Imprisoning People with Mental IllnessPeople with mental illness are increasingly ending up being imprisoned, rather than in the mental health care system where many of them belong. With the down economy, states and counties — who are …

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Imprisoning People with Mental Illness

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  1. Hello,

    I work for the Mental Health Center of Denver, the largest community mental health organization in the area. In cooperation with the local department of corrections, we have started a court to community pilot program for the mentally ill population in the correctional system. So far, initial results have been very promising. In fact, we have seen an 80% reduction in jail time among the clients involved in the program!

    I think this cooperative alliance between the courts and community mental health will prove invaluable in the near future, and I hope this will lead to some larger scale community improvement.

    Cheers,
    -Mickey

  2. The problem with imprisoning people suffering from a mental disability is that the criminal justice system, and sadly, the juvenile justice system does not have rehabilitation as its goal. The goal is a punitive model of punishment and NEVER restoration. What individual’s jailed with a mental illness REALLY meed is for society to understand them, understand mental illness better, and work together to create a system that does not place wayword individual’s away from society simply for societys’ good, but rather rehabilitates and helps to create a more functional individual so that person can perhaps return to society.

    I know this is difficult because many programs have been put into place to remedy the situation but with no positive results. Therefore, our system decided to focuse exclusively on a punitive model of punishment to make society better for the majority of citizens, that is, those who function well.
    Essentially, jail is a center that holds the mentally ill captive; it is a place where troubled people are placed AWAY from society. It is really kind of selfish because the people within these cells do not get help, while the majority of society moves on with their lives and forgetting the needy.

    We really must do something about this. It is about time don’t you think?
    http://www.time.com/time/health/article/0,8599,1651002,00.html

  3. I think the numbers from the past were actually inaccurate….I am sure that the number of mentally ill in the prison system has always been a lot higher than the numbers suggest.

    The fact is that we now diagnose more people with mental illness than in the past. We have more knowledge about the mental illnesses to be able to diagnose. I am sure that there were many more undiagnosed prissoners in the past which would have actually raised the number but our ability to diagnose wasn’t there.

    The whole population has increased in the diagnoeses of mental illness so it doesn’t surprise me that the numbers in the prisons have gone up also…..beyond the fact that state facilities have closed…..that only adds even more which is why the numbers look & are so high.

    It is sad that people with mental illnesses get caught in the prison system. I can understand how it happens & am glad to hear that there is a system being set in place to catch that. I was followed for 40 miles by someone while driving in my car until I could find a safe place to get help. Not knowing anything about who was following me, only that I knew I was in danger…..come to find out, yes, this person was mentally ill….or maybe on drugs, or maybe both. It seems that some with mental illnesses get themselves into situations where they are in a position where the legal system is needed. Making sure that they don’t get caught in that system is important & sometimes it is that legal system that is needed to start with to get them caugh to the point where thy HAVE to get the help they really need. The sad thing is that many of those who are in that situation get meds & then go off them & onto other drugs which only makes their mental illness worse & they end up cycling through the system over & over again because they are not willing or maybe even able to care for themselves enough to take the meds that would keep them out of the system especially if they have no one who is caring for them & they are all alone.

    There is no full proof system, but if we can keep them out of the jails to cycle through the mental health system rather than the jail system……that will definitely be a wonderful program to have in place.

  4. ‘This is what you would expect from a third world country?’

    Well, according to the Europeans, America has been a third world country for quite a long time, now.

    Yes, people think that the Bush government really sucked now, the majority. They now understand that the law has been broken, and the torture thing, and the economy, and all that.

    But what few ‘normal’ people know, even now, is that all this stuff we think may have been happening in those evil countries far away, has been going on in our own neighborhoods.

    When I accidentally stepped into this in the winter of 2001, and by 2002 declared for the very first time in my life, (used this word for the very first time ever in my life) that the Bush administration was ‘evil’, and that evil ‘DNA’ spread out everywhere, I was merely called psychotic and ‘sensation seeking’, and a psychopath, and worse.

