mentally ill and in jail

Mentally Ill and in JailMentally Ill and in Jail

Joseph J. Harper, LCSW, DCSW, ACSW, Joseph J. Harper, LCSW, DCSW, ACSW, MBA, CCHP, CADCMBA, CCHP, CADC

Travis J. Nottmeier, MSW, LCSW, CADCTravis J. Nottmeier, MSW, LCSW, CADC

October 2013October 2013

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Objectives:Objectives:

Review the statistics associated with the topic.Review the statistics associated with the topic. Identify the mental health issues typically Identify the mental health issues typically

identified in the incarcerated population.identified in the incarcerated population. Identify the issues associated with the Identify the issues associated with the

placement of the mentally ill in correctional placement of the mentally ill in correctional facilities.facilities.

Review concerns associated with the provision Review concerns associated with the provision of mental health services in correctional of mental health services in correctional settings.settings.


Adult correctional authorities supervised about 6,977,700 offenders at yearend 2011, a decrease of 1.4% during the year. The decline of 98,900 offenders during 2011 marked the third consecutive year of decrease in the correctional population, which includes probationers, parolees, local jail inmates, and prisoners in the custody of state and federal facilities.

Correctional Populations in the United States, 2011Correctional Populations in the United States, 2011Lauren E. Glaze, November 29, 2012 NCJ 239972Erika Parks

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• At yearend 2011, about 1 in every 50 adults in At yearend 2011, about 1 in every 50 adults in the U.S. was supervised in the community on the U.S. was supervised in the community on probation or parole while about 1 in every 107 probation or parole while about 1 in every 107 adults was incarcerated in prison or jail. adults was incarcerated in prison or jail.

• The community supervision population The community supervision population (including probationers and parolees, down (including probationers and parolees, down 1.5%) and the incarcerated population 1.5%) and the incarcerated population (including local jail inmates and federal and (including local jail inmates and federal and state prisoners, down 1.3%) decreased at state prisoners, down 1.3%) decreased at about the same rate in 2011. about the same rate in 2011.

• The majority (83%) of the decline in the The majority (83%) of the decline in the correctional population during the year was correctional population during the year was attributed to the decrease in the probation attributed to the decrease in the probation population (down 81,800 offenders). population (down 81,800 offenders).


StatisticsStatistics

At midyear 2005 more than half of all prison and jail inmates At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates had a mental health problem, including 705,600 inmates in State prisons, 70,200 in Federal prisons, and 479,900 in in State prisons, 70,200 in Federal prisons, and 479,900 in local jails. These estimates represented 56% of State local jails. These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail prisoners, 45% of Federal prisoners, and 64% of jail inmates.inmates.

Mental Health Problems of PrisonMental Health Problems of Prison

and Jail Inmatesand Jail Inmates

Doris J. James andDoris J. James and

Lauren E. GlazeLauren E. Glaze

BJS StatisticiansBJS Statisticians

September 2006, NCJ 213600September 2006, NCJ 213600


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National Estimates of Six Psychiatric Disorders among State Prison National Estimates of Six Psychiatric Disorders among State Prison Inmates and in US Population 1995Inmates and in US Population 1995

Source: Prevalence of Communicable Disease Chronic Disease and Mental Illness Among the Inmate Source: Prevalence of Communicable Disease Chronic Disease and Mental Illness Among the Inmate Population: in The Health Status of Soon-To-Be-Released Prisoners: A Report to Congress, vol. 1, The Population: in The Health Status of Soon-To-Be-Released Prisoners: A Report to Congress, vol. 1, The

National Commission on Correctional Health Care, May 2002.National Commission on Correctional Health Care, May 2002.

