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Incarcerated Mentally Ill Patients
It may sound unbelievable, but on any given day, scholars estimate that almost 70,000 inmates in U.S. prisons are psychotic; and up to 300,000 suffer from mental disorders like depression, schizophrenia, and bipolar disorders. In fact, the U.S. penal system holds three times more people with mental illness than the nation's entire psychiatric hospitals (Kanapaux, 2004). Indeed one of the most telling trends, say some sociologists, is to incarcerate the mentally ill in order to remove them from society. This is sometimes the only alternative because public mental health hospitals have neither the space nor the funding to treat this special population. In fact, the very nature of incarceration tends to have a more traumatic effect on the individual, causing additional damage to their fragile psyche. Women, it appears, are especially vulnerable. These women have often been victimized during an abusive childhood and succession of relationships. Indeed, women tend to have a higher percentage of mental illness within the penal system, but fewer resources to support their illness. Research shows that severe mental illness and substance abuse co-exist in the prison system, making it quite difficult to determine which is the primary issue since the co-existence is so rampant. Mental illness often masks the substance abuse and vice versa, yet both are treatable (Moss & Patton, 2000). According to a recent study by the United States Department of Justice, 56 per cent of jail inmates in State Prisons and 64 per cent of inmates across the country reported mental health problems with the past year. This, combined with the staggering new influx of inmates (from 200,000 persons in 1970 to more than 1.3 million in 2002) results in both the highest number of individuals behind bars and the highest incarcerated mentally ill of any reporting nation, and certainly the highest percentage ever in the United States (Harcourt, 2007).
Treatment Options- Conservatively, it appears that one of the predominant (about 44 per cent) treatment options for the incarcerated mentally ill is simply to not treat at all. Before one can have a treatment program, one must have an assessment for mental health; if there is no assessment, there is no diagnosis, no diagnosis, and no treatment. There are several reasons for this: type and nature of crime, lack of funds to complete adequate assessments, lack of staff to treat, crowded prison conditions in which individual issues are not readily visible, and extreme substance abuse and masked behavior (Majority of Mentall Ill Inmates Don't Get Treatment, 2010).
This is not to say that there are not current guidelines already established within the legal system for treatment. In fact, the Heal Services Manual (PS 6000.06) and Psychology Services Manual (PS 3510.12), both list rules governing the treatment of mentally ill offenders in the federal prisoon system. According to these documents, prisons must employ at least one full-time pscyhiatrist or psychologist to screen and treat priosoners for mental health disorders. However, despite these regulations, a 2001 study found that most potentially mentally ill prisoners were identified during intake by staff with no training, were perhaps incorrectly or hastily diagnosed, and then given psychotropic drugs to keep them sedated or quite. Most prisons, in fact, are given psychopharmacological means to mitigate even the lightest of symptoms. Oddly, the conundrum here is three-fold: 1) regulations say that medication is only to be used for a diagnosible psychatric disorder or symptomatic behavior; 2) typically no diagnosis exists, at least by trained personnel, with the lay person typically describing most any malady as "schizophrenia," and 3) prior to any psychotropic medication being prescribed, the patient is required to give their consent, or if they are mentally unable to do so, a wittness and desginated family member or care giver is asked to do so (Bosworth, 2002, 80-5).
The system does have guidelines and safeguards, even though we have established that they do not always work because of external issues and overcrowding. Essentially, the treatment options may be broken down into six basic areas: 1) screening and assessments; 2) mental health treatments; 3) substance abuse treatments; 4) mental health services in segregation; 5) mental health services and seclusion/solitary confinement; and 6) mental health services in a supermax prison.
