Essay Sample on Mental Illness & Criminal Justice: Over 1.2M Affected Annually

Introduction

About 1.2 million people with mental illness sit in prison and jail every single year (Gonzalez & Connell, 2014). Often, the involvement of people with mental illness with the criminal justice system starts with low-level crimes such as trespassing, disorderly conduct, and jay-walking. In general, mental health disorders among prisoners have persistently exceeded rates of such disorders in the general population. Despite this revelation and court mandates for access to mental healthcare, inmate's access to mental health and healthcare in general care has so far been sporadic. Studies have examined the correlation between mental health care and incarceration rates and revealed that the states with less access to mental health care have a high volume of adults in prisons and jails. In fact, as much as 26% of inmates have been diagnosed with mental health conditions at some point during their lifetime (Gonzalez & Connell, 2014). Only a small portion of these individuals are usually on medication on admission. This paper will elaborate on some of the challenges of providing mental health care in prison settings, how self-determination theory can be useful in helping prisoners with mental health problems and some methods and considerations of providing mental health care in prison settings.

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Challenges of Providing Mental Health Care in Prison

Prison Reactions

Healthcare providers, especially psychiatrists and psychologists, offering care in a prison setting have two conflicting roles. To begin with, psychiatrists working with incarcerated offenders face a large number of offenders whose mental health conditions are exaggerated by "prison reactions" prison reactions are conditions that are created by the prison environment such as the heightened presence of guards, surveillance cameras and sometimes solitary confinement (Mental Health Foundation, 2020). These conditions take a toll on the minds of the individual.

Hence, on the one hand, the psychiatrist has a professional and ethical duty to keep the prisoners fit mentally during their period in prison, serving a mollifying function which is an ethically questionable territory. However, on the other hand, the psychiatrist is always aware that the prison setting itself contributes to the mental health problem and can do nothing about it. This can be compared to a doctor who knows that his patient's poor health is brought about by smoke inhalation but cannot advise the patient to quit the job.

Disciplinary Measures

In most cases, mental health disorders go unrecognized in the prison setting. Deviant behavior of the mentally ill is often misunderstood as a disciplinary problem. As a result, occasionally, mentally ill detainees are put in disciplinary segregation rather than receiving medical attention. By nature, these disciplinary measures are coercive. Due to their mental health symptoms including misbehavior, mentally disordered inmates are likely to become victims of disciplinary measures some of which aggravate their disorders. Without a stipulated mental assessment prior to giving punishment to inmates, it becomes a huge challenge to practitioners on how to administer disciplinary measures without aggravating existing mental disorders among the inmates (Yasgur, 2018).

Privatization

Historically, the department of corrections in the US would employ its own staff and clinics to offer medical care and mental health care services to incarcerated offenders. However, more and more states have in the recent past privatized medical services and mental health facilities due to increased cost of health care, lack of qualified staff to provide health care in prisons, staff expense, ever-increasing litigation, lack of visionary correctional leadership, and mounting staff expenses. The rate of privatization of health care across all states escalated in the 1980s and this trend is still ongoing. Today, about 25 states and large urban jails have existing contracts with private companies for the provision of health care services (Al-Rousan, Rubenstein, & Wallace, 2017).

Some of these contractors include medical schools and small-scale vender. These contractors' main objective has been to expand their revenue sources. In most cases, the profit motive has trumped quality with the emphasis being placed on the provision of less expensive medications and treatment approaches, potentially jeopardizing the health of the patients. Hence, the privatization of prisons has affected the quality of mental health care provided for patients in prison because providers are profit-seeking entities that maximize these profits by cutting down on some of their services including cutting down on staff and encouraging less expensive treatment approaches and medication.

Self Determination Theory

Self-determination theory in psychology suggests that individuals are motivated to change and grow by three universal and innate psychological needs- competence, connection, and autonomy (Konrad & Opitz-Welk, 2014). Autonomy is the feeling of being the origin of one's own behavior. Competence is the feeling of being effective. Connection is the feeling of being understood and cared for by others. This theory is an important concept that refers to an individual's ability to make choices and manage their lives. This ability plays a critical role in the psychological wellbeing and health of a person.

