Mentally Ill and in Jail
Joseph J. Harper, LCSW, DCSW, ACSW, MBA,
CCHP, CADC
Travis J. Nottmeier, MSW, LCSW, CADC
October 2013
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Objectives:
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Review the statistics associated with the topic.
Identify the mental health issues typically
identified in the incarcerated population.
Identify the issues associated with the
placement of the mentally ill in correctional
facilities.
Review concerns associated with the provision of
mental health services in correctional settings.
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Adult
correctional authorities supervised about
6,977,700 offenders at yearend 2011, a decrease of
1.4% during the year.
The decline of 98,900 offenders during 2011 marked
the third consecutive year of decrease in the correctional
population, which includes probationers, parolees, local
jail inmates, and prisoners in the custody of state and
federal facilities.
Correctional Populations in the United States, 2011Correctional Populations in the United States, 2011
Lauren E. Glaze, November 29, 2012 NCJ 239972
Erika Parks
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At yearend 2011, about 1 in every 50 adults in the
U.S. was supervised in the community on probation or
parole while about 1 in every 107 adults was
incarcerated in prison or jail.
• The community supervision population (including
probationers and parolees, down 1.5%) and the
incarcerated population (including local jail inmates
and federal and state prisoners, down 1.3%)
decreased at about the same rate in 2011.
• The majority (83%) of the decline in the correctional
population during the year was attributed to the
decrease in the probation population (down 81,800
offenders).
•
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Statistics
At midyear 2005 more than half of all prison and jail inmates had
a mental health problem, including 705,600 inmates in State
prisons, 70,200 in Federal prisons, and 479,900 in local jails.
These estimates represented 56% of State prisoners, 45% of
Federal prisoners, and 64% of jail inmates.
Mental Health Problems of Prison
and Jail Inmates
Doris J. James and
Lauren E. Glaze
BJS Statisticians
September 2006, NCJ 213600
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National Estimates of Six Psychiatric Disorders among State Prison Inmates and
in US Population 1995
Source: Prevalence of Communicable Disease Chronic Disease and Mental Illness Among the Inmate Population: in
The Health Status of Soon-To-Be-Released Prisoners: A Report to Congress, vol. 1, The National Commission on
Correctional Health Care, May 2002.
Disease
State Prison Estimated
Lifetime Prevalence
(N=1,010,2228
inmates)
%
Total US Population
Lifetime Prevalence
Schizophrenia/Psychosi
s
22,994-39,262
2.3- 3.9
.8
Major Depression
132,619-188,259
13.1-18.6
18.1
Bipolar
21,468-43,708
2.1-4.3
1.5
Dysthymia
85,018-135,121
8.4-13.4
7.1
PTSD
62,388-118,071
6.2-11.7
7.2
Anxiety
222,147-303,936
22.0-30.1
N/A
Systemic Problems
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Human Rights Watch states that “the high
rate of incarceration of mentally ill people
is a consequence of under funded,
disorganized, and fragmented community
mental health services.”
(NASW News, January 2004)
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“The New Asylums”
From Frontline on PBS
Comorbid Disorders
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Epidemiological Catchment Area (ECA) Survey of
late 1980’s indicated that dual disorders are
more common among the homeless, prisoners,
and mental hospital patients.
ECA survey reflects that 56% of prisoners had
alcohol problems, 54% had drug problems, and
56% had another psychiatric disorder (Harvard
Mental Health Newsletter, August 2003)
ECA survey “almost all inmates with a mental
illness were also substance abusers (Harvard
Mental Health Newsletter, August 2003).
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Substance Abuse
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From 1990 t0 2000, drug offenders in
state prison increased from 149,700 to
251,000 (Dr. McNeiley, Univ. of Chicago)
Drug Use among state prisoners 1997
(Journal of Correctional Health Care, Vol.
10, 3 Fall 2003).
