Prison Based Mental Health Treatment
Brandt, A.L.S. (2012). Treatment of Persons with Mental Illness in the Criminal Justice
System: A Literature Review. Journal of Offender Rehabilitation. 51:541-558, 2012.
This literature review evaluates the prevalence and causes of mental illness in the criminal
justice system and describes inadequate care that is provided, the effects of imprisonment, and
the problem of rehabilitation. Overall, this article concludes that prisons have become de facto
mental health treatment centers that provide inadequate care. This low level of care effects the
prison environment and can exacerbate illnesses, increase suicide rates, create lasting
psychological effects, increase recidivism rates, and make it harder for inmates to re-enter
society. Finally, the literature review concludes that the correction environment is not
conducive to treatment.
Selective citations of support are as follows:
1) Due to limited resources such as time, space, and money, the most common form [of]
treatment given to mentally ill inmates is the administering of medications (p. 547).
2) Correctional staff are only able to assess inmates, provide crisis management, and monitor
inmates’ medications (p. 547-548).
3) [L]ess than half of mentally ill inmates receive any form of treatment (p. 548).
4) Correctional staff are not trained to handle mentally ill inmates, which creates another
treatment problem. Correctional staff are in the best position to watch for symptoms of a mental
illness, but most are not trained to do so (p. 548).
5) An examination of the in-facility offenses of inmates in the Colorado Department of
Corrections found that mentally ill inmates had a higher rate of disciplinary actions than the
general population, and because of the number of violations were more likely to be placed in
higher security units, such as administrative segregation (p. 548).
6) Rule violations, both violent and nonviolent, are more common in offenders with depression
and psychosis, as well as in those who experience hopelessness, paranoia, and hallucinations (p.
548).
7) Because of the inadequate care received and the effects of imprisonment, problems faced by
mentally ill inmates in corrections include rehabilitation, recidivism, and offender reentry (p.
553).
Bewley, M.T. and Morgan, R.D. (2010). A National Survey of Mental Health Services
Available to Offenders with Mental Illness: Who is Doing What? Law and Human Behavior.
35:351-363.
The purpose of this study was to examine the national practices of psychotherapy services for
male offenders with mental illness in state correctional facilities. Overall, researchers in this
Prison Based Mental Health Treatment
study found that mental health professionals provided a variety of services focused on six main
goals: mental illness recovery, emotions management, institutional functioning, re-entry, riskneed, and personal growth. Data analysis showed that mental health professionals in this study
generally viewed mental illness recovery, institutional functioning, and personal growth as
significantly more important than emotions management, re-enty, and risk-need. Additionally,
mental health professionals tended to believe the services they provided were effective in
addressing mental illness, skill development, behavioral functioning, and criminogenic needs,
with more progress perceived in areas related to mental illness and skill development than their
ability to effectively change behavioral functioning.
It was further determined that the implementation of evidence-based interventions for offender
populations such as cognitive therapy and risk-needs-responsivitiy frameworks were not
notably utilized, pointing to an implementation of treatments that are designed for general
populations, not offender populations. An additional lack of vocational training indicates a
deficit in specialized treatment available for the offender population in prison.
Some key citations from this study are as follows:
1) Simply stated, prison environments are not optimal to mental health functioning. For
example, [offenders with mental illness] are more likely to incur disciplinary infractions and
victimization (i.e., physically and sexually assaulted) while in prison (p. 352).
2) [M]ental health professionals generally perceive mental illness recovery, institutional
functioning, and personal growth as significantly more essential, spend more time on, and
perceive there to be more progress over the areas of emotions management, re-entry, and rsikneed (p. 356).
3) Given the benefits of cognitive-behavioral treatments to offenders, it is surprising that [only
43.9% of state prisons surveyed endorsed] cognitive-behavioral theory as their primary
theoretical orientation. This possibly suggests that mental health professionals may not be
attending to the offender literature when treating offenders with mental illness (possibly in
favor of attending to the general mental health literature) or…correctional administrators are
not attending to therapist-offender match during the hiring process (p. 360).
4) Only 15.7% of [state prisons surveyed] incorporated each of the Risk-Needs-Responsivity
principles into their treatment work with offenders with mental illness (p. 360).
