The Mentally Ill in Prisons - PowerPoint Presentation

Slide1

The Mentally Ill in PrisonsSlide2

Getting Started

Definitions

Prison

FunctionMinimum, Medium, and Maximum Security Private PrisonsJail Function (Gaines, 2006)Mental disorder (NAMI.org)Slide3

History

Demonology – Believed possession

Hippocrates’ (460-377 B.C.)

Plato (429-347 B.C.)Aristotle (384-322 B.C.)Greek and Roman thoughtTherapeutic approachEurope (500 – 1500)The first Mental HospitalMass MadnessExorcism(

Butchner

, 2007)Slide4

More History

Asylums and Shrines (16

th

Century .. on)Humanitarian Reform (Late 18th Century)Moral Management Hygiene Movement (Butchner,2007)Slide5

Changes again in the Twentieth Century

Class Action Litigation

Cooper

v. Pate (1964)Estelle v. Gamble (1976)Bowring v. Godwin (1977)Bell v. Wolfish (1979

)

Ruiz v. Estelle (1980

)

Section 1983

of Title

42 of the U.S.

Code

Section 1997 of Title 42 of the U.S. Code

Civil Rights of Institutionalized Persons Act of 1980 Prison Litigation Reform Act 1996 (Metzner,2009)Slide6

Types of Psychological Disorders

Schizophrenia

Bipolar disorder

Major depressive disorderNon-schizophrenic psychotic disordersDrug Dependence

Personality Disorder

(

Baillargeon

, J., Binswanger, I., Penn, J. V., Williams, B. A., Murray, O. J., 2008).Slide7

A comparison of disorders

Men

Women

Most likely to suffer from:

Psychotic disorder

Personality disorder

Delusional disorder

Dementia

Substance abuse

Most likely to suffer from:

Major depressive disorder

Post traumatic stress disorder

Psychosis

Substance abuse

James & Glaze (2006)Slide8

Match the Columns!

1

. # of mentally ill in prison

2. # of prison & jail inmates with mental health problems

3

. # of mentally ill incarcerated

4

. # of inmates with a mental illness

# of mentally ill patients in psychiatric hospitals in

5

. 1950

6

. 1994

A. 1.25 million

B. 16 %

C. Nearly 75%

D. 71,619

E. Has quadrupled in the past 6 yrs

F. 592, 853

(Human Rights Watch, 2006)Slide9

Answers

1 & E-

Number of mentally ill in prison has quadrupled in the past 6 years

2 & A- Nearly 1.25 million prison & jail inmates have mental health problems3 & B-

16 % of the mentally ill population are incarcerated

4 & C-

Nearly 75% of inmates suffer from a mental illness

5 &F, 6 & D

-The number of mentally ill patients in psychiatric hospitals in 1950 was 592,853, and in 1994 was 71,619

(L., D., 2010)Slide10

How Many?

State prison- 73% women, 55% of men have mental health problems

Prisons- 3 times more people with mental illnesses

US prison population-4 times the amount of mental illnesses than the general populationMentally ill inmates- 45 & 54 years old (Human Rights Watch, 2006)Slide11

Why are the numbers so high in prisons??

Mentally ill are often poor

Homelessness

Cost differences Involuntary What are prisons turning into? A cure-all for all of society’s problemsInmates with substance abuseNot enough mental health resources

Aufderheide, D., & Brown, P. (2005)Slide12

Ethics and Counseling Psychologists

Multiple Roles

Assessment

TreatmentTrainingConsultationResearch Concepts of trust and individual choice collide with prison policies and practices that emphasize control, security, and conformityScott, N. (1985)Slide13

Ethics and Client Welfare

Threatened violence and confidentiality

Environmental concerns and impact

Reporting Drug Abuse Necessary medication Scott, N. (1985)Slide14

Ethics

The obvious ethical concerns:

Beneficence and

nonmaleficence; fidelity and responsibility; integrity; justice; and respect for people’s rights and dignityAmerican Association for Correctional Psychology 2005 – American Association for Correctional and Forensic Psychology The Correctional PsychologistFollowed APA guidelines2008 – International Association of Correctional and Forensic Psychology Four more specific ethical guidelines

Association for Correctional and Forensic Psychology (2010)Slide15

IAFCP’s Ethics

Principle A: Recognize individual rights to dignity, respect, self determination, and humane treatment

Principle B: Avoid or minimize emotional or physical harm

Principle C: Maximize good: Provide and advocate for competent mental health services and researchPrinciple D: Recognize and practice social responsibilityAssociation for Correctional and Forensic Psychology (2010)Slide16

Principle D includes:

1. Advocating for and providing optimal psychological or other mental health services of

sufficient quality

and quantity to meet the professionally identified mental health needs of seriously mentally ill inmates and offenders;2. Contributing to the staff training needs of the correctional or forensic setting or agency, including identifying and caring for the mentally ill offenders and inmates, and effectively managing suicide risk;3. Educating policy makers and the public about the mental health, rehabilitation, and community reintegration

needs of offenders and inmates;

4. Advocating for research that supports evidence-based foundations for correctional

rehabilitation programs

, practices, and mental health treatment.

