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Impact of Incarceration on Individuals with Serious Mental Illness

4026 words (16 pages) Essay in Criminology

18/05/20 Criminology Reference this

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This paper will focus on Grand Challenge: Promote Smart Decarceration. The system this paper will examine is the criminal justice system and how it has contributed to the problem of mass incarceration, attempts to address the problem, and the impact of incarceration of individuals with serious mental illnesses (SMI). At the end of this paper, we can hopefully arrive at the opinion that incarceration of individuals with SMI is detrimental for their own mental health and the need for addressing adequate treatment and decreasing incarceration of individuals with SMI.

Keywords: serious mental illness, SMI, criminal justice system, prison, jail, deinstitutionalization, incarceration.

The Grand Challenge and Criminal Justice System

The Grand Challenge that I will focus on is Promote Smart Decarceration, and the problem focus will be diverting individuals with serious mentally illness (SMI) from jail when they come at contact with the law/authorities (911 call, arrest, booking) (Dickerman, 2018).  In order to address the incarceration of individuals with SMI, understand the reason behind the incarceration of individuals with SMI within the criminal justice system. The criminal justice system has impacted my Grand Challenge and can hopefully be utilized as a tool to address diversion of individuals with SMI.

Criminal Justice System

Gooch and Williams (2015) defines criminal justice system as:

A system intended to maintain social control, enforce laws, and administer justice, which is characterized by:

(1) explicit rules (laws) created by legislative authority;

(2) designated officials to interpret and enforce the rules; and,

(3) provision for punishment for those who offend and commit acts against the rules and society at large and compensation for those who are the victims of crime.

 Hooper and Masters (2017) informs us that the American criminal justice system is a “multilayered complex that interconnects courts, law-enforcement agencies, and corrections of federal, state, and local governments” and their goal is to reduce crime, punish wrongdoers, and rehabilitate offenders.

 Law enforcement, the courts and corrections organize the criminal justice system, and despite being related, they are not well coordinated and identified as fragmented, divided, and splintered (Hooper & Masters, 2017). Law enforcement, which include all police agencies, are in charge of reducing crime, eliminate the opportunities of criminal acts as well as apprehend and arrest law violators, investigating crimes, collecting and preserving evidence, and preparing cases for prosecution (Hooper & Masters, 2017).

 The court system, which includes judicial agencies, ensure that the “accused” receives a fair and impartial trial (Hooper & Masters, 2017).  Lastly, per Hooper and Masters (2017), corrections are comprised of executive agencies, are responsible for directly and indirectly housing and controlling individuals who have been convicted of crimes. Corrections obligation is to maintain prisons, jails and halfway houses, and provide law abiding citizens protection by “isolating criminal offenders in secure facilities” and the “confinement of offenders prevents them from committing further crimes.” (Hooper & Masters, 2017). 

Harding and Roman (2017) share with us how individuals who have contact with the criminal justice system experience other dilemmas, such as health and mental health issues, substance abuse, and social disadvantage.  Due to these dilemmas, an individual cycles in and out of jail, shelters, hospitals and other public systems (Harding & Roman, 2017). Harding and Roman (2017) identify the individuals who go through multiple systems over time as “frequent systems utilizers,” as they impact the costs of public hospital beds, mental health treatment, incarceration, criminal justice supervision and shelter stays. The high utilization of services and systems clearly demonstrates how current services are inadequate in meeting the needs of an individual who is justice system involved and with complex needs (Harding & Roman, 2017).

 In estimate, 64% of the United States’ jai population suffers from a type of mental illness (Harding & Roman, 2017). Per Harding and Roman (2017), data shows that jails spend between 9% and 30% of their $22 billion yearly budget on services such as health care for their inmates, but heath services are substandard and mental health care is scare or even nonexistent. When an individual with mental illness is released from jail, they are deemed “hard to house” or “hard to serve” which requires expensive solutions from multiple agencies to address those needs (e.g., health, mental health, substance abuse) (Harding & Roman, 2017). This label of hard to house or serve impacts an already vulnerable population vulnerable to homelessness and reincarceration. Harding & Roman (2017) share that if we can prevent homelessness among individuals who have complex health issues and mental health needs, it can assist in “repeat justice system involvement, poor health outcomes, and long-term housing instability.”

