There are moments in history when we as a people can reshape the landscape of America and make decisions that will actually make America great. We are at one of those crossroads with our mental health and criminal justice structure. The criminal justice system has found itself in the midst of a crisis with trying to reduce the number of people going in and out of our jails each year. This also creates a crisis for the mental health community being that so many of these inmates have mental health issues of some kind and with the criminal justice system reducing its numbers, many of those with mental health problems that have been deemed criminals, will likely be sent back into their communities with the same issues or even worse mental health issues. The U.S. Bureau of Justice reports that 64 percent of inmates in jails and 50 percent of state prisoners experienced a mental health problem versus 10 percent of the general population. Additionally, between 14.5 and 26.4 percent of incarcerated individuals experience a serious mental health disorder. (Tyler & Brockmann, 2017 p. 547)
Everyone that is in the criminal justice system and has mental health issues is affected. This problems cuts across all demographics as our jails and prisons are being used as mental health facilities and institutions. According to (Tyler & Beckmann, 2017) “Blacks and Hispanics are incarcerated at 6.6 times and 2.5 times the rate of white men respectively” (p.545). So, this problem disproportionately affects African Americans and Latinos. Added to the numbers is the understanding that those who make up our criminal justice system are also disproportionately poor, undereducated, uninsured and homeless and thus most of their mental health needs are not being addressed in their communities prior to detention as this population has the least amount of resources available to them and quite often they self-medicate which adds to their rate of arrest and has deleterious effects on their mental health. Many of these people are arrested for non- criminal offenses and it is understood that when they have mental health breakdowns, there are no mental health facilities to take them to so jail becomes the only option instead of a facility to help treat the mental health breakdown that may be occurring. This leads to one of the major social issues that we see with the way this system is set up. It can be said that what is leading the race to change this phenomenon is the treatment of mental health inmates, but the true catalyst is the cost to the American public to keep these people in jails and prisons. According to the Department of Justice, it costs American taxpayers a staggering $15 billion per year to house individuals with psychiatric disorders in jails and prisons ($50,000 per person annually; 300,000 incarcerated individuals with mental illness). (Org, 2017) The value of an individual’s life also comes into question as we are locking many of these people up for minor offenses that we would not put individuals without mental health issue in jail for. In my experience dealing with the courts and mental health, disorderly conduct seems to be the go to for charging individuals with mental health issues and once they are in the system and not being treated for their issues, it often leads to other charges being filed by the jails and prison is what follows these additional charges. The prisons are making a great deal of money by criminalizing mental health, but society and the inmates are paying the cost. Many are also simply put in jail with no charges, pending a psychiatric evaluation. (Sugie, & Turney) Use insights from the Stress Process Paradigm and national data to show that incarceration is only one form of criminal justice contact and they define criminal justice contact as “arrest, conviction and incarceration.” (p. 719) The stress process paradigm suggests that criminal justice contact increases mental health problems because of the stressors associated in all areas described in their definition of criminal justice contact. It explains how life events and chronic strains create and exacerbate social inequalities in health.
Partly because of the lack of understanding of mental health and having a picture painted of the most extreme mental health cases to be the norm, society has supported the criminalization of mental health. Our society has also supported the policing of low economic areas differently than more affluent areas although mental health issues cut across all socioeconomics. If we look at some of the stressors simply associated with living in low economic areas, we can see why the stress process paradigm makes sense. A child growing up in a highly policed area often has the unfortunate opportunity to witness police abuse of their friends and family. These alone crates stressors that can lead to deleterious mental health. There is also the stress of losing a loved one often to the criminal justice system and trying to figure out how to enact with law enforcement particularly when it comes to trust. Going to court, even for a minor traffic offense has been shown to be a stressor for those who live in communities of color and if we couple that with having mental health issues, and the lack of understanding that can be associated with this, the stress on the individual and the individuals family has also been proven to create a different level of stress. For those who are incarcerated, the stress can be astronomical and counterproductive to any efforts to stabilize, much less improve the mental health issues they may be facing. (Sugie, & Turney, 2017) There is a name in prison for the walk to and away from the pill call line for individuals with mental health issues and it is called “ the Seroquel Shuffle”, aptly named for the shuffling style of walking, in a zombie like state, that mental health inmates display on a daily basis. Quite often, other than to go eat, this is the only time you see these inmates interacting in the prison. It has been said that these inmates cannot be forced to take their medication but the alternative if they do not show up for pill call is a nurse reporting to the unit with a corrections officer and if they refuse their medication, they are put in the hole until they decide to comply. These types of stressors are not only linked to poor communities or African Americans but the sheer numbers of people from those communities, makes it a problem disproportionately affecting the people of those demographics.
