Mental Health Care and Psychology in U.S. Prisons

Introduction: Psychology in the Prison System

In a landmark study of psychologists working in U.S. prisons, Boothby and Clements (2000) identified several disturbing trends in corrections. Although the number of prison psychologists had doubled in the preceding twenty years, the vast majority remained Caucasian males — a demographic profile that may limit their ability to address the diverse needs of the incarcerated population. Biases and assumptions about inmates may further hinder inmates' willingness and ability to seek and receive psychological treatment. Moreover, a full third of prison psychologists' work time is spent on administrative duties — more than the time devoted to direct treatment. Only 26% of their work time is dedicated to directly treating inmates, meaning that structural and institutional variables are significantly impeding the delivery of quality mental health care in correctional settings.

Interestingly, the profession of clinical psychology was practically born in the prison context. As Magaletta et al. (2016) point out, prison wardens partnered with psychologists seeking training opportunities and research subjects as early as the 20th century. Prison psychologists have long had access to subjects for research into the endogenous and exogenous factors that may cause or contribute to criminal behavior. Prisoners have historically been viewed as a relatively dispensable segment of the population, and the persistent lack of attention given to their treatment remains a major ethical infraction (Magaletta et al., 2016). The psychological make-up of offenders — whose behavior may be symptomatic of underlying conditions ranging from mood disorders such as anxiety and depression to personality disorders and psychoses — presents unique challenges for prison administrators and correctional officers alike.

Prevalence of Mental Illness Among Inmates

Because criminal behavior can be the means by which mental illness first becomes recognized, it follows that a significant number of inmates suffer from some type of diagnosable mental illness. Furthermore, offenders are more likely than non-offenders to be victims of crime, while victims of crime are also more likely than non-victims to become offenders — a pattern that has been documented consistently throughout the literature (Entorf, 2013). Correctional officers lack the training and background in psychology necessary to provide daily support for inmates, which is why psychologists are the most frequently employed mental health professionals in correctional settings (Magaletta et al., 2016).

Yet because of persistent gaps in the delivery of quality mental health care in prisons, the needs of the diverse inmate population are not being met. Failing to meet the needs of this population may undermine efforts to lower rates of recidivism and promote genuine rehabilitation and community reintegration. Similarly, a more robust community-based psychological program may help prevent some criminal behavior from occurring in the first place. When precipitating factors such as abuse, substance use, and mental illness are treated outside the prison context, it may be possible to reduce the number of offenses by applying frameworks such as Hirschi's general theory of crime (Armstrong, 2005).

Biases and Assessment Failures in Correctional Psychology

Unfortunately, the biases and assumptions of correctional service providers influence their assessment of and interaction with offenders. Boothby and Clements (2000) found that many of the correctional psychologists in their study did not adequately administer psychological assessments. Due to the intense pressures of their work and the administrative demands the role entailed, psychologists were making intuitive judgments about personality disorders based solely on intake interviews. For example, some psychologists would evaluate a prisoner's Minnesota Multiphasic Personality Inventory (MMPI) score without actually administering the instrument. The MMPI was, incidentally, the most commonly used personality assessment tool in the correctional facilities studied (Boothby & Clements, 2000).

Correctional service providers may also be influenced by racial prejudices, which can cause problems not only in the form of inaccurate assessments but also in the form of ineffective treatment interventions. Many correctional service providers may fail to account for the exogenous factors that can precipitate criminal behavior or exacerbate mental illness.

Conclusion: Toward Organizational Reform

Psychologists remain integral to the functioning of prisons. Given the lack of representation from diverse groups among prison psychologists, these professionals need the cooperation of correctional officers who may better understand the cultural and social needs of the inmate population. Organizational leaders must guide institutional policies away from excessive administrative demands, and a broader commitment to community mental health prevention would ultimately help reduce the stress placed on law enforcement as well as correctional staff. Systemic reform — both within prisons and in the communities from which incarcerated individuals come — is essential to achieving meaningful improvements in inmate mental health outcomes and public safety.

References

Armstrong, T. (2005). Evaluating the competing assumptions of Gottfredson and Hirschi's (1990) A General Theory of Crime and psychological explanations of aggression. Western Criminology Review, 6(1), 12–21.

Boothby, J. L., & Clements, C. B. (2000). A national survey of correctional psychologists. Criminal Justice and Behavior, 27(6), 716–732.

Entorf, H. (2013). Criminal victims, victimized criminals, or both? Retrieved from http://ftp.iza.org/dp7686.pdf

Magaletta, P. R., et al. (2016). Correctional settings. In APA handbook of clinical psychology: Roots and branches (Vol. 1, pp. 539–549). American Psychological Association. http://dx.doi.org/10.1037/14772-031