The United States has the largest prison population in the world with over two million people incarcerated. A significant portion of prisoners suffer from mental illness, the percentage increasing after the deinstitutionalization movement. Following the 20th century deinstitutionalization of asylums in the United States, many large institutions were closed and abandoned (Amadeo). Instead of replacing these institutions with community health centers, many of our populations suffering from mental illness have been left to their own devices, often leading to suicide, homelessness, and prison. As prisons become more and more overcrowded with those in needs of psychiatric intervention, they essentially become the modern day versions of the asylums that were eliminated for inhumane practices. Lack of resources, poor care, and officer abuse contribute to poor health outcomes in an extremely vulnerable population. Many experience worsening or new symptoms within correctional facilities.
Alisa Roth of The Guardian adapts a case from her new book Insane: America’s Criminal Treatment of Mental Illness. Kristopher Rodriguez was fourteen when he was diagnosed with schizophrenia. Seventeen years later, he suffers severe psychosis within a Florida prison. Before his arrest, he had experienced many acute episodes and had been institutionalized many times. At the age of twenty-two, an armed robbery landed him in jail for five years while waiting for a plea bargain. Over the past nine years, his illness has become chronic and more severe. Hospitalization and self-mutilation did not stop the Florida department of corrections from placing him general population for several months. His mother claims that his condition has severely worsened with his time incarcerated and that she has not seen him lucid in years. Unfortunately, this case is hardly unique.
In Eyal Press’ Madness, featured in the May 2016 issue of The New Yorker, the reporter investigates the torture, suicide, and suspicious deaths occurring within the mentally ill population of Florida prisons. A firsthand account of abuse is given by a former counsellor, Harriet Krzykowski, at Dade Correctional Institution. Her accounts of mentally ill inmates enduring starvation, torture, beatings, and solitary confinement at the hands of corrections officers are astounding. She claims that the illness of prisoners become increasingly severe while in prison.
Post-traumatic stress disorder often goes unnoticed and untreated in prisons. Characterized by reliving experiences, avoidance behaviors, bursts of anger, reactivity, and changes in mood or cognition, 90% of prisoners suffering from post-traumatic stress disorder have unmet need for care, the highest of any mental illness (NIH). Untreated post-traumatic stress disorder increases the likelihood of suicide and self-harm, meaning that treatment is critical for affected individuals. Additionally, post-traumatic stress disorder is an indicator of the stress that leads to incarceration, as well as the stress that one endures within prison. Abuse, poverty, marginalization, and traumatic events can cause stress that triggers psychiatric disorders and impair functioning (Baranyi). With low or impaired functioning, it is harder for individuals to thrive in society. This inability to thrive can lead to crime and imprisonment. The United States has the largest prison population of any country, with over two million currently behind bars. This number is only growing. If many inmates are entering the prison system with untreated, undetected mental illness and only experience more severe symptoms and stress while incarcerated, then their reintroduction to society will not be successful. Using studies of post-traumatic stress disorder in incarcerated populations as well as the lens of ableism and classism, I intend to examine the claims that prison exacerbates mental illness.
According to the meta-analysis of post-traumatic stress disorder prevalence in prisoners, the rate of post-traumatic stress disorder in inmates is 5-fold for men and 8-fold for women against the general population (Baranyi). Approximately 300,000 inmates suffer from post-traumatic stress disorder and those imprisoned individuals are more likely to have comorbid mental illness. These rates, however, may not be surprising as childhood abuse, poverty, and marginalization lead to both post-traumatic stress disorder and prison. A major concern for the high rate of post-traumatic stress disorder amongst prisoners is the potential risk for repeat victimization. Those suffering from posttraumatic stress are more likely to be targets for physical, sexual, and emotional abuse (Baranyi). These types of abuse are common within prisons and significantly increase the distress felt by all inmates. Furthermore, post-traumatic stress disorder is associated with violence and those suffering after finishing their sentence are more likely to reoffend. This creates a violent prison cycle that does not benefit offenders or society.
This meta-analysis is unsure of a variety of factors. The significance of race is uncertain, only hispanic women were significantly more likely to be diagnosed with post-traumatic stress disorder. Also, the rate of post-traumatic stress disorder in prisoners that have experienced solitary confinement is unknown.
A study published in 1997 screened inmates in rural states for mental illness prevalence and found less prevalence in comparison to urban areas (Powell). The study was meant to attend to inmates outside of larger, more notorious prison systems, such as Cook County Jail. One aspect that was unique to this study was the mention of Ganser syndrome. Ganser syndrome is a dissociative disorder characterized by nonsensical responses and is frequently paired with amnesia or a fugue state. This syndrome is rare and sometimes called prison psychosis. The article did not screen for Ganser and it is doubtful that any participant that could be diagnosed with such a syndrome would be considered lucid enough to participate (Dieguez). The results of this study face the limitation of a lack of correlation between onset of symptoms and arrival to the prison system, as inmates interviewed had already spent some time incarcerated.
