Treatment of Prisoners and a Call for Improved Mental Health Care
AP Seminar
2023
Word Count: 2125
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Treatment of Prisoners and a Call for Improved Mental Health Care
The American Prison System has gone through a vast change in the lifespan of the
country. By the late twentieth century, the U.S prison population was under 200,000. In less than
half a century, that number would increase over seven-fold (Golembeski, 2008). Catalysts for
such a monumental increase would include revisions in sentencing regulations and a more strict
approach to reducing crime rates. Rather than providing much required help to prisoners and
converting them to ideal samaritans, these revisions in law have instead perpetuated gruesome
living conditions in American prisons. The autobiography “Long Walk to Freedom'', written by
former South African president Nelson Mandela, discusses in great detail the physical and
psychological turmoil he - alongside countless other prisoners - was forced to endure during his
nearly three decade sentence in South African prisons. Despite the text referring to prisons in a
completely different region, it still remains a valuable source for comparison to prison conditions
in the U.S while simultaneously introducing the importance of mental fortitude amongst
prisoners. The same year that Nelson Mandela was released, the United Nations adopted and
proclaimed the Basic Principles for the Treatment of Prisoners, which establishes the mandatory
maintenance of basic human rights of prisoners in prisons worldwide. Despite this, U.S prisons
completely disregard these principles, instead borderline torturing its inmates with overcrowding,
unnecessary violence, and containing them in disease-ridden conditions. When analyzing this
issue through a psychological and social lens, the frightening rates of recidivism, detriments of
solitary confinement, and the government’s tendency to sweep it under the rug all become
evident in their correlation to the decline of prisoners' mental health. This, in turn, begs the
question at hand: To what extent do the treatment of prisoners in American prisons call for
higher quality mental health care? The treatment of prisoners warrants immediate mental health
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innovations through prison-based programs alongside an increase in legal regulations in prison
operations.
The United States has the largest prison population in the world. The Federal Bureau of
Prisons reports the population held in federal prisons to be circa 1.2 million in 2021 (2022),
around 3 out of every 1000 people in the country. With such an astronomical percentage of the
population in prisons, concerns regarding the treatment of prisoners have been on the uprise. The
most salient of these concerns are on overcrowding, solitary confinement, and the lack of
government involvement in genuinely assuring criminal correction. The severity of these issues
are further coupled with the fact that mental illnesses in prisoners have far higher rates than that
of the general population (Gonzalez & Connell, 2014). Despite all this, the government fails to
provide mentally handicapped prisoners with proper treatment. Reasons behind this seem to be
limited resources (Gonzalez & Connell, 2014) and cuts in correctional funding (Scott-Hayward,
2009). Nonetheless, the detriments of this lack in treatment proves itself through disproportionate
rates of recidivism (Treatment Advocacy Center, 2009). As prisoners victim to mental illnesses
are subject to harsh living conditions in prisons, the need for action exponentially increases.
When analyzing this problem through a psychological lens, one of the most prevalent
factors in prisoner injustice lies in solitary confinement. The practice of solitary confinement in
the United States dates back to the late eighteenth century, with it first being implemented in
Pennsylvania in 1787 (Reiter, 2012). By the end of the first half of the nineteenth century,
prisons across the country began implementing solitary confinement as punishment (Reiter,
2012). However, the system was quickly condemned by many, with European visitors such as
Tocqueville and Beaumont describing it as a system that “devours the victim incessantly and
unmercifully; it does not reform, it kills”. (Beaumont & Tocqueville as cited in Reiter 2012).
