Although much has happened in correctional health care this year, the greatest news concerns are the rising needs of the incarcerated mentally ill and the relationship of mental illness and isolation practices. Thus, my year-end report summarizes the big news stories about mentally ill offenders and their treatment in the criminal justice system. Movement continues in the direction of reducing the use of isolation and solitary confinement for these inmates.
Mentally Ill and disabled Inmates Overpower the System
Decades of reducing resources for mental health treatment across the country has led to the over-criminalization of mental illness. Many jails and prison systems have more mentally ill inmates that any treatment facility. A study undertaken by the National Sherriff’s Association found that there are three times more seriously mentally ill persons in jails and prisons than in hospitals. Yet, jails and prisons are not arranged or organized to provide the kind of treatment and supervision this population desperately needs. The mentally ill (those with psychological conditions) and the mentally disabled (those with brain injury and learning disabilities)are difficult to manage behaviorally as well as difficult to protect from being victimized among the general incarcerated population.
Isolation is Not a Good Answer
A common solution to managing these inmates is through segregation and isolation. Yet, study upon study about the negative effects of solitary confinement and isolation practices in the criminal justice system point to the need for change in management practices. Even mentally healthy inmates can become anxious, depressed, paranoid, and psychotic when removed from normal social and perceptual stimulation. These detrimental effects are more significant for those already suffering from mental disorders such as schizophrenia, bipolar disorder, or major depression. Isolation can lead to self-mutilation, rage, and suicide attempts. These harmful effects are prevalent even when segregation is initiated for the protection of the inmate. Advocacy groups are increasingly sounding the alarm. This is leading to media attention such as a 2014 PBS Frontline episode and National Public Radio story. This year, state systems like California have moved to change isolation policies while state systems like Nebraska are urged by advocacy groups to do the same. Expect more movement in modifying isolation practices for mentally ill inmates in 2015.
Treatment Must Be Part of the Solution
A major difficulty in adequately managing mentally ill inmates is the lack of appropriate treatment resources. Government budgets are strapped and even providing adequate security and medical services is difficult. Mental health services are often minimal and correctional mental health staff can be difficult to recruit. Still, city and state governments like New York City and Illinois have unveiled plans for increasing treatment for the incarcerated mentally ill in 2014. Look for more mental health treatment incorporated into the criminal justice system in 2015.
Diversion before Incarceration
According to the Council of State Governments, there are now more than 300 mental health courts across the country. Mental health courts will continue to be advocated in the year ahead. 2014 startup examples abound in Illinois, Iowa, Ohio, and Pennsylvania. This can only be good news for jails and prisons as diverting management of selected mentally ill individuals reduces the volume of difficulties behind bars.
Lawsuits and Legislation
Both the legal and political systems will continue to bring pressure to bear to create chant in the criminal justice system in 2015. This year, for example, lawsuits in Indiana and legislation in New Jersey seek to hard wire mental illness treatment and reduction of isolation use into these correctional systems. Expect more lawsuits and legislation regarding treatment of mentally ill inmates in the year ahead.
It has been another newsworthy year for correctional healthcare. I look forward to the New Year and more dialogue with all of you in the Corrections1 Community!
