The Criminal Justice System and Mental Health

MENTAL HEALTH WITHIN CRIMINAL JUSTICE

Abstract

To a large extent, prisons and jails continue to be relied upon by the criminal justice system as an ideal mechanism for locking away offenders in efforts to deter, punish, reform, and ensure victims/aggrieved are restored in some way. This is what this particular system is designed for, and thus far, it has been effective in ensuring that the safety and wellbeing of law abiding citizens of this great nation are secured. The problem arises when this same system is used as a substitute for mental health institutions – i.e. by taking offenders who need mental health services through it. A review of available literature clearly demonstrates that there is no doubt whatsoever that the U.S. criminal justice system does not handle persons suffering from mental illness in an appropriate or ideal manner. Various studies conducted in the past have demonstrated that conditions in correctional facilities often end up worsening symptoms of mental illness among inmates suffering from various mental health disorders including, but not limited to; anxiety, depression, PTSD, bipolar disorder, etc. It therefore follows that the relevance of formulating and implementing policies meant to rein in this concern cannot be overstated. Ideal interventions ought to be founded upon proper understanding of the root problem.

Mental Health within Criminal Justice

Introduction

Various researchers and analysts in the criminal justice realm have in the past made an observation to the effect that a disproportionate percentage of mentally ill individuals are incarcerated in U.S. jails and prisons. Further, assessments of the country’s criminal justice system indicates that it fails to meet the treatment demands of the mentally ill individuals who happen to interact with the system at one point or another. What we have in place at this moment is a criminal justice system that is rigged against persons with mental illness. With ineffective arrest and detention policies, we send a disproportionate number of mentally ill persons to prison, only for their conditions to be worsened by an unconducive jail environment. Further, when these persons are released from jail, they lack access to treatment and therapeutic services that would decrease their chances of interacting with the criminal justice system. This essentially results in the creation of a vicious circle of sorts. For this problem to be addressed in an effective manner, there is need to not only trace its genesis, but also explore the current state of affairs. Further, there is also need to consider the consequences of inaction. It is only then that we can make recommendations that are meant to ensure that our nation’s criminal justice system is responsive to the unique needs of mentally ill persons.

From the onset, it would be prudent to note that symptoms associated with various mental health conditions are subject to the interpretation of mental health experts. However, for purposes of this discussion, there will be need to assign a concise and definitive definition to mental illness. Thus, mental illness, as Remch et al., (2021) indicate, could be conceptualized as “any diagnosed mental disorder (excluding substance abuse disorders) currently associated with serious impairment in psychological, cognitive, or behavioral functioning that substantially interferes with the person\\\\\\\'s ability to meet the ordinary demands of living…” (621). This is the definition that will be embraced in this discussion.

Background

Various theorists and experts have in the past indicated that there is need to ensure that the criminal justice system treats offenders presenting with symptoms of mental illness differently than sane offenders. For instance, as Scully (2021) – as cited in a National Alliance on Mental Illness (NAMI) piece - points out, “in the mid-1800s, Dorothea Dix first advocated for the creation of a system of care for people with mental illness after she witnessed deplorable conditions in a Massachusetts jail.” Previous studies have also indicated that incarceration could worsen mental health disorders (Remch et al., 2021).

Montross (2020) indicates that various decisions made by the government in the past have brought us to where we are at present in terms of the inappropriate handling of mentally ill persons or offenders by the criminal justice system. For instance, according to the author, the increase in the number of mentally ill persons in our prisons was originally triggered by the systematic closure of various state psychiatric hospitals. This has largely occurred over the last five decades, and more specifically as the authors specifically indicates, in the 60s, 70s, as well as 80s (Montross, 2020). To a large extent, the said move was well-intentioned in the sense that it followed findings that some long-term psychiatric institutions were notorious for the promotion of cruel and egregious treatment of patients. Thus, it was established that asylums were in some instances worsening the very problem they were meant to solve – and hence the need to defund and shut them down, and shift care to community settings. However, according to Montross (2020), the gains intentioned were never realized. This is more so the case given that amongst other things, the relevant social support systems were never established. Further treatment needs as well as vocational training needs were never addressed as originally intentioned. Thus, in what accurately captures the onset of the problem, Montross (2020) makes an observation to the effect that “without funds, without treatment, and suddenly also without housing, our nation’s most vulnerable citizens fell out of health care and into the realm of the legal system… the criminalization of mental illness had begun.”