Association for Correctional and Forensic Psychology (2010)Slide17

Treatment in Prison Today

Equation for effective incarceration includes

Detailed treatment plan with goals and objectives (discharge plan)

Effective drugs Cognitive Behavior TherapyLearn ways of coping, anger and stress management skills, and other skills to help them manage their illness better.Teaching of Self-Management SkillsActivity therapy, pet therapy, greenhouse therapy, or classesInformation passing between treatment facilities and prison pertaining to medical history and diagnosis

Caring staff that are properly trained to deal with disorders

(

Gater

, 2006)Slide18

Government

Federal

Required to provide pharmaceuticals and psychotherapy

33 % of federal inmates identified as mentally ill had been convicted of a violent offense, compared to 13 % of other inmates. State

Only encourage to provide medication

In

state facilities, 53

% of

mentally ill inmates had been convicted of a violent

offense,

compared to 46

%

of other inmates.Slide19

Of the options

34% of state inmates receive highest level of treatment

27% medicated

23% psychotherapy

Department of Justice (2006)Slide20

Prison Officials

Punished for symptoms

Confinement

Asphyxiation UnderstaffedSquirrel CagesDaisy Duke ShortsVirgin Islands

(Human Rights Watch, 2006)Slide21

Other Prisoners

Victims to assault, sexual assault, exploitation, & extortion

Antipsychotic Medication

“Dings” or “Bugs”Material Goods(Human Rights Watch, 2006)Slide22

Suicide in lock-up

Leading cause of death in lock-up

Jail - 47 per 100,000

Prison – 15 per 100,000General population – 11 per 100,000Isolation is more likely to increase these types of moodsSuicide assessment is not standardized (Cummings, 2009)Best PracticesTraining programs, screening procedures, communication between staff, documentation, internal resources, and debriefing after a suicide

(Lester, 2009)Slide23

What’s better?

Hospitals

$90,000-100,000

More training of staff Better treatment Incarceration

$

35,000

3x higher population

Higher suicide risk

Treated like a prisoner

Staff frustration

Nakagawa, S. (2004)Slide24

What are the requirements to wind up where?

Hospitals

There

are three potential routes to the state hospital:Civil commitment Inability to assist in one’s own defense to a criminal charge

Being

found guilty but for insanity

Prisons/Jails

Don’t plea insanity and found guilty

Don’t represent enough violence to be civilly committed

N

ot

officially stated, the law enforcement community and the courts will incarcerate a mentally ill person because it is the only way to get this individual the treatment they need

Taylor, B. (2008)Slide25

The Good and Bad

Pros

Has been successful

Lowered homicide and violent crime rates Continuing to reform policies and ethics Cons

People with mental illness often get worse while incarcerated, and tragedies involving victimization and suicide are too common

Repeated offenses

Qualified care?

PBS. (1999)Slide26

After Prison

350,000 mentally ill inmates released

Little to No treatment upon release

High rate of recidivism (PBS, 2010)Slide27

DiscussionSlide28

(2010).

A Crime of Insanity

. In PBS. Retrieved November 28, 2010, from

http://www.pbs.org/wgbh/pages/frontline/shows/crime/jailed/.(2010). Jailing the Mentally Ill. In American Public Media. Retrieved November 29, 2010, from

http://americanradioworks.publicradio.org/features/mentally_ill/poll/stats.html

Aufderheide

, D., & Brown, P. (2005). Crisis in Corrections: The Mentally Ill In America's Prisons.

Corrections

Today

, 

67

(1), 30-33. Retrieved from Academic Search Complete database.

Baillargeon

, J., Binswanger, I., Penn, J. V., Williams, B. A., Murray, O. J. (2008). Psychiatric Disorders and Repeat Incarcerations: The Revolving Prison Door. In The American Journal of Psychiatry . Retrieved November 23, 2010, from

http://ajp.psychiatryonline.org/cgi/content/full/166/1/103

.