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Treatment of Prisoners and a Call for Improved Mental Health Care
What makes solitary confinement so crippling is the extensive isolation prisoners are subjected
to. More so, the lack of social interaction that follows being in solitary confinement. According
to Sheldon Cohen, Professor of Psychology at Carnegie Mellon University, social interaction
with others aids in emotional regulations as well as limits the severity and span of negative
mental health affects (Cohen, 2004). When people begin to succumb to excess stress, it activates
coping responses such as substance abuse and sleep loss. Repeated activation of such responses
may lead to a myriad of psychiatric disorders (Cohen, 2004). However, social interactions
decrease the activation of such responses. This is because as people under stress begin to interact
with others, the belief that others will provide support and necessary resources is reinforced. As a
result, Cohen continues, the ability to cope with stress in a healthy manner is strengthened and
negative psychological and emotional effects are severely diminished (Cohen, 2004).
The significance of social interaction is further stressed in a report published by Debra
Umberson, professor of sociology at the University of Texas at Austin, and Jennifer Karas
Montez, Ph.D holder and professor of psychology at Syracuse University. According to the
report, it's stated that as greater social connections are made, one’s sense of purpose and meaning
in life increases (Umberson & Montez, 2010). This can directly enhance mental health and
psychological well-being, which in turn may decrease involvement in unhealthy physical habits
(Umberson & Montez, 2010), consistent with Cohen’s findings. These findings all reinforce the
significance of social interaction in an individual’s life. Thus, by stating the positive effects of
social interaction, these reports also naturally imply that there is severe harm in the lack of such
interaction. According to the Treatment Advocacy Center, prisoners in solitary confinement are
typically held in cells for 23 hours a day, with severely limited human interaction (2009).
Furthermore, with the number of severely mentally ill prisoners multiplying in recent years, a
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large percentage of these prisoners find themselves locked up in solitary confinement (2009).
With these two problems stacked up on one another, implications from the findings of Cohen,
Umberson, and Montez become clear: the conditions of mentally ill prisoners in solitary
confinement become severely worse as a result of being deprived of human interaction.
The importance of social interaction, especially in a prison environment, is implied
greatly in Nelson Mandela’s autobiography “Long Walk To Freedom”. In the latter half of the
book, Mandela discusses the prison lifestyle and how it’s created with the intent of mentally
breaking prisoners. Prisoners were forced into routine, with every day exactly the same as the
one before. This seemingly endless pattern was one of the prison warders’ numerous methods for
reinforcing superiority over prisoners. As Mandela describes it: “Prison is designed to break
one’s spirit and to destroy one’s resolve” (Mandela, 1994). Authorities will manipulate every
weakness of each prisoner in efforts to get them to submit. They treat prisoners similar to
animals in hopes of “stamping out that spark that makes each of [them] human” (Mandela,
1994). With such an agenda, Mandela continues, it was nearly impossible for any inmate to resist
order individually. However, what gave Mandela hope during his sentence was the relationships
the inmates had with one another. With every interaction, they lifted each other up in high spirits.
This would exponentially augment their determination in staying strong, fortifying Umberson’s
and Montez’s findings. Despite not being alike in every aspect, “the stronger ones raised up the
weaker ones, and both became stronger in the process” (Mandela, 1994). This developed sense
of camaraderie allowed them to maintain their individuality while signifying that although their
hardships were far from over, they would face this struggle together.