Current Issues and Status

Montross (2020) indicates that in her opinion, the criminal justice system is not designed to address the unique needs of persons presenting with mental illnesses. The problem, according to the author runs deep – starting from law enforcement policies in place to the incarceration environment. Montross (2020) is uniquely qualified to comment on an issue of this nature owing to the fact that she has in the past served as a forensic evaluator for the courts. Indeed, in her own words, the criminal justice system “runs counter to every principle of human flourishing” that she is aware of (Montross, 2020). In as far as the law enforcement policies in place are concerned, it is important to note that Montross (2020) is categorical that law enforcement encounters often call for a great deal of attention and obedience. This is to say that failure by a citizen to obey police instructions could be interpreted as a deliberate attempt to defeat the course of justice or challenge their mandate to maintain law and order. Persons who suffer from various mental illnesses may not be able to obey police directions and/or instructions. This places them on a confrontational course with law enforcement officers – significantly increasing their chances of being arrested, detained, and charged. This, in my opinion, is where the problem begins. The situation then further worsens.

According to Scully (2021), a huge percentage of persons incarcerated in our prisons today are suffering from a particular mental illness. Indeed, the author indicates that the percentage of mentally ill patients in prison could be as high as 37%. According to Remch et al. (2021), the standard practice in our criminal justice system happens to be sending inmates presenting with symptoms consistent with mental health illnesses to solitary confinement or other restrictive housing. This often ends up aggravating the situation. As a matter of fact, according to the author, this approach has been known to result in worsening state of mental health. This, as Remch et al. (2021) observe, is more so the case given that the conditions of solitary confinement in most cases worsen anxiety and could result in poor outcomes for persons with other mental health conditions such as depression. More specifically, according to the authors, “a recent study in Washington state correctional facilities found that people in restrictive housing had more symptoms of depression and anxiety and more psychiatric distress than peers in the general prison population” (Remch et al., 2021, p. ).

As indicated, persons presenting with mental illnesses are more likely to be sent to solitary confinement as a consequence of behavioral concerns brought about by their condition. This appears to go contrary to rational expectations – in which case Montross (2020) makes an observation to the effect that in hospital settings, patients who are assaultive are not locked away in worse conditions. Instead, more effective interventions are implemented to address their states, i.e. via easement of their hallucinations or delusions. However, it is important to note that as Montross (2020) indicates, in correctional facilities, those who assault their colleagues or correctional officials are likely to incur additional charges, i.e. for a felony. According to the author, penalties in such a case could be extreme – with some felonies on this front attracting up to an additional 15 years behind bars. It is easy to see why the criminal justice system is somewhat rigged against persons with mental illnesses.

According to Walker (2010), present studies indicate that persons with mental illnesses and engaging in substance abuse are more likely to be rearrested following release from jail, in comparison to persons who neither abuse drugs not have a mental illness. It is important to note that mental illness is not by itself linked to the high recidivism rate on this front as it has to co-occur with substance abuse or use. More specifically, in the words of Wilson, Draine, Hadley, Metraux, and Evans (2011), “substance use is a driving force behind the recidivism of people with mental illness leaving a US urban jail” (265). The authors indicate that blame could in this case be assigned to failure to develop and implement interventions meant to address the two co-occurring concerns among recently released persons.