Ball, D. W. (2008). Mentally ill prisoners in the

california

department of corrections and rehabilitation: strategies for improving treatment and reducing recidivism.

Butcher, J.;

Mineka

, S.; Hooley, J. (2007) Abnormal Psychology. (Ed.). Boston, MA.: Pearson Education, InCordner, G. (2006). People with mental illness. Problem-oriented Guides for Police Problem-Specific, 40.

Retrieved from: www.cops.usdoj.gov.

Croft, H.. (March 29, 2010).

Guilty of Mental Illness

. In America's Mental Health Channel. Retrieved November 22, 2010, from

http://www.healthyplace.com/thought-disorders/articles/guilty-

of-mental-illness/menu-id-64/.

Cummings, D.L. & Thompson, M.N. Suicidal or manipulative? The role of mental health counselors in overcoming a false dichotomy in identifying and treating self-harming inmates. Journal of Mental Health Counseling, 31, 201-212.

Fellner

, J. (2010). A corrections quandary: mental illness and prison rules.

Gaines, L. & Miller, R. (2006) Criminal Justice in Action.

The Core.

(Ed.). Belmont, CA.: Thomson/Wadsworth

Hartenstein, M. . (July 8, 2010).

ACLU demands Louisiana prison stop locking suicidal prisoners in 'squirrel cages,' humiliating them

. In NY Daily News. Retrieved November 23, 2010, from

http://www.nydailynews.com/news/national/2010/07/08/2010-07-

08_aclu_demands_louisana_prison_stop_locking_ suicidal_prisoners_in_squirrel_cages_h.html.Slide29

References

International

Association for Correctional and Forensic Psychology (2010) Criminal justice and behavior,

37(7), 749-808. doi: 10.1177/0093854810368253Jacobson, S. (July 23, 2010). Bedlam: mentally ill trapped in bulging county jail. In The Payson Roundup. Retrieved November 23, 2010, from

http://www.paysonroundup.com/news/2010/jul/23/bedlam-mentally-ill-

trapped-bulging-county-jail/.

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

Bureau of Justice Statistics Special Report

L, D. (2010). Individuals with Mental Illnesses in Jail and Prison. In

Bazelon

Center for Mental Health Law. Retrieved November 29, 2010, from http://www.bazelon.org/LinkClick.aspx?fil

eticket

=zvzRLXFf3cU%3D&tabid=246.

Metzner

, J. (2009). Monitoring a correctional mental health care system: The role of the mental health

expert. 

Behavioral Sciences & the Law

, 

27

(5), 727-741. doi:10.1002/bsl.879.

Nakagawa, S. (2004). Prisons as the new mental hospitals. Justice Matters, 12. Retrieved on November 26, 2009 from www.safetyandjustice.org. (November 30, 2007).

ACLU Urges Court to Fine Virgin Islands Officials for Indefinitely Detaining Innocent Mentally Ill Inmates

. In American Civil Liberations Union. Retrieved November 29, 2010, from

http://www.aclu.org/prisoners-rights/aclu-urges-court-fine-virgin-islands-officials- indefinitely-detaining-

innocent-

ment

.

(October 21, 2003). VII. Difficulties Mentally Ill Prisoners Face Coping in Prison. In Human Rights Watch. Retrieved November 29, 2010, from http://www.hrw.org/en/node/12252/section/8.

PBS. (1999). A crime of insanity: the jailed and imprisoned mentally ill. Retrieved from:

http://www.pbs.org/wgbh/pages/frontline/shows/crime/jailed/

Scott, N. (1985). Counseling prisoners: Ethical issues, dilemmas, and cautions. 

Journal of Counseling &

Development

, 

64

(4), 272-273. Retrieved from

PsycINFO

database.

http

://www.safetyandjustice.org/story/237.

(September 5, 2006). U.S. Number of Mentally Ill in Prisons Quadrupled. In Human Rights Watch. Retrieved November 22, 2010, from

http://www.hrw.org/en/news/2006/09/05/us-number-mentally-ill-prisons-quadrupled

.

Taylor

, B. (2008). Mentally ill in prisons and jails. State of Oregon. Retrieved from: www.leg.state.or.us.

Windmill, H. (September 29, 2010).

The High Prevalence of Mental Illness in Prisoners

. In Suite101. Retrieved November 28, 2010, from

http://www.suite101.com/content/the-high-prevalence-of- mental-illness-in-

prisoners-a291556.