specialized environments there can be a reduction of stress or other detrimental experiences, thus reduce allowing the inmate to act casually.

For example, Ax et al. (2007) noted that there are distinct environmental triggers for irritable aggression. This type of aggression often occurs in response to a frustration or insult. It is accompanied by angry emotions, it is not directed at a tangible goal, and the outburst usually is disproportionate to the triggering stimuli. With more careful matching of inmates, especially those who are mentally ill, to prison environments, it is likely that the incidence of such violence can be reduced (Adams & Ferrandino, Managing Mentally Ill Inmates in Prisons, 2008)

Many prisons fail to adequately screen inmate for mental illness during intake, fail to offer special programming or housing, fail to provide basic treatment for many prisoners, and fail to address special needs upon release, as described infer at 8 et seq. (Ball, 2006). The result is that mentally ill prisoners get sicker, say longer, suffer more- and wind up back in prison soon after they are released (Ball, 2006). This lack of clearance and improper implementation, has clearly negatively affected the housed mentally ill. We all have family members who suffer from different forms of mental illnesses, and if they happened to get imprisoned; due to the acts of going against the norms of society, proper care and help would be all we wanted for them. But it is also clear that, that help would not be properly administrated properly in a general population.

Mentally ill prisoners serve, on average, 15 months longer for the same crimes as those who do not suffer from mental illnesses. Their illness prevents them from engaging in prison programs that results in the acquisition of “good time” credit, meaning that they serve a greater percentage of their sentences (Ball, 2006). If properly treated in their own specialized institution, mentally ill inmates may not have to serve the full length of the sentences placed onto them.

And just like other prisoners, they may be able to shorten their sentences by being granted “good time”.

By: Zakia Knight

It is imperative our justice system combats the needs of the mentally ill inmates. Car and colleagues (2006) noted that strategies of adaptation that integrate inmates into the prison culture can be counterproductive to their therapeutic goals for mentally ill inmates. For example, mentally ill inmates often have greater difficulties socializing with inmates, and this deficit can have harmful consequences, including victimization and acting out behavior. Therefore, they may benefit from less socialization or more structured socialization (Adams & Ferrandino, Managing Mentally Ill Inmates in Prisons, 2008).

Level 4 inmate waits in a temporary holding tank. These tanks are used when an inmate is in the process of being moved to the Administrative Segregation Unit and is deemed a threat to the safety and security of the institution. (Angela Carone/KPBS)

Implementing separate but equal prisoner for the mentally ill can better reform them. An example is the McNeil Program, which was established for mentally ill offenders at the McNeil Island Corrections Center in Washington State, with three coordinated program settings that emphasized return to the general population.

This program also had three main treatment strategies: “careful monitoring and counseling concerning medications by psychiatrists and nurses; psych-educational classes (anger management, chemical dependency) and a low-stress milieu” (Lovell, Johnson, Jemelka, Harris, & Allen, 2001, p. 475). To follow up with the program, research was done. The research indicated that the incidence of psychiatric symptoms was reduced while inmates were in the program, and the environmental features rated most positive by the inmates were “architecture, freedom of movement, protection from the stresses of general population and availability of activities” (Lovell et al., 2001, p. 484).

Numbers do not lie. Mentally ill inmates deserve a chance to conform to society, just as the inmates without mental illnesses do.

Image taken from goodmenproject.com

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An Infographic By: Staneshia Griffin

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References Adams, K., & Ferrandino, J. (2008). Managing mentally ill inmates in prison.

Criminal Justice and Behavior, 35(8), 913-927.

Aufderheide, D. (2014). Mental Illness In America’s Jails And Prisons: Toward A Public Safety/Public Health Model. Retrieved from Ethics & Health Law News.

Ax, R., Fagan, T. J., Magaletta, P. R., Nussbaum, D., & White, T. W. (2007). Innovations in correional assessment and treatment. Criminal Justice and Behavior, 893-905.

Baillargeon, J., Hoge, S. K., & Penn, J. V. (2010). Addressing the challenge of community reentry among released inmates with serious mental illness.

American Journal of Community Psychology, 46, 361-375.

Ball, D. (2006). Mentally Ill Prisoners in the California Department of Corrections and Rehabilitation:Strategies for Improving Treatment and Reducing Recidivism. Standford Criminal Justice Center, 1-41.

Beynon, J., & Drew, N. (2005, 12 19). Mental health and prisons. Retrieved from World Health Organization.

Carlson, N. A. (2015). Mentally Ill Persons in Corrections. National Institute of Corrections.

DeMoss, D. (2015, 03 25). The nightmare of prison for individuals with mental illness. Retrieved from Huffington Post.

Fellner, J. (2006). A corrections quandary: Mental illness and prison rules. Harvard Civil Rights-Civil Liberties Law Review, 391-412.

Giliberti, M. (2015). President's New Freedom: Comission on Mental Helath.

Insel, T. (2004). Inmate mental health. Retrieved from National Institute of Mental Health.

James, D., & Glaze, L. (2006). Mental health problems of prison and jail inmates.

Bureau of Justice Statistics: Special Report, 1-12.

Kouyoumdijan, F. (2015, 02 25). Improving inmate health can lead to better community health and safety. Retrieved from EurekAlert.

Lafortune, D. (2010). Prevalence and screening of mental disorders in short-term correctional facilities. International Journal of Law and Psychiatry, 33, 94 -100.

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References Lovell, D., Johnson, C., Jemelka, R., Harris, V., & Allen, D. (2001). Libing in prison after presidential mental health treatment: A program follow-up.

The Prison Journal, 473-490.

Magaletta, P. R., Diamond, P. M., Faust, E., Daggett, D. M., & Camp, S. D. (2009). Estimating the mental illness component of service need in corrections restules from the mental health prevalence project. Criminal Justice and Behavior, 36(3), 229-244.

Metzner, J. L., & Fellner, J. (2010). 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.

Toch, H. (1992). Living in prison: The ecology of survival. Washington, D.C: American Psychological Association.

Torrey, E. F., Kennard, A. D., Eslinger, D., Lamb, R., & Pavle, J. (2010). More mentally ill persons are in jails and prisons than hospitals: A survey of the states.

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Thank you!