    This article is nice and friendly, and it’s made for those who have just realized that things ain’t perfect in America any longer.

    To me, it is …..I don’t know! (unbelievable!)

  5. I want to apologize to the author for my above comment. It sounded condescending, I think.
    plus, the truth is that even I, and who witnessed ‘the evil’ I am referring to…I still did not believe it myself. Seeing is not always believing.

  6. Staggering article. Thank you for writing it. It is just as reprehensible and Nazi Germany when this is being done. The sad thing is, I don’t see a solution coming soon.

  7. Be aware, as much as true mental health patients are incarcerated, there is a sizeable portion of sociopaths who feign mental illness to access controlled substances and get their sentences reduced or removed as “not guilty by reason of insanity”.

    Gotta love that term, not guilty by reason of insanity. Applicable sometimes, completely a farce of a defense in others.

  8. ‘….who feign mental illness to access controlled substances?’

    I don’t think so, skillsnotpills. It’s not like mental patient are served ‘morphine’ and ‘cocaine’, and none of these drugs are controlled substances. Nobody takes them for pleasure, never mind commits a crime to get there.

    The sociopath you are referring to, he’s got more skills than I can even imagine.

  9. To Katrin:

    I am talking about prescription drugs, like benzodiazepines xanax and klonopin, stimulants Adderall and ritalin, even Seroquel, an antipsychotic, has street value these days; hell, cogentin, an anticholinergic drug used to offset side effects from old antipsychotics like Haldol had a street value back in the 1990s for awhile. And, I have patients show up who cop an attitude I should be prescribing them opiates for alleged pain issues, and since I am a doctor, albeit a psychiatrist and do not treat pain issues in my office, nonetheless I should write for it per their opinion?

    Apart from the Seroquel, you won’t get the other drugs in jails or prisons, but it is not just the correctional population I am worried about, it is what comes out back into the community that tries to legitimize what some fool labeled these sociopaths while incarerated.

    And, with prescription drug abuse the largest increasing group of substances being abused in the U.S. these days, people need to start realizing that statistic and stop focusing on street drugs alone. The Heath Ledgers, Anna Nicole Smiths, Michael Jacksons, are the tip of the iceberg of this culture, folks, not as examples of sociopaths, but the consequences of minimizing the use of prescription drugs.

    Hear it, learn it, and change your attitudes!

  10. Sorry, skillsnotpills, I am way overtired and should not have commented at all, and I am sorry that I misunderstood you. I know what you mean, and I think I get the idea of what you are saying. Your psychiatric patient has just such a horrible backache or migraine today and can you write him an RX for hydrocodone. and the next just has been really unable to concentrate and she needs Ritalin or Adderall, either one will work, but she thinks she does better on the short acting Ritalin now that she thinks about it?

    Cheers, Katrin

  11. Oh, just checked my blood sugar and its 420, so no wonder!! Just thought I’d share. Could you write me a script for…? (just kidding!)

  12. Hello there:

    Great post! I was reminded of when the state mental hospitals began developing. Prior to their development, those suffering from a mental disorder seemed to either wind up in jail or homeless.

    While there is still an abnormally large amount of homeless people who suffer from a mental illness, under a government comission mental hospitals, or asylums, began being constructed (coincidentally…or most likely not…right next door to jails!).

    The state hospitals were effective in getting people out of prisons, but they were merely a place to warehouse humans. To stabilize them rather than to treat them and encourage them to be a functional, contributing member of society.

    I have great concern that the mentally ill are once again returning to the prisons. After doing a bit of digging, I discovered that those being arrested are asked immediately if they have any sort of mental disorder. Most entering the system (or re-entering the system as is more likely), are aware that there is a seperate ward for those with mental disorders wherein the living conditions are far worse than any other block at the facility. Thus they simply answer ‘no.’

    But as those with mental illnesses remove themselves through self selection from the system, they are not recieving the treatment that is necessary, thus are much more likely to become repeat offenders. It is a terrible cycle!