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Substance Use Among State & Federal Prisoners
(Data from Bureau of Justice Special Report 1997)
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Type of Drug
Ever Using Drugs
Used Drugs Month
Prior
Using at Time
Any Drug
83.0
56.5
32.6
Cannabis
77.0
39.2
15.1
Cocaine/ Crack
49.2
25.0
14.8
Heroin/Opiates
24.5
9.2
5.6
Depressants
(barbiturates,
tranquilizers, Quaalude)
23.7
5.1
1.8
Stimulants
(amphetamine and
meth.)
28.3
9.0
4.2
Hallucinogens (LSD &
PCP)
28.7
4.0
1.8
Inhalants
14.4
1.0
-
Systemic Problems
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Drug offenders from 1990 to 2000 have
increased from 149,700 to 251,000 (Dr.
McNeily, University of Chicago).
Currently 2.1 million incarcerated. One in
every 75 men in jail or prison. Violent
crime is at a 30 year low. 715 inmates for
every 100,000 residents.
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Statistics With Placement
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More than half of all prison and jail inmates
nationwide- some 1,255,000 men and women
have mental health problems (Bureau of Justice
Statistics, 2006)
An estimated one hundred thousand are
psychotic on any given day. (American
Psychiatric Association, 2000)
Prisoners have rates of mental illness that are
two to four times greater than the rates of
members of the general public. (Metzner et al.,
2006)
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Policies with Placement
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Prisons were never intended to function as mental
health facilities
Two distinct policies that have shaped the
placement of mentally ill.
Deinstitutionalization
Punitive approach to anti-crime efforts
Corrections systems have not been able to keep
up with the exploding prison population much less
the mentally ill prisoner
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The Physical Conditions of Placement
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In the most extreme cases conditions of
confinement are horrific.
Extremely restrictive housing acts as an
incubator for psychiatric breakdowns
Poorly trained correctional officers have
accidentally asphyxiated mentally ill
prisoners whom they were trying to
restrain.
Society gains little from incarcerating
mentally ill offenders in poor environments
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The Physical Conditions of Placement
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Prisoners with mental illnesses have
impaired thinking, emotional responses,
and ability to cope
More likely to be exploited and victimized
Twice as likely to be injured in a fight.
(James & Glaze, 2006)
Higher rates of rule breaking. (Abramsky
& Fellner, 2003)
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The Provision of Mental Health
Services
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Prisoners receive little or no meaningful
treatment
Neglected, accused of malingering, or are
treated as disciplinary problems
Even acts of self-mutilation and suicide
attempts are too often seen as
“malingering” and are punished as rule
violations
Accumulate extensive disciplinary histories
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The Standards set by courts and
human rights
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Federal court rulings made it clear that correctional
authorities could not simply ignore the mental health
needs of prisoners
The eighth amendment to the Constitution of the United
States. “Deliberately indifferent”
International Covenant on Civil and Political Rights
(1966)
Human Rights Watch “prisons are not equipped to
handle mental illness and, more often than not, resort to
punishment to control those afflicted, aggravating their
illness.” (NASW News, January 2004)
Litigation Reform Act of 1995 has hampered these
rights. (1995)
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The Mental health professional
obstacles to provide services
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Competent and committed mental health
professionals struggle to provide good
services
Too limited resources
Officials who resent or begrudge their
work
Lack of decent pay and recognition
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What does the provision of mental
health services offer?
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Helping individual prisoners regain health
and improve coping skills
Encourage the development of more
effective internal controls
Promote safety and order within the prison
community
Enhance community safety when offenders
are released
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What do provisions currently lack?
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A sufficient number of qualified mental
health professionals
Peer review and quality assurance
programs. Paper to practice
Lack of specialized facilities
Mental health staff have very limited
administrative authority
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What do provisions lack?
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Needed private counseling, group
therapy, or structured activities
Training to non-mental health staff to
recognize these prisoners and needs
limiting treatment to the most acutely ill
Mental health staff limit their attention to
only a few
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Systemic Problems
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American Correctional Association indicates that
funding for mental health professionals
(particularly social workers) was reduced in the
1980’s and 1990’s as the focus of corrections
became punitive.