DiseaseDisease State Prison State Prison Estimated Lifetime Estimated Lifetime Prevalence Prevalence (N=1,010,2228 (N=1,010,2228 inmates)inmates)

%% Total US Population Total US Population Lifetime PrevalenceLifetime Prevalence

Schizophrenia/Schizophrenia/PsychosisPsychosis

22,994-39,26222,994-39,262 2.3- 3.92.3- 3.9 .8.8

Major DepressionMajor Depression 132,619-188,259132,619-188,259 13.1-18.613.1-18.6 18.118.1

BipolarBipolar 21,468-43,70821,468-43,708 2.1-4.32.1-4.3 1.51.5

DysthymiaDysthymia 85,018-135,12185,018-135,121 8.4-13.48.4-13.4 7.17.1

PTSDPTSD 62,388-118,07162,388-118,071 6.2-11.76.2-11.7 7.27.2

AnxietyAnxiety 222,147-303,936222,147-303,936 22.0-30.122.0-30.1 N/AN/A

Systemic ProblemsSystemic Problems

Human Rights Watch states that “the Human Rights Watch states that “the high rate of incarceration of mentally high rate of incarceration of mentally ill people is a consequence of under ill people is a consequence of under funded, disorganized, and fragmented funded, disorganized, and fragmented community mental health services.”community mental health services.”

(NASW News, January 2004)(NASW News, January 2004)


““The New Asylums”The New Asylums”From Frontline on PBSFrom Frontline on PBS

Comorbid DisordersComorbid Disorders Epidemiological Catchment Area (ECA) Epidemiological Catchment Area (ECA)

Survey of late 1980’s indicated that dual Survey of late 1980’s indicated that dual disorders are more common among the disorders are more common among the homeless, prisoners, and mental hospital homeless, prisoners, and mental hospital patients. patients.

ECA survey reflects that 56% of prisoners had ECA survey reflects that 56% of prisoners had alcohol problems, 54% had drug problems, alcohol problems, 54% had drug problems, and 56% had another psychiatric disorder and 56% had another psychiatric disorder (Harvard Mental Health Newsletter, August (Harvard Mental Health Newsletter, August 2003)2003)

ECA survey “almost all inmates with a mental ECA survey “almost all inmates with a mental illness were also substance abusers (Harvard illness were also substance abusers (Harvard Mental Health Newsletter, August 2003).Mental Health Newsletter, August 2003).


Substance AbuseSubstance Abuse

From 1990 t0 2000, drug offenders in From 1990 t0 2000, drug offenders in state prison increased from 149,700 to state prison increased from 149,700 to 251,000 (Dr. McNeiley, Univ. of Chicago)251,000 (Dr. McNeiley, Univ. of Chicago)

Drug Use among state prisoners 1997 Drug Use among state prisoners 1997 (Journal of Correctional Health Care, Vol. (Journal of Correctional Health Care, Vol. 10, 3 Fall 2003).10, 3 Fall 2003).


Substance Use Among State & Federal PrisonersSubstance Use Among State & Federal Prisoners(Data from Bureau of Justice Special Report 1997)(Data from Bureau of Justice Special Report 1997)


Type of DrugType of Drug Ever Using DrugsEver Using Drugs Used Drugs Month Used Drugs Month PriorPrior

Using at TimeUsing at Time

Any DrugAny Drug 83.083.0 56.556.5 32.632.6

CannabisCannabis 77.077.0 39.239.2 15.115.1

Cocaine/ CrackCocaine/ Crack 49.249.2 25.025.0 14.814.8

Heroin/OpiatesHeroin/Opiates 24.524.5 9.29.2 5.65.6

Depressants Depressants (barbiturates, (barbiturates, tranquilizers, tranquilizers, Quaalude)Quaalude)

23.723.7 5.15.1 1.81.8

Stimulants Stimulants (amphetamine and (amphetamine and meth.)meth.)

28.328.3 9.09.0 4.24.2

Hallucinogens (LSD Hallucinogens (LSD & PCP)& PCP)

28.728.7 4.04.0 1.81.8

InhalantsInhalants 14.414.4 1.01.0 --


Drug offenders from 1990 to 2000 have Drug offenders from 1990 to 2000 have increased from 149,700 to 251,000 (Dr. increased from 149,700 to 251,000 (Dr. McNeily, University of Chicago).McNeily, University of Chicago).

Currently 2.1 million incarcerated. One Currently 2.1 million incarcerated. One in every 75 men in jail or prison. in every 75 men in jail or prison. Violent crime is at a 30 year low. 715 Violent crime is at a 30 year low. 715 inmates for every 100,000 residents.inmates for every 100,000 residents.