Rise of Mass Incarceration

In the 1970’s, the United States started to make policy changes over the decades (i.e. War on Drugs in President Nixon’s campaign, President Reagan’s Tough on Crime approach, and President Clinton’s 1994 Crime Control Act) that helped cause the current dilemma of mass incarceration by contributed to the current incarceration problem, as well as longer jail time, mandatory minimum sentences, taking away judges’ ability to mitigate relevant situations of offenses, such as mental health (Epperson et al., 2018).

In the mid-1970’s, incarceration prevalence within the United States started to increase as evidence by 312 of every 100,000 residents were incarcerated by 1985 and increased to 743 per 100,000 twenty years later (Wildeman & Wang, 2017). These policy changes were possibly devised to keep society crime free but has unfortunately resulted in an era of mass incarceration. Furthermore, Federal Sentencing Guidelines passed by Congress in 1984 made a huge impact throughout the federal system as it specified mandatory minimums for drug offenses and was concrete on “specific required sentences for nearly every crime on the federal books” (Kilgore, 2015).

Kilgore (2015) shares with us that by 1994, every state within the United States had implemented a form of mandatory minimum sentencing. In 1994, the Three Strikes and You’re Out initiative in California passed which made the sentence of a person who was convicted of a felony who had two prior convictions for a violent offense to twenty-years to life mandatory (Kilgore, 2015). This initiative also included a “second strike” provision that mandated a doubling the normal sentence of someone who was convicted of a second crime of violence (Kilgore, 2015). In 2015, jails and prisons held daily close to 2.2 million individuals. (Epperson, Pettus-Davis, Grier, & Sawh, 2018).

Another event that impacted the rise of incarceration rates was psychiatric deinstitutionalization.  In the 1960’s and 1970’s, the asylum population began to decrease as a result of deinstitutionalization as mental hospitals were deemed an inappropriate setting to address mental illness and the mentally ill (Kim, 2016). In the late 1970’s and throughout the next three decades, due to the decrease in mental hospital populations, there was a sudden increase in prison populations, those these trends are still up for public debate (Kim, 2016). It is important to note, the relationship between mental health and prison systems may be due to the period of time the data were collected (i.e. both emerged and “grew together” around the same time periods as “institutional solutions to social problems brought by industrialization and urbanization.”) (Kim, 2016).

 Due to deinstitutionalization policies, community health centers were not appropriately funded to provide follow-up care for the mentally ill, and lack of personal and community resources, the individuals with SMI were at risk of homelessness, poverty, or being a victim of a crime or crime involvement which in the end being “being trans-institutionalized in different institutions such as nursing homes, board-and-care homes, jails, and prisons” (Kim, 2016).

Individuals with Serious Mental Illness

Individuals with incarceration history have been found to have higher mortality rates, stress related and infectious diseases, health impairments, and worsened mental health (Sugie & Turney, 2017). The stress process paradigm identifies the correlation between the criminal justice and mental health problem (Sugie & Turney, 2017). Starting from the arrest, to the conviction, through incarceration, stressors start to impact the individual and the criminal justice system may proliferate beyond mental health and have “broad intra- and inter- generational consequences” (Sugie & Turney, 2017).

Prisoners are deprived, degraded, have loss of autonomy and loss of freedom, experience strained relationships with prison staff and inmates, are exposed to violence, lose their identity, and have minimal to nonexistent contact with friends and family (Porter & DeMarco, 2019). Per Porter and DeMarco (2019), incarcerated individuals by the time they are incarcerated suffer of poor health, exhibit symptoms of depression or mania, and incarceration experiences affects their post-release outcomes such as marital status, employment, increase in mortality risk, feelings of hopelessness, body mass index, housing possibilities, and education (Porter & DeMarco, 2019).

Findings by Harner and Riley (2013) share how women have disclosed that while they were in prison, their mental health was not addressed suitably, and their mental health became worse while in jail (Harner & Riley, 2013). Furthermore, the following were identified as factors that contributed to poor mental health: isolation, lack of mental stimulation, misuse of drugs, unhealthy relationships with prison personnel, bullying and not having family contact (Harner & Riley, 2013). Turney, Wildeman, and Schnittker, J. (2012) also shares most psychiatric disorders happens before incarceration and incarceration impacts their mood disorders.