    The Mental Health Center of Denver has begun a prison-court alliance to help intervene in this cycle, but it is rather new thus its effects aren’t entirely known yet, though the Denver prisons are experiencing a decreased rate of re-entry for those who recieve treatment for a mental illness while in prison.

    Great post though, very interesting and very sad, but very interesting none-the-less.

    I have another topic to shoot your way if you wouldn’t mind? I know you are very busy but I was wondering if you might let us know what your stance on the Recovery Movement is? Whether you think it is viable, more effective, less effective, etc. What its implications are from a practioner’s stance, etc.

    If you do have time to respond, would you mind if I quote you (with reference back to your blog of course) in my Mental Health Recovery Blog? It is rather new and designed to start a dialogue about what recovery really is, what are its good points, its bad points, etc.

    Of course if you prefer I not quote you then of course I will respsect your wishes and would love to continue the dialogue on your own blog!

    Warm regards and I look forward to speaking with you more on the issue!

    Lex Douvasa
    MHCD Research and Evaluations

  13. Hello everyone:

    I must agree with Katrin and respectfully disagree with skillsnotpills. You know, the NGRI-Not Guilty By Reason of Insanity defence (usually includes a longer sentence within a hospital unit which can sometimes be much longer than one doing time in a prison) and the GBMI-Guilty but Mentally Ill verdict (where the accused receive treatment within a prison) have very strict criteria and it would make it a bit difficult for a sociopath or psychopath to trick the system. A good prosecutor would certainly be able to trace a perpetrators steps and a good forensic psychologist (who gives psychological testimony of the accused mental state) would be able to detect deception.

    You are right that there are some people who do try to trick the system in order to gain a lesser sentence and unfortunately it almost worked and has worked with some previously famous sociopaths.

    Sociopathy has trully made it difficult for the court system to be able to objectively evaluate when an individual, who honestly has a mental illness, is controlled by uncontrollable behaviors, thought processes, and perceptions. That is why the court system and even some psychologists run from the topic of criminology and mental illness, it truly complicates matters.

    Essentially, I would be careful not to perpetuate the idea that “criminals” are sociopaths trying to gain lesser sentences. While this may be true, this probably a small percentage of the population.

  14. Oh yes we have treatments that make people better, so we should just diagnose all the prisoners w/depression, give them an antidepressant and say they are cured and then release them into society. Great way to keep stigma alive and well!

  15. I don’t understand the meaning of this last comment but I figure, the percentage of true criminals are equal on both sides of the bars in the prison.

    A true criminal often responds so well to his prison treatment that he will get hired by the prison to make the perfect guard, and use his ‘gifts’ to terrorize the ones that are locked up.

    The sick and vulnerable on the other hand, they break down in prison, and/or are broken down, and that makes it even more fun to abuse and torture them further in there.

    Thanks, Dr. T.

    PS: And treatment centers? most people still think they are what they used to be like.

    I say that if you got no money and/or insurance to visit one, you may be the lucky one.

  16. SkillsnotPills has an incredibly important point. Mental illness is not the cause of all crime. We need to understand that those with a diagnosable and treatable psychotic disorder that was directly related to their offending behavior need to be averted from the prison system. This requires more than just mental health courts. High risk patients with severe and chronic psychotic disorders often do not take their medication and need to be living in well monitored supported accommodation in the community.

    Most prison inmates will qualify for anti social personality disorder (ASP) and it is their attitudes and beliefs that contribute to their offending behavior. ASP is not a disorder treated by medication. Rehabilitation through offence specific targeted psychology programs, such as drug and alcohol, sex offending, violence etc, teaching skills is the only way to reduce re-offending behavior. Solid risk assessment targeting those with high risk and high needs will make sure that individuals are directed to the most appropriate program with intensity matched to their level of need.

    In other cords cognitive behavioral programs that target offence specific attitudes and beliefs that offenders have which support their offending behavior need to be targeted and changed to reduce re-offending.