5) Vocational counseling and vocational skills training are going largely ignored with only 16%
of [state prisons surveyed] offering such services to offenders with mental illness (p. 360).
6) The relative shortage of vocational counseling…highlights an important deficit and gap in
continuity of care geared toward offenders’ re-entry (p. 360).
Prison Based Mental Health Treatment
O’Keefe, M.L. and Schnell, M.J. (2007). Offenders with Mental Illness in the Correctional
System. Mental Health Issues in the Criminal Justice System. 81-104.
This study examined correctional offenders with mental illness and found a growing number of
offenders with mental illness in Colorado’s prison system. Not only is this population
expanding, offenders with mental illness have higher rates of recidivism, oftentimes a result of
failing under parole supervision. Offenders with mental illness present with characteristics that
differentiate them from the general offender population, exhibiting greater rehabilitation needs
and prison adjustment difficulties, which has a direct impact on the resources required to house
them (p. 81).
Selective citations from this study are as follows:
1) Expanding incarceration rates of persons with mental illness pose many challenges for the
criminal justice system, and, in turn, confinement in correctional facilities can exacerbate
preexisting mental health conditions. Meeting the rehabilitative needs of this special subgroup
is complicated, costly, and often comes secondary to maintaining security and control. Criminal
justice system challenges are largely related to screening difficulties and limited resources. (p.
84).
2) Even when screening procedures identify offenders with mental illness, correctional
budgetary constraints leave minimal funding available for mental health treatment and
rehabilitative measures (p. 85).
3) Notwithstanding the limitations on group enrollment, most therapy programs do not address
comorbid substance abuse disorders, which have been estimated to exist in three quarters of the
offenders with mental illness population. Many treatment groups focus on these areas
individually or exclude offenders with dual diagnoses. This limits the treatment efficacy of
offenders with mental illness, as mental illness and substance abuse interchangeable affect each
other negatively (p. 85).
4) An important finding from this study was that technical returns are increasingly responsible
for many of the offender with mental illness prison intakes. This supports the literature that
indicates that mentally ill offenders are cycling in and out of the prison system. Indeed,
recidivism rates showed that offenders with mental illness were more likely than [offenders
without mental illness] to return to prison, even at 5 years post-release (p. 101).
5) Although the seriously mentally ill offenders receive the most attention, this study suggests
that those who have mental health needs but do not meet strict diagnostic criteria should not be
neglected. Effective management and treatment of offenders with mental illness may be costly,
but without these, the price paid by prisons and society may be even more costly (p. 102).
Prison Based Mental Health Treatment
Milkman, Harvey and Wanberg, Kenneth. (2007). Cognitive-Behavioral Treatment: A Review
and Discussion for Corrections and Professionals. National Institute of Corrections and U.S.
Department of Justice. Retrieved from: http://static.nicic.gov/Library/021657.pdf
From the preface:
This publication is intended to inform corrections and probation/parole
professionals about the availability and benefits of cognitive-behavioral
treatment (CBT) services geared toward the specific risks and needs of offender
populations. The publication is also intended as a resource for mental health
professionals seeking to evaluation or improve delivery of treatment services in
correctional institutions, community corrections centers, and outpatient
programs serving probation and parole clientele.
Chapter 1 discusses the increasing need for psychiatric and behavioral treatment
in the nation’s prisons and jails. Chapter 2 explores the history of cognitivebehavioral therapy and explains its principles.
Chapters 3 to 5 review literature on cognitive-behavioral treatments for
individuals who have come in contact with the criminal justice system. Six
programs in general use are reviewed: Aggression Replacement Training ®,
Moral Reconation Therapy ®, Thinking for a Change, Relapse Prevention
Therapy, Reasoning and Rehabilitation, and Criminal Conduct and Substance
Abuse Treatment: Strategies for Self-Improvement and Change (a program
developed by the authors of this publication).
Chapter 6 covers ‘real world’ issues that need to be addressed when providing
CBT for offenders, such as diversity considerations and how to treat clients with
serious mental disorder. This chapter concludes with a discussion of two
strategies: targeting the appropriate treatment for the particular offender, and the
‘manualized’ approach (giving practitioners a precise curriculum to follow).
These strategies have been shown to greatly improve offender outcomes” (p. xii).