Historical and Current Policy
The question of how we got to where we are today and what policies have helped to shape the state of mental health and criminal justice is one that has many facets but there are a couple of huge policy decisions that have truly shaped the discussion and led to different policies that have helped and hurt in the fight to balance mental health and criminal justice. Prior to the 20th century, Dorothea Dix had fought to get mental health patients with serious issues out of jails and prisons and into mental health institutions for treatment in leu of incarceration. We began putting people with serious mental health issues into these facilities but without true knowledge of how to treat them. We then began to lock those up with less than serious mental health issues and created a problem of overcrowding and treating all as one. The turn of the century found mental health professionals fighting in favor of deinstitutionalization based on the horror stories of the treatment of these people within the institutions. They believed that persons with serious mental health issues could be treated in the community with community mental health centers. For many, the hope of community treatment never came to fruition. The fallout started with those who had serious mental health issues and needed highly structured care. Communities were not equipped to handle these individuals thus they ended up back in jails, prisons, and homeless. (Lamb & Weinberger, 2017)
When the United States began their “War on Drugs” (Lamb & Weinberger, 2017, p. 306) in the 1980s, and enacted the tough on crime policies, the prison population took off and reached numbers that no one could have anticipated. Because of the prevalence of mental health patients and substance abuse, they again became lost in the shuffle of the criminal justice system. At year in in 2014, the jail and prison populations were 2,224, 400 and the percentage of inmates assumed to have mental health issues was estimated at between 10 to 25 percent. (Lamb & Weinberger, 2017 p.303) The policy decisions in and of themselves carry huge implications for social work practitioners to study and understand because they form a pattern which is back upon us again. The closing of the institutions or deinstitutionalization was based largely in part to the horror stories of the treatment of individuals in these institutions, consequently, this was the main reason for the fight to institutionalize in the first place. We are again in the same place in the United States and decarceration is upon us as we try to figure a way to reduce the numbers of people incarcerated. Much as was the case in the past, there are horror stories of the treatment of mental health patients in jails and prisons and society is being forced to see the err of their ways when it comes to the cost and the consequences of dehumanizing persons with mental health issues and persons of certain demographics.
The real task for social workers as frontline community workers will be to first and foremost, educate themselves on past and present issues of mental health and criminal justice. The mistakes of the past should not be the future. As social workers we are tasked with enhancing human wellbeing and trying to meet the basic human needs of all people. This includes people with mental health issues no matter how taunting the task may be. We must join in the advocacy efforts that are taking place right now and those of the past and enhance them as we go along. As we educate ourselves, we must educate the public on mental health issues because we are in a time where these issues are showing up at much earlier stages in life. I believe that more than educating the public at large, social workers must join in the effort to educate law enforcement and push for more training on how to handle persons in their communities with mental health issues. More courts that deal with the special issues faced by mental health patients need to be advocated for and managed. The fight to secure funding sources for community clinics has to continue to be advocated for, if we can afford to incarcerate these individuals, as we decarcerate, that money can be used to operate in the community and lessen the burden that incarceration costs. It means that the work of social workers in the community will continue to increase and more who specialize in mental health will be needed. There has to be creative ways to join in the efforts to create housing for these individuals to live to help combat homelessness among this population. “Between one fourth and one third of homeless persons have a serious mental health issue”. (Lamb & Weinberger, 2017, p. 305)
With the implications showing that we are in another place that we have been in in the past in this country, there is wonder to as a country, how can we improve. Mental health and criminal justice have is an issue that has been shown to be a problem since prior to the turn of the century. Efforts must be made at reducing this problem or we run the risk of a repeat of the problem
- Lamb, H. R., & Weinberger, L. E. (2017). Understanding and treating offenders with serious mental illness in public sector mental health. Behavioral Sciences & the Law, 35(4), 303–318. https://proxy.ulib.csuohio.edu:2096/10.1002/bsl.2292
- Org, M. (2017). Criminalization of Mental Illness – Mental Illness Policy Org. Retrieved from https://mentalillnesspolicy.org/consequences/criminalization.html
- Paterson, C., & Pollock, E. (2016). Editorial: Global Shifts in the Policing of Mental Ill Health. Policing: A Journal of Policy & Practice, 10(2), 91–94. https://proxy.ulib.csuohio.edu:2096/10.1093/police/pav044
- Sugie, N. F., & Turney, K. (2017). Beyond incarceration: criminal justice contact and mental health. (Author abstract). American Sociological Review, (4). https://proxy.ulib.csuohio.edu:2096/10.1177/0003122417713188
- Tyler, E. T., & Brockmann, B. (2017). Returning Home: Incarceration, Reentry, Stigma and the Perpetuation of Racial and Socioeconomic Health Inequity. Journal of Law, Medicine & Ethics, 45(4), 545. Retrieved from http://proxy.ulib.csuohio.edu:2050/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=127270978&site=eds-live&scope=site
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