Managing Mentally Ill Inmates in Prisons

Abstract

Mentally ill inmates now comprise a substantial portion of the prison population and pose administrative and therapeutic challenges to prison administrators and mental health professionals. Some evidence suggests that both the size of the population and the seriousness of their illnesses are increasing. Given this context, several issues are highlighted and discussed in terms of contemporary efforts to deal with mentally ill inmates. Specifically, discussion centers on the use of actuarial devices for prediction and classification, the conflict between treatment and control and the relation between treatment and management, the distinction between risks and stakes and use of the environment as therapy, use of medication and isolation, and the role of correction officers in mental health treatment. The authors make an argument for more sophisticated approaches in dealing with mentally ill inmates that rely on expanded therapeutic options, broader role definitions for prison staff, and an evidence-based approach for individualizing treatment.

Treatment perspectives on interned mentally ill offenders in a forensic psychiatric center (FPC): a Delphi study on experts' opinions

“…These underlying controversies are acknowledged by international authors (e.g. Adams & Ferrandino, 2008;Adshead & Sarkar, 2005;Fitzpatrick et al, 2010;Steadman, Morrissey, & Robbins, 1985;Weinberger & Sreenivasan, 1994) and will be discussed in relation to the Delphi results.…”

“…The balance between treatment and control is delicate in forensic psychiatry as acknowledged by many authors (e.g. Adams & Ferrandino, 2008;Adshead & Sakar, 2005;Fitzpatrick et al, 2010): "the treatmentcustody conflict was recognized early on by Clemmer (1940), and since that time it has become clear that there is no simple and easy solution for the conflict" (Adams & Ferrandino, 2008:917). This conflict also has an influence on the character of a forensic institution.…”

“…Besides the absence of a systematic collection of statistics on mental disorders in most European prisons, there has been an increasing concern regarding the availability and provision of adapted treatment both inside (e.g. Adams & Ferrandino, 2008;Arboleda-Flórez, 2009;Salize, Dressing, & Kief, 2007) and outside prison walls (e.g. Arboleda-Flórez, 2006;Rice & Harris, 1997).…”

Hoping Against Hope: The Prison-to-Community Transition Experience of Men With Co-Occurring Severe Mental Illness and Substance Use Disorder

“…Mental health services have historically screened out drug users and drug treatment services have historically screened out people with severe mental illness (Danzer, 2012). Judgemental attitudes towards people with co-occurring disorders by mental health staff has been well documented, with a tendency for staff to differentiate between people with a mental illness who are "deserving" of care, and people who use substances who are perceived to have "brought it on themselves" (Adams & Ferrandino, 2008;Flanagan & Lo Bue-Estes, 2005). People with co-occurring disorders have been described as "a kind of mental health under-class" with many people experiencing multiple unmet needs (Hawkings & Gilburt, 2004, p. 57).…”

“…It has been found that overcrowding, noise, strict rules and lack of privacy in the prison environment can both exacerbate existing symptoms of mental illness, as well as cause new symptoms, such as anxiety and depression (Gelman, 2007). There is also some evidence that prisoners with severe mental illness have increased risk of self-harm and suicide that can be related to the prison environment (Adams & Ferrandino, 2008;Soderstrom, 2008). Much is still not known about the access and quality of healthcare in prison, which varies between jurisdictions.…”