• Bree Bonner

Inmates Are People Too: The Effect of Poor Mental Health Care in Prisons

In Alissa Roth’s book Insane: America’s Criminal Treatment of Mental Illness, she says, “More than half the prisoners incarcerated in America suffer from some kind of mental illness, yet the American prison system is woefully unprepared to offer treatment or provide even basic mental health care to its wards.”


Today, the prison system in the United States has both intentionally and unintentionally fueled several problems in American society, most strenuously affecting society's mental health. The United States prison system is currently filled with mentally ill inmates.


Poor living conditions and inadequate care for inmates have unfortunately allowed prisons to develop into a dumping ground for the mentally ill. According to the World Health Organization, of the nine million people who are detained in penal institutions around the world, at least half of them deal with personality disorders, and one million prisoners or more worldwide suffer from serious mental disorders.


Furthermore, the American government quickly grew to neglect the needs of those incarcerated. When developed, prisons existed as a place for rehabilitation and reflection, allowing inmates to progress beyond their previous mistakes. In the early nineteenth century, reformers like Dorothea Dix attempted to reform the prison system by calling attention to the harsh treatment of inmates with mental health issues.


Even with these attempts in the past, prisons continued to develop into places that unjustly hold inmates captive and constantly treat them unfairly, in terms of not only their health, but also other vital aspects of life. In the twentieth first century, unfair treatment and neglect of people in the American prison system exacerbates and generates mental health issues among individuals, bringing about permanent damage in their lives.


As those with mental health issues in prison continue to remain untreated and live in the shadows, their troubles only increase, often leading to self harm both in prison and in life post incarceration. In a psychiatric autopsy study conducted by psychiatrist Dr. Tanney in 2009, he discovered that an average of 90 percent of those who committed suicide in prison received a diagnosis for a mental disorder after their death; most commonly depressive disorder leading with 61 percent, followed by substance abuse at 41 percent, anxiety at 10 percent, and schizophrenia at 16 percent.


Suicide rates have risen extremely high because prisoners experience neglectful care and lack the same treatment and open mindedness as those who have not committed a crime. The psychiatric problems inmates have developed while imprisoned and the neglectful treatment given to those inmates ultimately cause drawbacks within the inmate’s life, negatively affecting their post prison recovery.


Subsequently, prisons have proven to be poorly suited for human mental health. The factors that contribute to this include overcrowding, various forms of violence, enforced solitude, insecurity about future relationships in life and the workplace, and inadequate physical and mental health services. This build up leads to an increased risk of suicide in prison.


The inhumane treatment of inmates during their time incarcerated contributes to the exacerbation of their mental health issues. When these mental health issues go unnoticed, they begin to weigh on the inmates. Unfortunately, these mental health barriers can develop into something one cannot combat, leading to suicide. A study conducted in Washington in 2002 discovered that the prevalence of mental illness among inmates who attempted suicide was 77%, compared with 15% in the general jail population. Woefully, the increased risk of harm of prisoners stems from their inadequate treatment and therefore causes extreme, yet preventable consequences such as suicide.


The large gap in attempted suicide between those with mental health issues and those without demonstrates that mentally ill inmates continue to receive inferior care in comparison to those of the general inmate population. Those in the general prison population that do not have mental illness have the freedom to think more concretely and not let their feelings of paranoia and anguish consume them. Therefore, these individuals have less suicidal thoughts because they shed a more optimistic light on their life in prison and on their release.


Furthermore, in a 2006 study, psychologist Dr. Stuart Grassian discovered that isolation had created an agitated state among inmates, characterized by confusion, paranoia, and hallucinations, eventually leading to self-directed violence. The placement of inmates with mental health illnesses in solitary confinement to remove what the prison guards would refer to as a “problem” out of the general prison population has caused mental health issues to heighten. The increased rates of self harm experienced by those with mental illness fully reflect their neglectful care and unjust treatment while incarcerated, leading them into confinement in the first place.


Therefore, if confinement generates mental illnesses for individuals, it is an excellent way to exacerbate pre-existing mental health issues as well, ultimately prompting even more damage in terms of the consequences of self inflicted trauma.


Most Americans do not realize the detrimental effect of solitary confinement on an individual. Data suggests that non-disordered inmates can develop psychological problems when placed in prolonged periods of confinement, and worsen problems for those with pre-existing mental illnesses. Because these individuals have so little social contact, they become even more vulnerable to suicide.


Heightened mental health issues stemming from inadequate treatment, including confinement, pose more of a threat to the individual’s own well-being and therefore increases the likelihood of suicide. Therefore, those with mental health issues need to receive more thoughtful care before being placed in confinement because their rates of self inflicted distress and injury will only increase.


Not only does confinement accentuate mental health issues leading to self harm, but those with mental health illnesses experience confinement the most often. For instance, in 2009, between 23 and 31 percent of prison and jail inmates with a history of mental-health problems spent time in isolation. A significant portion of prison inmates with mental illness have experienced solitary confinement, and these statistics encompass only those formally diagnosed.


Therefore, when prisoners with undiagnosed mental illnesses are placed in solitary confinement, they may experience exacerbated symptoms of a possibly unknown mental illness. Additionally, this statistic does not include the mental health issues that develop once an inmate experiences solitary confinement, increasing their likelihood of self harm once released.