At a social standpoint, the issue of recidivism presents itself. Recidivism is defined as a
“relapse into previous criminal behavior” (Baillargeon et. al., 2009) and is signified through
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repeated arrests and incarceration. According to a report published by the U.S Department of
Justice, a population of a little over 400,000 state prisoners released in 2005 were reported to
have a collective sum of nearly 2,000,000 arrests within 9 years of their release; about 5 arrests
per prisoner on average. (Alper et. al., 2018). Furthermore, it was found that 68% of prisoners
were rearrested within 3 years of their release, 79% within 6, and 83% within 9 (Alper et. al.,
2018). Such astonishing rates hold true for federal prisoners as well. In a report published by the
U.S Sentencing Commission, it was found that 49.3% of federal prisoners released in 2010 were
rearrested at some point following their release, the same percentage of that in 2005. With no
signs of decreasing, it’s evident that the U.S has some of the highest rates of recidivism in the
world. The most common causes behind this unfortunate statistic include lack of connections to
resources and unemployment (U.S Department of Justice, 2022). However, Jacques Baillargeon,
professor at the University of Texas and Ph.D holder in psychiatry, alongside four other doctors,
explored the correlation between mental disorders and recidivism in an article published to the
American Journal of Psychiatry. The study involved evaluating a body of prisoners incarcerated
in Texas prisons. Results from the study showed that prisoners suffering from major mental
disorders were substantially more likely to have been previously arrested in comparison to
prisoners without them (Baillargeon et. al., 2009). The study suggests that the risk of recidivism
is much higher amongst prisoners with mental health disorders. Reasons behind this correlation,
Baillargeon states, include “limited availability of community-based mental health services, mass
downsizing of state psychiatric institutions, and a legal system with a limited capacity to discern
underlying mental health problems” (Baillargeon et al., 2009). Constantly shifting from crisis
hospitals to prisons, prisoners with mental illnesses seldom receive necessary treatment. As a
result, they’re more likely to commit crimes after release.
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A coterminous conclusion was found by Danielle Wallace and Xia Wang, associate
professors at Arizona State University, in a report published to SSM - Population Health. It was
found that prisoners with better mental health in prison had lower odds of recidivating, with
recidivism rates dropping even further among prisoners who have significantly improved their
mental health following release (Wallace & Wang, 2009). There seems to be a negative
correlation between mental health conditions within prisoners and recidivism rates, as poor
mental health follows high recidivism rates and vice versa. As rates of recidivism increase,
public safety is greatly compromised as the endless cycle of criminals committing crimes and
being rearrested is perpetuated, greatly affecting victims of these new crimes (Department of
Justice, 2019). In the study conducted by Baillargeon et al., prisoners with psychiatric disorders
had higher rates of assault, homicide, and robbery (Baillargeon et al., 2009), all of which cause
severe societal harm and diminish public safety.
When studying causes for such staggering rates of recidivism, a conclusion consistently
reached is the lack of proper treatment and resources, seemingly as a result of failure to remain in
a single facility. Action can be taken in the form of admitting prisoners with moderate to severe
mental illnesses into mental health courts. Mental health courts are special courts that provide
services and treatments to defendants with mental illnesses that “substitute a problem-solving
model for traditional criminal court processing” (Justice Center, 2023). Their effectiveness was
evaluated in a study done by Dale McNiel and Renée Binder, professors at USCF. Results of the
study showed that those who participated in mental health courts went longer without acquiring
novel criminal charges compared to those who haven’t (McNiel & Binder, 2007). In a two year
follow-up, it was found that mental health court participants who have been active in the
program for 18 months were up to 26% less likely to recidivate compared to those who received
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regular treatment (McNiel & Binder, 2007). The results of the study imply a great correlation
between participation in mental health courts and diminishing recidivism rates within mentally ill
prisoners. Furthermore, as a result of the sample size including a vast percentage of those
charged with criminal offenses, the results of the study act as a green light for an expansion in
the number of mental health courts in the country as well as the programs offered (McNiel &
Binder, 2007).
Despite the desirable implications, the solution holds one major flaw: restricted
accessibility. Mental health courts only accept those with moderate to severe mental illnesses
(Wallace & Wang, 2009). As a result, those suffering from mild mental illnesses, despite
suffering as well, are excluded from the benefits of mental health courts. This lack of acceptance
can prove to be fatal, as mild mental illnesses that are left untreated may lead to worsened
conditions, which in turn may cause excess societal harm. However, in spite of such limitations,
if initiative is taken in this direction, a shift from the status quo will be made. Steps must be
taken in order to ensure genuine treatment of mentally ill prisoners, as doing so is as important as
guaranteeing the safety of society.
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Works Cited
Alper, Mariel, and Matthew R. Durose. 2018 Update on Prisoner Recidivism: A 9-Year
Follow-up Period (2005-2014 ...
https://bjs.ojp.gov/content/pub/pdf/18upr9yfup0514_sum.pdf.