A study focused on current and lifetime mental illness about inmates not identified as acutely mentally ill avoids the limitations of the previous study by conducting interviews at intake (Trestman). All participants had never before been hospitalized, treated, or diagnosed with a psychiatric illness and had not been identified as mentally ill by Connecticut jails’ screening protocol. The results of this study suggest that screening protocol is severely lacking as the interviewed inmates had high rates of mental illness despite being previously deemed without. The Global Assessment of Functioning implied a high rate of impaired functioning. A limitation of this study is diversity. The researchers are unsure if inmates of color were less willing to participate due to the majority white research team.
All studies reviewed shower a higher incidence of mental illness in female inmates and many suggest targeted programs to help women transition in and out of incarceration. A study published in 2014 focused specifically on women in jail and had similar findings (Lynch). 91% of women interviewed met lifetime criteria of mental illness and 70% met 12-month criteria for at least one disorder. Comorbidity for a lifetime serious mental illness and post-traumatic stress disorder was 29%. The study was multisite and collected data from both rural and urban areas. The data suggests a serious need for improvement of mental health resources for female inmates.
Using MINI-Plus, a study of men and women entering the Iowa prison system found similar results of underdiagnosed inmates (Gunter). Researchers found that 90% of inmates newly committed to the general population of the Iowa prison system met criteria for a psychiatric disorder, 60% met criteria for two more disorders, and 30% were considered at risk of suicide. Over 30% met criteria for post-traumatic stress disorder. The study expresses concern for prisons’ ability to screen for psychiatric disorders as well as provide adequate care.
A limitation found in all of these studies, as well as all studies I reviewed regarding post-traumatic stress disorder, is a lack of any qualitative research. The experiences of the prisoners is not considered or reviewed, which contributes to the problem of causation of symptoms and worsening severity. While all studies suggest targeted programs and in-depth screening, none propose how to address a prison population with a potential majority of inmates suffering from mental illness.
The popular media articles concern is focused on the worsening symptoms that the mentally ill experience within prison due to abuse and lack of care. This is not explicitly addressed in any of the peer-reviewed articles. Both show clear concern about the wellbeing of incarcerated individuals with psychiatric disorders, however, the conclusions of the articles are different. The popular media call for a rehabilitative experience outside of prison, particularly since deinstitutionalization seems to have led to the mentally ill being imprisoned instead. The peer-reviewed articles call for better screening and care of inmates and does not address potential abuse as significantly.
The finding from the articles and the concerns from the popular media are similar but with completely different end goals. The implications of the popular articles are a complete overhaul of the prison system and how the mentally ill are cared for and treated in society. The studies I reviewed seem more interested in designating funding for better screening and greater care for the mentally ill within prisons.
Based on the diathesis stress model, a combination of environmental factors and genes cause mental illness. Factors like poverty and abuse can cause enough stress to trigger mental illness. These same factors can lead to crime and eventual imprisonment. Inequalities like poverty and lack of mental health resources disproprotionately place impoverished people in jail. The additional stigma against psychiatric disorders, ableism, and impaired functioning makes it harder for those suffering from mental illness to cope in society.
Instead of rehabilitation for mentally ill offenders, they are sentenced to prison. So many inmates are improperly screened and placed into general population that it is fair to assume that the majority of the mentally ill inmates are not receiving proper care, treatment, and rehabilitation. Therefore, upon completing their sentences, they are released back into society without coping or life skills and the cycle only continues. The current prison system in the United States and many other countries does not facilitate justice or a fair chance at life.
o Is this relationship discussed in the popular article? In the literature review? In the additional peer-reviewed articles?
The relationship between trauma and poverty causing mental illness is described in the meta-analysis as well as the peer-reviewed articles. It is also mentioned in The Guardian and New Yorker articles. Rodriguez’s symptoms began after the death of a close relative. Grief trauma could have potentially triggered his symptoms. Krzykowski mentions prisoners who entered the mental-health ward friendly and response soon entering psychosis following the stress and abuse they encountered. The research repeatedly mentions the effects abuse and trauma can have on an individual’s mental state and the potential violence and crime that can accompany impaired functioning.
All articles recognize the correlation between mental illness and incarceration, however, only the popular media and meta-analysis consider the excartarbating effects of incarceration on mental illness. Both media articles described an increase in severity of illness over the course of prisoners’ stay.
There is an implicit assumption apparent in all of the articles about the disregard the prison system and the society that condones it has for the mentally ill. The lack of funding, screening and care for those suffering of mental illness within the prison system as well as the justice system is clear.
The qualitative evidence provided by the media articles and the quantitative data presented by these articles creates a heavy question. How can we rehabilitate inmates and criminal offenders? How must we overhaul our prison system to create justice and safety for all? Without being given a fair chance at life, those who could not receive help for their mental illness end up in prison. This hurts not just the mentally ill populations but the general population as well.