There are multiple other factors that continue to bedevil the criminal justice system in as far as the inappropriate treatment of mentally ill offenders is concerned. One of the key concerns that has been highlighted by Scully (2021) is a poor crisis response system. Indeed, at present, the primary first responders in scenarios that involve a person presenting with symptoms of mental illness are police officers. This, according to the author, is more so the case given that whereas police officers are largely available around the clock, most mental health response centers mostly operate during business hours. This results in an increase in the likelihood of such persons being put into custody, instead of being booked into a mental health facility. Those who are disadvantaged, from an economic point of view, happen to be mostly disadvantaged because they may not be able to afford available psychiatric treatment options. This ends up making jail the only ‘treatment’ options for such persons. This is well-captured by Montross (2020) who observes that “across the country, jail is now seen as a treatment option—and sometimes the lone treatment option—for disadvantaged citizens with mental illness.” The problem with an approach of this nature is that it reeks of cruelty and lack of compassion for those who present with various mental health conditions but are unable to ‘buy’ their way out of the criminal justice system by seeking competent psychiatric help. Montross (2020) raises an important concern in this regard. According to the author, if we do not imprison persons who have various illnesses such as cancer and diabetes, in the pretext of bettering their condition, why should we imprison those who present with mental illnesses and cite the need for their wellbeing as a reason for the said imprisonment?

Probable Future Concerns

There is no doubt whatsoever that failure to address the current failings of the criminal justice system in as far as the treatment of mentally ill persons is concerned will likely result in catastrophic outcomes going forward. This is especially the case given that as Montross (2020) indicates, the criminal justice system, as presently constituted, does not make meaningful distinctions between persons of sound mind and those who could be suffering from various psychiatric conditions. Indeed, according to the author, the incarceration conditions happen to be the same at present – confinement and strict rules.

We keep sending persons who would be better off receiving therapeutic assistance in treatment wards to such settings. Montross (2020) is categorical that if the status quo is maintained going forward, everyone will likely lose. This is more so the case in relation to increased costs. Persons presenting with various mental illnesses are a threat to both themselves and those that they closely interact with. When there is a poor mechanism in place to address the mental health concern of inmates, prison officials have to deploy more resources to prevent and contain ugly scenarios that in most cases are likely to be triggered by factors that could be traced to the mental instability of the said inmates. Yet another concern closely related to this particular issue is increased rates of recidivism, as has been highlighted elsewhere in this text. An increase in prison population does not augur well for a society that considers itself progressive. The resources allocated on this front could be utilized in more productive formats elsewhere, i.e. in infrastructural development. It would also be prudent to note that according to Donohogue (2014), “the Prison Policy Initiative’s analysis of a recent federal study on mental illness in the jail and prison population concludes that incarceration fails to address the social, economic, and health problems of people who are incarcerated” (198). This could inform a cycle of negative life outcomes for a vast proportion of citizens of this great nation.

Recommendations

Based on the assessment above, there are clear indications that the criminal justice system is ripe for reform in relation to the handling of mentally ill offenders. A total of six recommendations have been highlighted below for perusal by policy makers.

a) Revamp the Crisis Response System

As has been indicated elsewhere in this text, one of the concerns bedeviling the criminal justice system in as far as the treatment of mentally ill offenders is concerned happens to be a poor crisis response system. Towards this end, a recommendation is made in this text that a more effective crisis response system be set up. This is to say that the role of law enforcement officers in the handling of persons presenting with symptoms of mental illness ought to be scaled down, and that of mental health experts further enhanced. This would help minimize chances of mentally ill persons being put into custody instead of accessing the relevant help in a mental health facility. There is, therefore, need to invest heavily into crises response systems that are accessible, available on a 24-hour basis, and robust. This ought to be the very first move in efforts to address our criminal justice system’s inappropriate handling of mentally ill persons. This is more so the case given that in this case, we shall be able to ensure that the number of mentally ill persons who are involved with the criminal justice system is significantly reduced at first instance.

