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Why we incarcerate: Treatment

In the second segment of this three part series, this article examines some of the research surrounding the primary reason we incarcerate those who violate our laws

By Dr. Bruce Bayley, Sean Franzen, Jerica Dahlberg

In the second segment of this three part series, this article examines some of the research surrounding the primary reason we incarcerate those who violate our laws – treatment.  Please keep in mind that these reviews are not position pieces, but simply an overview of the current research that addresses each topic.  We are not supporting one ideal over another, but instead hope to continue the dialogue on the central issues that relate to the fundamental question: Why do we incarcerate?

While punishment and public safety deal primarily with safety staff within a facility, the concept of treatment begins the integration of medical staff and their contributions.  As with any type of condition or behavior that needs modification, you cannot rehabilitate someone unless they are first brought to some degree of stabilization.

Think of it this way, if you’re out skiing and accidently break your leg, you are not immediately sent to rehab.  Instead, you must first be treated and once a certain degree of recovery has occurred, you can then work on rehabilitation that will hopefully re-establish you as a functioning individual. 

The treatment aspect of incarceration is no different.  These programs serve a vital function that begin the process of returning inmates to society and ultimately, give them the tools necessary to function as productive members of their communities.

Before a discussion on treatment can occur, it’s imperative to first define the term.  Unfortunately, there is no universally accepted definition, but the primary concepts and goals can usually be found among the three primary treatment professions that service incarcerated individuals.   These are the fields of social work, psychology, and the medical profession.

The first of these, social work, does not have a universal definition for the concept of treating those who are incarcerated.  The National Association of Social Workers (NASW) begins by defining treatment as “medical care by procedures or applications intended to relieve illness or injury.” 

Dr. Rudolph Alexander, a professor from The Ohio State University, further refines this concept by breaking the definition down into two distinct concepts: 1) “prison treatment consists of diagnosis, classification, a variety of treatment activities, punishment, and prognoses for rehabilitation” and 2) "treatment includes not only the contacts with a psychiatrist but also activities and contacts with the hospital staff designed to cure or improve the patient.”  It should be noted that the latter definition applies to specifically to psychiatric or mental health treatment

Within the field of psychology, treatment can be defined in a variety of ways.  The American Psychological Association (APA) defines treatment as “therapists and clients working together to understand problems and come up with plans for fixing them. The focus is generally on changing ineffective thoughts, emotions or behaviors.” 

Using this definition, most therapeutic programs focus on the individual; however, some can be facilitated in a group setting.

Yet another definition for this essential concept comes from the discipline of psychiatry where the American Psychiatric Association defines treatment as “the use of a variety of mental health therapies, biological as well as psychological, in order to alleviate symptoms of mental disorders which significantly interfere with the inmates’ ability to function in the particular criminal justice environment.” 

As you can see, even among disciplines with somewhat similar goals and training it is hard to find universal agreement on the primary focal point of their efforts – treatment. For the purposes of this discussion, however, the definition provided by the American Psychiatric Association will be used, as it is an explanation that is generally accepted by multiple disciplines and helps to illustrate the goals of the different treatment programs that will be discussed.

As anyone who works in corrections knows, there are a multitude of treatment programs available to those incarcerated in any type of lockdown facility. These treatment courses are designed to help individuals begin the process of managing their problems or symptoms. A key element to any type of treatment option begins with the fundamental acknowledgement that males and females are different. 

The largest variance has been shown to be between sexes, meaning the biological anatomy a person is born with, as opposed to gender, which is the sex an individual identifies with.  Women, for example, when incarcerated are often more depressed, as well as entertain feelings of self-harm and hopelessness when compared to newly incarcerated men.

The Justice of Bureau Statistics has estimated that as many as 50% of women incarcerated have suffered from some form of physical or sexual abuse over an extended period of time and roughly 35% have been raped. These types of traumatic events have led to some of the psychological problems women exhibit; they also play a role in why women commit the illegal acts that cause them to be incarcerated.

Programs that are accommodating to a specific group of individuals have been shown to be more effective than a standardized form of treatment. For instance, programs for women need to be based on different criteria than for men because the reason they committed the crime is likely to be different.

Women often commit crimes as a way to avoid abuse from their boyfriends or to repay a debt. For example, Barbara Zust, an Associate Professor of Nursing at the Gustavus Adolphus College, suggests that three different components must be present for an effective women’s treatment program. 

These elements are awareness, response to vulnerability, and empowerment. While blended together to form a coherent treatment option, it must also be noted that each component is also a focus and treatment plan in and of itself. 

Differences also exist between court-mandated treatment programs and self-referral treatment programs. Court-mandated programs occur when the offenders are ordered by the courts to participate in a certain program as part of their sentencing. In self-referral programs, the offenders are not required to attend, but instead, seek help of their own volition.

Even if the program is exactly the same, the attitude of an inmate while attending treatment will play an important role in how successful the offender will be upon release. Actively participating and graduating from the program will increase the likelihood of success once the offender leaves the facility.

Treatment has a variety of definitions that often depend on the discipline being used.  Regardless of this lack of conformity, however, the treatment of jail and prison inmates is an important component to the discussion of incarceration because it begins the process of allowing offenders a way to manage their symptoms and aversive behaviors.

To be effective, treatment programs must be organized is such a fashion as to address the specific needs of those attending the courses.  To help facilitate this organization, oversight, and ultimate management of the behavior or condition being treated, incarceration provides a safe, secure, and professional environment from which this process can begin.  

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