Screening/Assessment -- Screening is an absolute necessity with such a large and burgeoning system. Without the ability to adequately reach those in need of mental health options, we set up the institution for failure before even getting started. All offenders entireing the prioson system should thus be screened for both legal and clinical reasons. This will identify those at risk for suicide or delf-injury; determin if the inmate is capable of functioning inside the system, and to what degree, determine whether the inmate should actuaully be transferred out of the institution and to find out whether the inmate has the potential to benefit from available treatment at the particular institution in question (Hills, Siefdried, & Ickowitz, 2004)
Mental Health Treatments -- The American Psychiatric Assocation recommends at least the following: a crisis intervention program for stays of up to 10 days; an acute care program; and chronic care progams; outpatient treatment services; consultation services; and discharge planning. Any inmate that has been screened for mentaol illness should also have a health assessment within 14 days of arrival that includes a complete mental health history and plan. Prison procedures must address psychatric emergencies and suicide attempts as well as respect the dignity of the patient (American Psychatric Assocaition, 2000).
Substance Abuse Treatments -- Because substance abuse is so significant in both the general and mentally ill portions of the prison population, it often receives the greater visible attention. Still, there are shortages of trained drug and alchohol abuse counselors; not to mention gambling or sexual addiction programs. Both state and federal programs fro 1991 on though show that about 80 per cent of those incarcerated have a substance abuse issue. It is critical for the mentally ill patients to receive treatment in order to separate the issues of substance abuse from a proper mental health diagnosis, and to provide an integrated approach to prison-based treatment programs. In addition, although one-on-one counseling sessions are likely rare due to staffing, group meetings and therapy sessions of not less than once per week are considered mandatory. Prisons are encouraged to set up therapeutic communities, teach relapse prevention skills, and support self-help groups. Only in this way can the prison system prove parallel, sequential, or integrated treatment options for the mentally ill (Pallone, 2003)
Mental Health Services in Segreation -- A challenge for both prison officials and mental health professionals is finding safe and humane ways to use seclusion, segregation, and restraints within the context. The conundrum is that there are times in which psychotic or extremely violent offenders need to be confined. During these occurances, prison and mental health officials do need to be able to address issues with psychotropic drugs or other physical restraints to protect the patient/inmate, other inmates, and staff (American Psychiatric Association, 2006)
Solitary Confinement -- The ACLU and many other liberal groups are fighting to ban the use of solitary confinement as either a punishment, treatment option, or incarceration option. This view challenges the constitutionality of housing mentally ill patients in solitary confinement and believes it contributes to suicide attempts and is actually harmful to the patient (ACLU, 2007). Further, the APA strongly recommends that prisons apply the use of solitary confinment, especially to women, under only the most dire needs since there may be an underlying history of abuse that the solitary may exacerbate.
Supermax Systems -- This is an extreme conundrum. Supermax facilities are meant for only inmates who are violent or seriously disruptive. These inmates typically pose a threat to themselves, other prisoners, guards, staff, and most certainly the public. In fact, their behavior is often controlled by separation, restricted movement, and limited access to staff and other inmates (National Institute of Corrections, 1999). This isolation and deprivation, though, has the potential to induce even more mental problems in what many consider an already mentally ill population. The difficulty is that these individuals are so violent and unpredictable that they need special treatment just to be housed, let alone take part in a treatment program. Many criminologists view this population as not receptive to treatment, but by the very nature of the field, the APA believes that they can be treated, at least marginally (Haney, 2003)
Prevention Options- Realistically, in the best of all possible worlds, each prison would have adequate mental health facilities in order to screen the inmates prior to sentencing and, if sentenced, upon arrival or shortly thereafter at the prison; adequate mental health personnel and training to provide short- and long-term care; senior medical staff to manage and dose appropriate medications; adequate staff and services to provide therapeutic training, education, and support sessions for psychotherapy and substance abuse; counseling as needed; and of course, viable options for the severely ill. However, since this is an ideal and not a…[continue]
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" (Finnerty, 2008) It is reported that those who suffer from co-occurring mental illness and substance abuse problems are also likely to be homeless. According to the Health Care for the Homeless Clinicians' Network (2000) "Co-occurring mental illness and substance abuse makes it more likely that people will be chronically homeless." (cited in Finnerty, 2008) Factors that are known to contribute to homelessness in those with co-occurring mental illness and