Baillargeon, Jacques, et al. “Psychiatric Disorders and Repeat Incarcerations: The Revolving
Prison Door.” American Journal of Psychiatry, vol. 166, no. 1, 2009, pp. 103–109.,
https://doi.org/10.1176/appi.ajp.2008.08030416.
Carson, E. Ann. “Prisoners in 2021 – Statistical Tables.” Bureau of Justice Statistics,
https://bjs.ojp.gov/library/publications/prisoners-2021-statistical-tables.
Cohen, Sheldon. “Social Relationships and Health.” American Psychologist, vol. 59, no. 8, 2004,
pp. 676–684., https://doi.org/10.1037/0003-066x.59.8.676.
Golembeski, Cynthia, and Robert Fullilove. “Criminal (in)Justice in the City and Its Associated
Health Consequences.” American Journal of Public Health, vol. 98, no. Supplement_1,
2008, https://doi.org/10.2105/ajph.98.supplement_1.s185.
Mandela, Nelson, et al. “Chapter 60.” Long Walk to Freedom, Macmillan Children's Books,
London, 2022. McNiel, Dale E., and Renée L. Binder. “Effectiveness of a Mental Health
Court in Reducing Criminal Recidivism and Violence.” American Journal of Psychiatry,
vol. 164, no. 9, 2007, pp. 1395–1403., https://doi.org/10.1176/appi.ajp.2007.06101664.
“Mental Health Courts.” CSG Justice Center, 7 Jan. 2022,
https://csgjusticecenter.org/projects/mental-health-courts/. “Recidivism of Federal
Offenders Released in 2010.” United States Sentencing Commission, 9 May 2022,
https://www.ussc.gov/research/research-reports/recidivism-federal-offenders-released-20
10.
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Reingle Gonzalez, Jennifer M., and Nadine M. Connell. “Mental Health of Prisoners: Identifying
Barriers to Mental Health Treatment and Medication Continuity.” American Journal of
Public Health, vol. 104, no. 12, 2014, pp. 2328–2333.,
https://doi.org/10.2105/ajph.2014.302043.
Reiter, Keramet Ann. “The Most Restrictive Alternative: A Litigation History of Solitary
Confinement in U.S. Prisons, 1960–2006.” Studies in Law, Politics, and Society, 2012,
pp. 71–124., https://doi.org/10.1108/s1059-4337(2012)0000057006.
Scott-Hayward, Christine S. The Fiscal Crisis in Corrections: Rethinking Policies and Practices .
https://www.vera.org/downloads/publications/fiscal-crisis-corrections-rethinking-policies
-and-practices-2.pdf.
“A Second Chance: The Impact of Unsuccessful Reentry and the Need for Reintegration
Resources in Communities.” A Second Chance: The Impact of Unsuccessful Reentry and
the Need for Reintegration Resources in Communities,
https://cops.usdoj.gov/html/dispatch/04-2022/reintegration_resources.html.
Stringer, Heather. “Improving Mental Health for Inmates.” Monitor on Psychology, American
Psychological Association, Mar. 2019,
https://www.apa.org/monitor/2019/03/mental-heath-inmates. The Treatment of Persons
with Mental Illness in Prisons and Jails: A State Survey.
https://www.treatmentadvocacycenter.org/storage/documents/treatment-behind-bars/treat
ment-behind-bars.pdf.
Umberson, Debra, and Jennifer Karas Montez. “Social Relationships and Health: A Flashpoint
for Health Policy.” Journal of Health and Social Behavior, vol. 51, no. 1_suppl, 2010,
https://doi.org/10.1177/0022146510383501.
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Wallace, Danielle, and Xia Wang. “Does in-Prison Physical and Mental Health Impact
Recidivism?” SSM - Population Health, vol. 11, 2020, p. 100569.,
https://doi.org/10.1016/j.ssmph.2020.100569.
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