b) Establishment of a Therapeutic Diversion Units in Prisons

In their study, Remch et al. (2021) make a finding to the effect that conditions in prison end up worsening mental illness symptoms among inmates with various mental health disorders. This is especially the case given that such persons are likely to be sent to restrictive housing following behavioral concerns exuberated by their condition. Restrictive housing have far worse outcomes in terms of mental health and wellbeing than placement in general prison population. This, as Remch et al. (2021) indicate, is more so the case because in addition to triggering a sense of loss of identity, it is largely dehumanizing. With this in mind, the authors propose a model of therapeutic diversion units. Some of the state corrections departments that have embraced this approach, as Remch et al. (2021) further observe, are inclusive of, but they are not limited to; Virginia, Pennsylvania, and Colorado departments of corrections. It is important to note that the said therapeutic diversion units have programs meant to rein in adverse symptoms of mental illness and prevent worsening of the said conditions. Thus, measures deployed on this front could be inclusive of access to mental health professionals and evidence-based treatment services (i.e. depending on results of diagnosis). It therefore follows that the said units should have individualized interventions that seek or strive to address the specific needs of the inmate. The therapeutic diversion units could also have environments that are less restrictive than the general prison environment and ensure that personnel serving in those units have the relevant training on the proper handling of persons presenting with symptoms of mental illness. I am of the opinion that diversion units of this nature should be embraced across all state and federal facilities. This is more so the case given that the various variations of these units have proved effective in various state correctional departments. To ensure that they are effective and are embraced across the entire system, there may be need to deploy the relevant incentives for participation. For instance, offenders who participate in the same could earn some time off their sentence. State facilities could also receive structured federal assistance in their efforts to implement the said therapeutic units.

c) Address Recidivism Linked to Co-Occurring Mental Health Illness and Substance Use

As has been indicated elsewhere in this text, one of the concerns that has been prominently highlighted relates to high recidivism rates among persons with dual diagnoses of substance abuse and mental illness (Wilson, Draine, Hadley, Metraux, and Evans, 2011). In the words of the authors, this is an indication of “the importance of developing interventions that provide timely access to intensive co-occurring substance abuse and mental health treatment during the immediate period after release” (Wilson, Draine, Hadley, Metraux, and Evans, 2011, p. 264). It should be noted that as the authors in this case further indicate, such interventions ought to be designed in such a way that they are able to effectively tackle the various elements that could increase the likelihood of return to substance abuse following discharge from prison. According to the authors, the said factors could be either environmental or individual. On this front, there may also be need to put in place measures to ensure that those recently released from prison and have a dual diagnosis are able to access the needed services at rates that could be deemed cost-effective. A review of available literature indicates that interventions such as ones proposed in this particular recommendation have been effectively deployed in multiple other settings, i.e. in Washington, Florida, and Michigan. For instance, according to Scully (2021), “in Michigan, a pilot program that linked formerly incarcerated people with care in the community saw a significant drop in recidivism rates.”

d) Awareness of the Aggravating Role Racial Bias and Disparities Play

There is also need to ensure that measures or interventions put in place to address the concerns revolving around the criminal justice system’s handling of mentally ill persons take into account the issue of race as available data indicates that this could be an aggravating factor on this front. Indeed, Scully (2021) is categorical that without reflecting the realities on the ground, policy change efforts in as far as the reformation of the criminal justice system is concerned are likely to be ineffective.

Waldron, Quartles, and McEleath (2017) point out that available data clearly indicates that the U.S. criminal justice system is pervaded by racial disparity. This is specifically the case when it comes to the overrepresentation of African Americans in the said system. This is an assertion collaborated by Scully (2021) who indicates that Black persons as well as mentally ill persons are overrepresented in our nation’s criminal justice system. Yet, as Scully (2021) further observes, “there is alarming evidence that people of color are less likely to be identified as having a mental health condition and less likely to receive treatment during incarceration.” To a large extent, this is a concern that has received little attention. For this reason, there is need to ensure that the interventions implemented are able to address the highlighted inequalities in an effective manner. This could be accomplished by, amongst other things, reaching out to communities of color, embracing cultural competence and ensuring that the interventions gain the confidence and trust of the target groups and/or individuals.