According to the theory, self-determination allows individuals to feel that they have control over their lives and choices. The satisfaction of the three fundamental psychological needs of autonomy, connection, and competence are believed to lead to improved mental health. For example, they result in lower depression, higher quality of life, and reduced anxiety. Moreover, the satisfaction of the three, according to the self-determination theory is believed to lead to improved physical health and health-conducive behaviors. For example, the satisfaction of the three needs is associated with subjective vitality, life satisfaction, levels of physical exercise, and positive effect among people.

In the prison setting, the self-determination theory can be hugely beneficial in optimizing the offender's mental health. For instance, the model can inspire the in-charge psychiatrist to practice an autonomy-supportive climate in the prison. This treatment type can be characterized by encouraging inmates to engage in health-conducive behavior for their own reasons, facilitating success in dealing with some of the barriers to change. For example, by reminding inmates that they are connected to and loved by their families outside the prison walls, the psychiatrist can ease anxiety and depression among the prisoners. The desire to see loved ones when finally free can ease stress and depression and help the inmates significantly even if the quality of mental health offered to prisons has been diminishing. This can especially be a motivating factor for many inmates to seek mental health treatment because they are motivated by the desire to see their loved ones.

In terms of competence, the psychiatrist among other health care providers can stress to the inmates that they possess the ability to effectively produce the desired outcome by exercising their capacities. Feeling capable of overcoming the challenges associated with the prison climate can be helpful in dealing with mental health. The self-determination theory can aid psychiatrists by communicating to the inmates that they possess the ability to effectively overcome some of their mental health issues. With the aid of these psychiatrists, this model can help the prisoners to know and feel that they possess the tools to travel the journey into mental health treatment.

Methods and Considerations of Providing Mental Health Care in Prison Settings

Race, Ethnicity, and Substance Abuse

One of the things to consider when providing mental health care in a prison setting is race and ethnicity. Over the past decade, the total number of sentenced inmates increased significantly. However, it is worth noting that the number of African-American males outnumbers that of Hispanic and Caucasian males among offenders with sentences of over a year. With the African-American offenders representing about 44% of all inmates, it would be essential for anyone or any entity considering providing mental health care in prison settings to customize their care, largely to target the African-American ethnic group (Stringer, 2019).

About 75% of inmates in American prisons are held for substance abuse and dependence disorders (Stringer, 2019). It would be prudent for anyone considering providing mental health to inmates to have in mind that any kind of help should also be accompanied by treatment for drug use and drug dependence.

Conclusion

This paper sought to elaborate on some of the challenges of providing mental health care in prison settings, how self-determination theory can be useful in helping prisoners with mental health problems and some methods and considerations of providing mental health care in prison settings. As revealed, privatization of health care services, prison reactions, and disciplinary measures pose a serious challenge in providing mental health care in a prison setting. As revealed, the self-determination model and its three pillars can be very helpful in helping prisoners with mental health disorders. The paper has also outlined that race, ethnicity, and substance abuse are some essential considerations in providing effective mental health care in a prison setting.

References

Al-Rousan, T., Rubenstein, L., & Wallace, R. B. (2017). Inside the nation's largest mental health institution: a prevalence study in a state prison system. BMC Public Health, 342, 17. Retrieved from https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4257-0

Gonzalez, J. R., & Connell, N. M. (2014). The mental health of prisoners: identifying barriers to mental health treatment and medication continuity. American Journal of Public Health, 104(12), 2328-2333. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232131/

Konrad, N., & Opitz-Welk, A. (2014). The challenges of treating the mentally ill in a prison setting: the European perspective. Clinical Practice, 11(5), 517-523. Retrieved from www.futuremedicine.com

Mental Health Foundation. (2020). How to look after your mental health in prison. Retrieved from Mental Health Foundation: https://www.mentalhealth.org.uk/publications/how-look-after-your-mental-health-prison

Stringer, H. (2019). Improving mental health for inmates. Monitor on Psychology, 50(3), 46. Retrieved from https://www.apa.org/monitor/2019/03/mental-heath-inmates

Yasgur, B. S. (2018, Oct 11). Correctional psychiatry: challenges and rewards. Retrieved from Psychiatry Advisor: https://www.psychiatryadvisor.com/home/news/correctional-psychiatry-challenges-and-rewards/