(NASW NEWS, January 2004)
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The root of the Mentally ill and in
Jail
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Can we afford to continue expanding
prison populations?
Radical changes to community mental
health, as well as poverty and
homelessness
Public commitment, compassion, and
common sense.
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Policy Statement From: Social Work Speaks
Social Work in the Criminal Justice System
In 2006, there were 2,245,189 individuals
incarcerated in local, state, and federal correctional
facilities in the United States (Sabol, Minton, &
Harrison, 2007). The United States has the highest
incarceration rate in the world, and the rate
increased 700 percent between 1970 and 2005
(Public. Safety Performance Project, 2007). In
addition, up to 60 percent of incarcerated
individuals who are released will be reincarcerated
within two years (Langan & Levin, 2002).
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Mental Health
Correctional facilities have become the treatment facility of last resort for
individuals who have been failed by other systems. The dismantling of the
psychiatric hospital system and the fragmentation of community mental health
systems has shifted the care of those with chronic mental health issues to the
correctional system. Substantial numbers of offenders have mental health
disorders that have not been diagnosed or treated. Many of these individuals
have comorbid substance abuse issues. Weedon (2005) reported there are
five times more persons with mental illnesses in jails than in state psychiatric
hospitals. Conservative estimates propose that 10 percent of offenders have
a mental illness (Norton, 2005), with rates of mental health problems in
incarcerated individuals reported as high as 64 percent Qames & Glaze,
2006).
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As Showalter and Hunsinger (2007) stated, "in
essence our prisons are full of people extremely
short on resources and long on problems" (p. 366).
Social workers trained in the corrections field are
uniquely qualified to provide services addressing all
the problem areas. Yet little has been written about
delivery of services in this field, and schools of social
work rarely address correctional social work and
criminal justice. Incarceration needs to be closely
analyzed.
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POLICY STATEMENT
NASW recognizes the importance of providing quality social work
interventions to the incarcerated population. The provision of an adequate
level of professional social work services could reduce the rates of recidivism,
reentry, and incarceration for the betterment of the individual as well as
society. Thus, NASW supports:
• ongoing advocacy to address issues surrounding and leading to
disproportionate rates of incarceration for individuals of racial or ethnic
minorities, juveniles, women, and undocumented individuals;
• increased use of professional forensic social workers to provide culturally
competent treatment and intervention for the growing population of
incarcerated individuals, including mental health and substance abuse
services;
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• safe, humane, and equitable treatment for all incarcerated individuals,
including cessation of sexual abuse, sexual harassment, and differential
sentencing and treatment;
• access to quality health care, medications, nutrition, treatment,
rehabilitation programs and support for incarcerated individuals includ ing
resisting all forms of discrimination based on diagnosis in delivery of
medical care;
• appropriate educational and vocational opportunities to assist
incarcerated individuals with transitioning back into their communities;
• access to affordable and adequate housing to assist incarcerated
individuals with transitioning back into their communities;
• establishment of best practice standards for professional social work in
criminal justice settings;
• specialized training on the unique application of social work skills and
values in a correctional environment for social workers practicing in
criminal justice settings;
• research to identify effective alternatives to incarceration, such as
diversion programs.
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• expansion of prevention , screening, and treatment efforts, including
issues such as sub stance abuse and dependence, mental illness,
sexually transmitted disease, blood and airborne pathogens, confidential
testing, and domestic violence;
• increased funding for community-based options, especially for those
individuals with substance dependence or serious mental ill ness who
may be better rehabilitated by these services;
• identification of and response to the special needs of any individual under
the supervision of the criminal justice system, including, but not limited to,
racial, sexual, and gender minorities; juveniles; women (including
pregnant women); the elderly; and those with impairments;
• advocacy and social work leadership to establish national policy on
criminal justice, issues in collaboration with other organizations.
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