 Per Al-Rousan, Rubenstein, Sieleni, Deol, and Wallace (2017), there are ten times more individuals with SMI in prisons and jails than there are in state mental hospitals. Individuals with SMI who are incarcerated are more likely to be deemed as being under “active treatment” than being deemed resolved or remission, more like to be charged with breaking correctional facility rules, and very probable to be injured in a fight and be charged with a physical or verbal assault on another inmate or staff (Al-Rousan et al., 2017). In turn, treatment for mental illness are very costly and the individuals are at high risk of recidivism, hospitalization and suicide upon release (Al-Rousen et al., 2017). Al-Rousan et al. (2017) shares that leading cause of clinical expenditures in correction facilities are due to mental illness.

Criminal Justice System programs to address the Grand Challenge

In the decision of Brown v. Plata of 2011, it was deemed that California prisons were unconstitutionally crowded, and California was ordered to reduce its prison population as well (Ball, 2016). Currently, the criminal justice system has programs such as the assisted outpatient treatment (AOT) and mental health programs (Horne & Newman, 2015) in order to address the individuals with SMI who have been incarcerated.


AOT, a court-ordered outpatient program, uses assertive community treatment and works jointly alongside law enforcement and mental health providers in order to supply community integration and housing assistance (Horne & Newman, 2015). AOT, which is a program accessible in 44 states, remains inconsistent with its laws in many states and policies (Horne & Newman, 2015). In 2002, California Legislature and Governor Gray Davis put into effect Laura’s Law which is California’s own version of AOT, and California’s AOT law placed coordination of the program and its funding to individual counties (Horne & Newman, 2015).

Data acquired in Nevada County, a state that implement Laura’s Law in 2008, demonstrated that AOT can decrease instances of psychiatric hospitalizations, reduce homelessness, and reduce incarcerations (Horne & Newman, 2015). Nevada County’s data that in the first three years of starting the program, days of being incarcerated were reduced by 67%, approximately $75,000 in jail costs were reduced, and approximately $500,000 in total cost savings in the 3- year period following the start of the program (Horne & Newman, 2015). Despite the success in savings, Horne & Newman (2015) reports that all individuals with a mental illness who are qualifies for AOT.

Another finding by Cripps & Swartz (2018) informs us that not having enough access to or accessibility of intensive services for individuals with SMI was not the main reason the individuals failed AOT engagement or treatment. Mandated supervision, such as AOT, promotes encouragement to an individual to follow through with treatment, but findings suggest that intensive services alone does not ensure patients engaging in treatment (Cripps & Swartz, 2018).

Mental Health Courts

Mental health courts are another attempt in addressing the problem of the incarceration of individuals with SMI. Mental health courts have been in service since the late 1980s and have been utilized as a problem-solving approach through “judicially supervised, community-based treatment plans to divert mentally ill defendants from the normal incarceration process” (Horne & Newman, 2015). The mental health court’s objective is to decrease the number of incarcerated individuals with mental illness and address the root issues that contributed to the criminal behavior (Horne & Newman, 2015).

Mental health courts were created to pick out, step in and change the course of individuals with SMI from the criminal justice system to community treatment programs in order to decrease recidivism and reduce overcrowding in jails (Trawver, Rhoades, Anderson, Peak, Hughes, & Castellano, 2013). Horne & Newman (2015) shares that mental health courts can be successful, and studies have demonstrated promising results in decreasing recidivism, general improvement and positive outcomes for individuals who completed mental health court programs.  In a study that involving San Francisco Behavioral Health Court graduates showed a reduction in new charges for violent crimes as well as a longer time period of re-arrest (Horne & Newman, 2015). Also, San Fernando Behavioral Health court enrollees demonstrated a 26% reduction in the possibility of any new charges and 55% reduction “in the probability of new violent charges compared with results in those not enrolled” at 18 months. (Horne & Newman, 2015).

Mental health courts have demonstrated success, but they have had challenges in acquiring data on long-term outcomes. Some mental health courts have not been successful such as a 2005 study of Broward County’s mental health court in Florida “found that the mean number of arrests was not significantly lower for enrollees than control nonenrollees” (Horne & Newman, 2015). Skeem, Manchak, and Peterson (2011) shares with us that mental health courts, which derived from drug courts, and evidence gathered for recidivism reduction was mixed, “but not quite as weak, for criminal justice-based models that emphasize supervision by specialized courts or probation officers (Skeem, Manchak, & Peterson, 2011). Furthermore, Skeem, Manchak, and Peterson (2011) shared that they learned that menta health court staff members or other programs would at times target factors that would get an offender in trouble, such as an individual “hanging out with her/his drug dealing cousin.”