Statistics With Placement Statistics With Placement ** More than half of all prison and jail More than half of all prison and jail

inmates nationwide- some 1,255,000 men inmates nationwide- some 1,255,000 men and women have mental health problems and women have mental health problems (Bureau of Justice Statistics, 2006)(Bureau of Justice Statistics, 2006)

An estimated one hundred thousand are An estimated one hundred thousand are psychotic on any given day. (American psychotic on any given day. (American Psychiatric Association, 2000)Psychiatric Association, 2000)

Prisoners have rates of mental illness that Prisoners have rates of mental illness that are two to four times greater than the are two to four times greater than the rates of members of the general public. rates of members of the general public. (Metzner et al., 2006)(Metzner et al., 2006)


Policies with PlacementPolicies with Placement Prisons were never intended to function as mental Prisons were never intended to function as mental

health facilitieshealth facilities Two distinct policies that have shaped the Two distinct policies that have shaped the

placement of mentally ill.placement of mentally ill. DeinstitutionalizationDeinstitutionalization Punitive approach to anti-crime effortsPunitive approach to anti-crime efforts Corrections systems have not been able to keep Corrections systems have not been able to keep

up with the exploding prison population much less up with the exploding prison population much less the mentally ill prisonerthe mentally ill prisoner


The Physical Conditions of The Physical Conditions of PlacementPlacement

In the most extreme cases conditions of In the most extreme cases conditions of confinement are horrific.confinement are horrific.

Extremely restrictive housing acts as an Extremely restrictive housing acts as an incubator for psychiatric breakdownsincubator for psychiatric breakdowns

Poorly trained correctional officers have Poorly trained correctional officers have accidentally asphyxiated mentally ill accidentally asphyxiated mentally ill prisoners whom they were trying to prisoners whom they were trying to restrain.restrain.

Society gains little from incarcerating Society gains little from incarcerating mentally ill offenders in poor mentally ill offenders in poor environmentsenvironments


The Physical Conditions of The Physical Conditions of PlacementPlacement

Prisoners with mental illnesses have Prisoners with mental illnesses have impaired thinking, emotional impaired thinking, emotional responses, and ability to coperesponses, and ability to cope

More likely to be exploited and More likely to be exploited and victimizedvictimized

Twice as likely to be injured in a Twice as likely to be injured in a fight. (James & Glaze, 2006)fight. (James & Glaze, 2006)

Higher rates of rule breaking. Higher rates of rule breaking. (Abramsky & Fellner, 2003)(Abramsky & Fellner, 2003)


The Provision of Mental Health The Provision of Mental Health ServicesServices

Prisoners receive little or no meaningful Prisoners receive little or no meaningful treatmenttreatment

Neglected, accused of malingering, or are Neglected, accused of malingering, or are treated as disciplinary problemstreated as disciplinary problems

Even acts of self-mutilation and suicide Even acts of self-mutilation and suicide attempts are too often seen as attempts are too often seen as “malingering” and are punished as rule “malingering” and are punished as rule violationsviolations

Accumulate extensive disciplinary historiesAccumulate extensive disciplinary historiesTweet us at #NASWILTweet us at #NASWIL

The Standards set by courts The Standards set by courts and human rightsand human rights

Federal court rulings made it clear that correctional Federal court rulings made it clear that correctional authorities could not simply ignore the mental health authorities could not simply ignore the mental health needs of prisonersneeds of prisoners

The eighth amendment to the Constitution of the United The eighth amendment to the Constitution of the United States. “Deliberately indifferent”States. “Deliberately indifferent”

International Covenant on Civil and Political Rights International Covenant on Civil and Political Rights (1966)(1966)

Human Rights Watch “prisons are not equipped to Human Rights Watch “prisons are not equipped to handle mental illness and, more often than not, resort handle mental illness and, more often than not, resort to punishment to control those afflicted, aggravating to punishment to control those afflicted, aggravating their illness.” (NASW News, January 2004)their illness.” (NASW News, January 2004)

Litigation Reform Act of 1995 has hampered these Litigation Reform Act of 1995 has hampered these rights. (1995)rights. (1995)


The Mental health professional The Mental health professional obstacles to provide servicesobstacles to provide services

Competent and committed mental Competent and committed mental health professionals struggle to health professionals struggle to provide good servicesprovide good services

Too limited resourcesToo limited resources Officials who resent or begrudge Officials who resent or begrudge

their worktheir work Lack of decent pay and recognitionLack of decent pay and recognition


What does the provision of What does the provision of mental health services offer?mental health services offer?