  17. ‘In the most extreme cases, conditions are truly horrific.’ the report stated.

    Yes, I bet, they usually are. In this sentence, the meaning of ‘extreme’ to me sounds more like ‘rare cases’?

  18. FPsych, good points. I do agree partially, that is. Don’t quote me but I think the general prison population of sociopaths consists of only around 20%. That’s really doesn’t account for all the imprisoned people within the system.

    There are many innmates who do indeed meet the criteria of sociopathy, but how many of those innmates also show co-morbidity? Co-morbidity may include ASPD (antisocial personality disorder)along with major depression, schizophrenia, or bipolar disorder. They may show some anti-social characteristics, yet not meet the full criteria to be diagnosed as a sociopath. So then the bipolar disorder, schizophrenia, and/or major depression, which may be influencing overall behavior, needs to be treated away from the prison system. Although there may be antisocial characteristics and behaviors, those behaviors may be due to an underlying mental illness of some sort. It can get very complex.

    Additionally, what can seem like antisocial personality disorder, may be something like multiple personality disorder, which needs treatment away from the prison environment.

    Furthermore, ASPD affects about 3 to 5 percent of men and 1 percent of women according to the Mayo Clinic. Considering that women are the least to experience ASPD, then we certainly do need to be more enlightened to the fact that women who are acting criminally, may not have ASPD, but rather is suffering from a mental illness and should be diverted from the prison system.

    The sociopath next door (2005) by Martha Stout may interest you and it’s an easy read.

  19. Dr. T. I work in the prison system and have studied extensively correctional psychology, and taught in academia. ASP (Anti social personality) is not the same as sociopathy and is the most common diagnosis in the male prison system. Which is a different population to the community that you speak of. Comorbid mental health conditions like anxiety, depression etc are not related to offending behavior and treating those only will not reduce re-offending. Doesn’t mean we should ignore them they still need to be treated. Evidence based practice in correctional psychology no longer operates under a medical model of care for reducing reoffending because it doesn’t work. For over twenty years Canada has lead the way with a new model. Risk Need and Responsivity is the new model to address re-offending behavior.

    An indvidual with a serious and chronic psychiatric diagnosis that whose offending behavior is directly the result of their psychosis needs to treated in a forensic hospital with careful management and release back into the community with strict supervison and for the hardest of cases supported accommodation to monitor their health and behavior and compliance with medication.

    Read this link to Canada Corrections for an understanding of the Risk Need Responsivity Model

    http://www.publicsafety.gc.ca/res/cor/rep/risk_need_200706-eng.aspx

  20. The above clinicians don’t get it, as I have done some correctional work in my travels, and while there are those who have legitimate psychiatric disorders who end up behind prison bars, I am fed up with the rationalizing of antisocial personality disorder as a diagnosis worthy of some efforts at treatment. I do not address the following comments to these above providers, but to the general readers and clinicians who are still naive and interested in other opinions besides those who are out of touch with this population that is a danger to mental health providers.

    Why do you think Alan Frances wrote what he did in his DSM 4 case studies companion to DSM 4 in the vignette about APD?: he describes a fairly nasty case of a predator in mental health services, and in the review section ends with this comment I try to best paraphrase, “these patients are not amenable to treatment…If this sounds pessimistic, IT WAS MEANT TO BE.” (my bolding of the comment end)

    When you accurately identify someone with antisocial personality features, if not florid diagnosis per the DSM criteria, you as a clincian should step back and do some serious soul searching to engage with such patient. These people prey on your caring, empathy, and compassion and will use it against you in a heart beat. I am not advising or condoning abandoning people who are amenable to treatment with disorders that can be impacted for the better, but do not buy the false hype there are interventions for this personality disorder on a whole.

    Anyone who says otherwise is most likely clueless or has someone else do the actual treatment while the speaker is behind the safe side of the bars/doors.

