The Worst Place to Have a Mental Health Diagnosis: Prison

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Often I receive questions from readers on Quora related to criminal justice, prison and psychology. Early this month I received the question below and felt that my comment was worthy of sharing here as well. 

What are the psychological effects of incarceration on prisoners, specifically those with diagnosed mental disorders?
How can this be treated or mitigated by staff and/or other prisoners?

I truly appreciated this inquiry because it highlights a critical topic that I failed to detail when I wrote “How Would You Survive? The Incident, The Arrest, and Jail.” This was basically because the book was written prior to me conducting the required research while completing my Counseling Psych program; but, I will definitely give a thorough account in the 2nd edition.

Two key points to note are that every individual who is or has been incarcerated needs mental health treatment, and every individual who works in a jail/prison that provides direct care or supervision of jail residents also needs regularly scheduled mental health therapy for self-care.

Prison is the worst place to be for a person with a mental health diagnosis.

Let me briefly say that prison is the worst place to be for a person with a mental health diagnosis. They are disproportionately incarcerated and unfortunately, treatment by psychotherapy is not prioritized in most prisons. Treatment via psychotropic drugs is however prevalent as a means of addressing an inmate’s symptoms while neglecting the underlying issues that contributed to the diagnosis. According to research by the Prison Policy Initiative, approximately 43% of persons in state prisons have been diagnosed with a mental health disorder, and 74% of all persons in state prisons reported that while they were incarcerated, they never received mental health services. Two key points to note are that every individual who is or has been incarcerated needs mental health treatment, and every individual who works in a jail/prison that provides direct care or supervision of jail residents also needs regularly scheduled mental health therapy for self-care.

Mitigating this negligence requires intense lobbying and passing of prison reform laws that, at their core, genuinely are invested in providing mental health treatment to every incarcerated person both pre and post-release. Proper treatment is not defined as keeping them doped up on antidepressants, dependent on sleeping meds, or neglected because of a deficit of quality mental health practitioners.

Thousands of students are graduating from mental health programs every semester. Currently, many of our nation’s police jurisdictions have offered signing bonuses for individuals that apply and are hired as police officers to address personnel shortages (for example $75,000 for applicants that maintain their positions for 5 years in Alameda, CA). As a similar public safety initiative, generous bonuses should be extended to mental health practitioners that will exercise their craft in our nation’s correctional system. With more clinical hands on deck, we can proactively minimize recidivism fueled by the untreated mental health disorders affecting many of the annual 600,000 individuals released from state and federal prisons. Among these disorders is, the highly neglected, prison-induced PTSD.

Mental health therapy, I believe, should be mandated for all individuals returning to the community who were incarcerated for 12 months or more. That’s not to imply that individuals incarcerated for shorter terms don’t experience prison trauma also. My theory is that individuals that are incarcerated for longer periods tend to suppress many of their emotions to survive and appear stronger to their peers than they may genuinely feel. They need the opportunity to begin talking through their anger, depression, anxiety and trauma pre-release.  Systematically, we have neglected to prioritize policies that proactively meet these mental health needs.  As a result, thousands of individuals return to their homes and communities with bottled-up mental turmoil squeezed tightly like a hand grenade with a misplaced pin.

To improve retention in mental health services, a therapeutic relationship with a therapist must be initiated months before an individual is released.  Let’s start with telehealth sessions.  In many jails, hearings and even visits are conducted virtually.  Expanding the use of this technology to introduce jail residents to virtual mental health therapy before they become overwhelmed with all the stressful stimulants and expectations that accompany the reentry process, may promote their willingness to continue therapy post-release.  Let’s unpack this with your feedback.

 

Updated 6/23/2023

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A.J. Crenshaw, III

A. J. Crenshaw, III is the author of his debut book, How Would You Survive? The Incident, The Arrest, And Jail, and CEO of his premiere publishing company Acuité Media. He has spent two decades as a public servant, motivational speaker, mentor and counselor for historically underserved youth and their families, and an advocate for returning citizens.

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