The Criminal Justice System’s Impact

The policy changes that occurred within the past 3 decades has heavily impacted the current criminal justice system, exacerbating the jail system and impacting the care and treatment of individuals with SMI. Epperson and Pettus-Davis (2017) report the prevalence of SMI in prisons and jails within the United States is about 14%, which is “more than double the rate of serious mental illness in the general adult population,” and meaning that more than 375,000 individuals with SMI, on any given day, are incarcerated.

Data acquired and presented by Cloyes, Wong, Latimer, & Abarca (2010) found that 13% of state prisoners with mental disorder shared they were homeless the year prior to their incarceration; 74% individuals disclosed an alcohol or substance dependency or abuse; 77% of female state prisoners, in contrast to 55% of male prisoner, made known that they had symptoms or history of mental disorder; and three or more prior incarcerations were found to be by around 25% of state prisoners with mental disorder symptomology.

Further data acquired by Fazel and Danesh (2002) through surveys from 12 countries which included 22,790 prisoners demonstrated how 588 of 16 047 male prisoners and 119 of 2964 female prisoners were diagnosed with a psychotic illness, and 743 of 7631 male prisoners and 350 2898 female prisoners were diagnosed with major depression. Fazel and Danesh (2002) share how applying the prevalence rates to the prison population of the US puts forward to consideration that some hundred thousand prisoners might have a psychotic illness, major depression or both, which is “twice the number of patients in all American psychiatric hospitals combined.”

Cloyes et al. (2010) informs us how individuals with SMI require stable, successful mental health treatment and intervention, but the individuals do not receive adequate treatment in jail or in the community which leads to their increase in behaviors and in turn leads recidivism and reincarceration. According to Epperson et al. (2018), “successful re-entry to the community remains a great challenge for those returning home from incarceration.” In 2005, it was found that 67.8% of the 404,638 state prisoners that were released were re-arrested within 3 years of their release, and 76.6% were arrested within 5 years of release (Durose, Cooper, & Snyder, 2014). Furthermore, Durose et. Al (2014) found that over a third of prisoners who were re-arrested within 5 years of their release were re-arrested within six months after their release.

 In the past three decades, states have cut back on mental health services which results in police having to take individuals in a mental health crisis to jail (Kilgore, 2015). Furthermore, poor, especially the homeless, are more likely to be taken to jail for mental health crisis, end up with minor charges (i.e. disturbing the peace or loitering) and even the short stay in jail can “traumatize a person who already has mental health issues” (Kilgore, 2015). It is also noted that individuals with mental health needs are plausibly likely to be victimized in jail.


It is understood that there is an evident dilemma in the number of individuals with serious mental illness being incarcerated. Factors that have contributed to the incarceration of individuals with SMI has stem back close to three decades, and the mental health care in place, or lack thereof, not adequate or suitable. Though there have been programs such as AOT and mental health court, and they have been beneficial in implementing interventions to reduce incarceration and possible treatment for individuals with SMI, they have not been successful in eliminating a legal and judicial monitoring or supervision.

If we could utilize the identified barriers in the treatment of individuals with SMI, and the recommendations, plus including programs that encourage re-integration, housing placement, outpatient mental health treatment, medical assistance and treatment, departments that have contact with the individual (i.e. court, sheriff, probation) in one setting, we could create a holistic proposal that can impact the individual as a whole. In theory, if we can make a wholistic approach program and/or intervention, we make a meet the individuals’ immediate needs and sense of being a part of their community, and in turn, reduce the number of individuals in the jails and prisons.


We are in need of creating an innovative approach that does not only focus on smart decarceration, but decarceration of individuals with SMI. Incarceration has overwhelming effects during and after serving time in jail which impacts an individual with SMI’s mental health significantly as well as their ability to function or operate well in society. Incarceration also contributes to inadequate mental health treatment, and individual is likely to get re-arrested and be back in jail shortly after releasing due to lack of community and individual resources that could assist in community reintegration. My hope is that the innovative approach of diverting an individual with SMI at first contact can assist in the decreasing rates of recidivism and increase mental health stability. This proposed innovative approach/intervention will be discussed further in SOWK 706’s Assignment 3: Large Scale System Design to Address your Grand Challenge.


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