Helping individual prisoners regain Helping individual prisoners regain health and improve coping skillshealth and improve coping skills

Encourage the development of more Encourage the development of more effective internal controlseffective internal controls

Promote safety and order within the Promote safety and order within the prison communityprison community

Enhance community safety when Enhance community safety when offenders are releasedoffenders are released


What do provisions currently What do provisions currently lack?lack?

A sufficient number of qualified A sufficient number of qualified mental health professionalsmental health professionals

Peer review and quality assurance Peer review and quality assurance programs. Paper to practiceprograms. Paper to practice

Lack of specialized facilitiesLack of specialized facilities Mental health staff have very limited Mental health staff have very limited

administrative authorityadministrative authority


What do provisions lack?What do provisions lack?

Needed private counseling, group Needed private counseling, group therapy, or structured activitiestherapy, or structured activities

Training to non-mental health staff to Training to non-mental health staff to recognize these prisoners and needsrecognize these prisoners and needs

limiting treatment to the most acutely limiting treatment to the most acutely illill

Mental health staff limit their attention Mental health staff limit their attention to only a fewto only a few



American Correctional Association American Correctional Association indicates that funding for mental health indicates that funding for mental health professionals (particularly social workers) professionals (particularly social workers) was reduced in the 1980’s and 1990’s as was reduced in the 1980’s and 1990’s as the focus of corrections became punitive.the focus of corrections became punitive.(NASW NEWS, January 2004)(NASW NEWS, January 2004)


The root of the Mentally ill and The root of the Mentally ill and in Jailin Jail

Can we afford to continue expanding Can we afford to continue expanding prison populations?prison populations?

Radical changes to community Radical changes to community mental health, as well as poverty and mental health, as well as poverty and homelessnesshomelessness

Public commitment, compassion, and Public commitment, compassion, and common sense.common sense.


Policy Statement From: Policy Statement From: Social WorkSocial Work SpeaksSpeaks

Social Work in the Criminal Justice SystemIn 2006, there were 2,245,189 individuals incarcerated in local, state, and federal correctional facilities in the United States (Sabol, Minton, & Harrison, 2007). The United States has the highest incarceration rate in the world, and the rate increased 700 percent between 1970 and 2005 (Public. Safety Performance Project, 2007). In addition, up to 60 percent of incarcerated individuals who are released will be reincarcerated within two years (Langan & Levin, 2002).


Mental Health

Correctional facilities have become the treat ment facility of last resort for individuals who have been failed by other systems. The dismantling of the psychiatric hospital system and the fragmentation of community mental health systems has shifted the care of those with chronic mental health issues to the correc tional system. Substantial numbers of offend ers have mental health disorders that have not been diagnosed or treated. Many of these individuals have comorbid substance abuse issues. Weedon (2005) reported there are five times more persons with mental illnesses in jails than in state psychiatric hospitals. Conservative estimates propose that 10 percent of offenders have a mental illness (Norton, 2005), with rates of mental health problems in incarcerated indi viduals reported as high as 64 percent Qames & Glaze, 2006).

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As Showalter and Hunsinger (2007) stated, "in essence our prisons are full of people extremely short on resources and long on problems" (p. 366). Social workers trained in the cor rections field are uniquely qualified to provide services addressing all the problem areas. Yet little has been written about delivery of services in this field, and schools of social work rarely address correctional social work and criminal justice. Incarceration needs to be closely ana lyzed.

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• expansion of prevention , screening, and treatment efforts, including issues such as sub stance abuse and dependence, mental illness, sexually transmitted disease, blood and airborne pathogens, confidential testing, and domestic violence;

• increased funding for community-based options, especially for those individuals with substance dependence or serious mental ill ness who may be better rehabilitated by these services;

• identification of and response to the special needs of any individual under the supervision of the criminal justice system, including, but not limited to, racial, sexual, and gender minorities; juveniles; women (including pregnant women); the elderly; and those with impairments;

• advocacy and social work leadership to es tablish national policy on criminal justice, issues in collaboration with other organizations.

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mentally ill and in jail

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