    Sorry this is a harsh statement, but this is an issue that is one of the nails in the coffin of psychiatry. Forensic Psychiatry is more a blemish to the field than a benefit. If this sounds pessimistic or offends, it was meant to be!

    Skillsnotpills, board cert psych MD

  21. Skills I respectfully disagree with you. The DSM is an outdated diagnostic tool with poor validity and is no longer used for working with offenders. It’s all about risk assessment now. Perhaps you were in the system years ago, or the United States has been too slow to adopt the new evidence based practice in correctional psychology. Evidence based because it works. I’m assuming you are not familiar with the the new research and theory in the area of Forensic Psychology otherwise you would have seen the statistics on the reduction of re-offending by intervention programs that target changing anti social attitudes which lead to offending behavior for example; drug and alcohol offending, drink driving (in my own country by 50%) violent offences and other kinds of offending behavior.

    You can read the weblink in my other post its very imformative.

  22. This is a really controversial debate and a debate that forensic psychologists, clinical psychologists, and many lawyers have trouble coming to a common consensus on. It is something that many of my mentors have gotten migraines over. :) It is a debate that perpetuates stigma of mental illness, criminalizes mental disabilities, and keeps people uninformed when many voices disagree, feel strongly and enormously positive about their legal system, and see very little wrong with the inner-workings of the system.

    I hope that some time in the near future experts will be able to come to an agreement on how we should deal with prison inmates who suffer from mental illness. While sociopathy (or antisocial personality disorder) is something most of the prison population suffers from, the remaining deserves attention, understanding, and then most significantly, HELP.

    Just a brief correction: antisocial personality disorder is in fact the same as sociopathy or psychopathy. The terms are used interchangeably by some professionals, it can get confusing (but we need to know this tiny detail)! http://www.mayoclinic.com/health/antisocial-personality-disorder/ds00829

    http://www.scientificamerican.com/article.cfm?id=what-psychopath-means (really good link).

    very best

  23. FPsych, are you speaking of such things as drug courts, and programs for criminals that also have a drug addiction problem, like especially with meth-amphetamines?

    The type, where the repeat offender has a chance to have all his past criminal record erased if he manages to complete the program? Like the program that attempts to change the offender’s ‘criminal thinking’? (and supposedly, the criminal does not need to have an addiction to qualify for this treatment?)

    The thing about treatment like this is that it works well, like you say, but what matters here is ‘why’ it works, and that is not such a pretty picture.

    1) All the effective ‘treaters’ have to be, or are, ‘criminals’ themselves, or ‘recovering criminals’? and who graduated from such a program themselves, and had their records erased?

    2) They are very touch programs that involve severe brainwashing techniques.

    3) Now, criminals treating criminals may be a better deal than not, but this treatment is ‘killing’ for those who are misdiagnosed and do not benefit, and become even sicker from it.

    4) One reason the success rate is so high is, because of the people who die and commit suicide?

    5) The way the law works in those programs is the way the law worked under Bush. There is absolutely zero respect for any law, except the one they secretly observe and without the public’s knowledge. They claim this is in the public’s own interest. They take the law into their own hands. (and understandably, since the other way doesn’t work)

    6) They hate psychiatrists and play them like a toy..and successfully.

    7) I cannot do this any more, and have to go now.

  24. Well…I guess I should have said in my previous post that psychopathy and sociopathy are the same, with some researchers stating that antisocial personality disorder is a bit different. The symptoms are said to overlap by those who support the belief that symptoms overlap and therefore, there is confusion about sociopathy and antisocial personality disorder.

    I wouldn’t tire myself out Katrin. It’s not worth it. :) I think I’ve gotten myself a migraine.

  25. Katrin,

    click on the weblink from my earlier post and give it a good read, it will explain to you what I am talking about.

  26. Thanks, I forgot. I heard really great things about the rehabilitation of women offenders in Canada. If I remember correctly, they have about 1000 incarcerated women in Canada vs. like 100000000 in the US? That matters quite a bit? Yes, lets go to bed.

  27. FPsych, I respect your experiences, but I sense per the tone of your post you are not practicing in the US, so maybe there are differences between your country’s population and ours.

    I will respectfully agree to disagree and hope your efforts are successful moreso than not and risks to you are minimal.

    Again, I do not argue against truly mentally impaired patients accessing services in correctional facilities, it is just not for those who are NOT mentally impaired. And I do not view antisocial personality disorder as a mental impairment, but a societal matter that society manages by prisons and cemetaries. DSM has gone too far in allegedly labeling certain disorders giving the misperception they are amenable to interventions.

    Just my opinion. My last comment at this posting.

  28. The problem with putting those who are mentally ill and have committed a crime(s) in a psych hospital is that it causes the staff to treat all patients like they have done something wrong. Not everyone has. So, you throw the depressed person in with the guy who worked out a deal with the judge to get a lighter sentence in his upcoming DWI trial. No wonder staff treat patients like criminals. Some are.

  29. This was a very good article I commend you.

  30. I came to this site because i google searched ‘prison bar’ images. I am a 48 year old single female in the first few days of house arrest for my second DUI and I wanted a really good reminder not to step out of the house for anything or I *will* be behind bars. I want to cry all of the time about this but I can’t. I do know that I abuse, rather, have abused drugs and alcohol in the past. I do know that I have done this behavior because I really never have been properly treated for my psych disorders. So, now, being forceably retired as a 911 dispatcher at 43 and trying to *not* abuse anything but rather cope with life on life’s terms, is getting harder and harder.

    Briefly, my father was a violent abusive alcohol who I have forgiven for breaking my nose and such. I’ve forgiven my mom for not leaving him. I’ve been taught that it’s *ok* to be an alcoholic because someone will always be there for you…uhm…yeah, that is my f’d up thinking but he is still alive at 83 with my mom now also serving her own house arrest because he needs 24/7 care.

    Next, probably due to hanging out with the wrong types cause of low self-esteem, lost two fiances before I was 25 then set out on a course to be alone in life by again, wanting someone who was emotionally or otherwise unavailable for me….and, well, if you can see where i’m going……the cycle spirals downward and I start sounding like a victim rather than the intelligent, yet bi-polarish, add-y, always recovering alcoholic depressed, panic type personality that I am. (If that sentence didn’t show how scattered I am then let me continue my run on sentences)

    As a 911 dispatcher and a despressive person, my first dui was pretty much a few weeks after i took a cops suicide call. I went to a 3 month rehab paid for by my employer. Diagnosed with ADD when I returned, put on medication and this past May went off it because I couldn’t afford it. I do believe I was clinically depressed before that but now, no health insurance. I was told by the courts after I got ARD that if i didnt get another dui for 7 years i would not have to have that first offense charged against me. Three months shy of 10 years sober, going off meds, I was charged with this last dui as a second offender because they changed the laws and there is mandatory minimum sentencing ( I was enroute to the hospital to get help for my mental health and addiction for the 3rd of 7 times in 2 months when I stopped). My BAC was somewhere between .28 and .33 yet I remember every event of that day very clearly. I’ve also been recently diagnosed Diabetic (no surprise there) and was not yet on medication.

    So……hours later, after looking for a prison bar picture, I’ve read all everyone had to say, all the links….and here I sit. A criminal. I don’t feel sorry for myself. I know I have consequences to pay. I actually am glad that I got popped for DUI because it finally *FINALLY* got me the help I desperately needed. (Oh yeah….forgot to mention that my mother and I drove to a rehab a week before this and I was turned away)

    I just wanted to say that I’m glad there are some people out there working on solutions. Even though I am a mess all by myself…I know I am a good person with some mental issues and am very very scared right now about where my life is headed.

    Thanks for listening,
    Suzanne K

  31. This is one of the sickest things I have ever read on the topic of mental health treatment. Thank God they still had functioning, inpatient, mental health facilities when I was at my most vulnerable.

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