Unfortunately, since 2017, the United States has done the most damage in this regard. The U.S. holds the largest number of prisoners in the world in isolation, and this confinement can last for years and years, resulting in dehumanizing outcomes. Placement in solitary confinement strongly connects to an increased rate of suicide, depression, alienation, and even more severe forms of mental illness.


The continuous wrongful treatment and abuse mentally ill inmates experience can result in their initial placement into solitary confinement. America’s largest global incarceration of prisoners into confinement only serves to support the argument of inmate mistreatment, particularly for those with mental health issues. Moreover, unethical actions against those with mental health issues have resulted in an increased rate of self harm for these victims.


Subsequently, the “rosy-cheeked” version of passing in prison stands far from the ruthless and unnatural deaths that occur after years in confinement. The deaths of those with mental illnesses in solitary confinement are much more gruesome and unnatural than those within the general prison population.


These deaths occur after an inmate’s release from solitary confinement as a direct result of one not knowing what to do with themselves, experiencing emotions they cannot express. This build up of emotions that has resulted in the forming of a mental illness while in confinement and when released into the real world possibly creates worse problems than those in prison. This uneasiness and confusion once the inmate achieves exoneration can easily lead to self harm.


On a personal account, in There Will Be Seeds for Next Year, the protagonist, Clyde, attempts a gruesome suicide. Afterwards he is unrecognizable to his friends and family: “I came back to familiar faces that didn’t know me anymore. I was a different person with bandages on my wrists and a softened face that scared me enough to turn my mirror backward.”


From this experience, Clyde learned how much his time in prison and mental illness truly affected him. Society should take experiences like Clyde’s to prevent this from continuing to happen in American communities and to restore trust within American citizens on treatment within prisons.


Additionally, the neglect and lack of treatment those in prison receive from others allows for their mental illnesses to develop significantly, resulting in their acceptance of an identity as merely a prisoner, deteriorating their self confidence, heightening their lack of motivation to improve, and therefore increasing their susceptibility to marginalization.


The overrepresentation of the incarcerated population as disadvantaged and carrying a high burden of disease accentuates marginalization among inmates. Mental health issues in these debates contribute not only to their involvement in the criminal justice system, but also their involvement in society and how others treat and respect them.


With the marginalization mentally ill inmates face, their confidence to live normally in society deteriorates, leading to the development of the mentality that they will never receive forgiveness. Therefore, the efforts of prisoners to reintegrate into society will diminish. This, in combination with existing mental health issues that go untreated, proves to inmates that after their release, it will be nearly impossible to overcome previous challenges and discrimination.


In a similar regard, when Dr. Montross, author of Waiting for an Echo: The Madness of American Incarceration, spoke with her advisors to see what she should do with her newly obtained psychiatry degree, one suggested that she put it to use by helping prison inmates with psychological issues; she reacted in a shocking manner.


Montross deemed it imprudent for one to suggest that she use her newly earned degree to help those imprisoned: “Why would I want to work in the prisons?” Montross asked. “Why devote my time and attention to people who had committed crimes when there were so many innocent people who needed care?” Dr. Montross grew extremely offended by this comment, as she believed that helping those who underwent incarceration would waste her time, as opposed to those innocent of any crime.


This mentality has brainwashed society today into thinking that those imprisoned do not deserve equal respect and consideration as others in society. Dr. Montross considering it rude for someone to even suggest that she help out those in need in prison deepens the divide between those incarcerated and those not. More importantly, actions like these make those incarcerated feel marginalized and less worthy because others have broadcasted this persona onto them.


Furthermore, prisoners often feel “infantilized” and “degraded” under the conditions they live in, constantly reminded of their stigmatized role as prisoners. Low self confidence and diminished self-worth result from this treatment, leading prisoners to believe they are someone that deserves degradation and stigma because of their incarceration. Therefore, prisoners deem themselves less worthy and, consequently, start to accept and normalize the unjust treatment they receive from others.


Moreover, when inmates experience this discrimination for a while their susceptibility to a loss of personality and a lethargic way of life increase. The loss of motivation of prisoners is a direct response to those around them showing disinterest in the lives of the inmates. Their constant neglect results in isolated lives of quiet desperation. Eventually, this mentality will consume these individuals and increase not only their own negative thoughts and feelings about their condition, but also the negative thoughts others generate about them.


Putting this into perspective, New York Times author, Petula Dvorak provides insight on an inmate's prison experience: “‘I woke up in the hospital, and I just wanted it to all go away,’ said the young man, who agreed to talk about his mental illness on the condition of anonymity because mental illness is stigmatized. ‘But I survived. And I saw the aftermath. And I had help this time.’” Unfortunately, the inmate wanted to remain anonymous during his interview because those with mental illnesses continually receive less respect than those without.


Prisoners with mental illness should feel as if they can express themselves and their issues without experiencing marginalization from others. To address this problem, society should treat all with kindness and respect, rather than judge based on one’s past. Unfortunately, although this man recovered and obtained the help he needed, he still felt that others would view him differently if aware of his mental health issues.


Subsequently, people with mental disorders are exposed to stigma and discrimination in the social, economic, and health spheres, because of the widespread misconceptions related to mental disorders. These stigmas persist especially in the prison atmosphere and upon their release, as prisoners face even more discrimination due to imprisonment.


This applies to those with mental health disorders in prison because they fear how their life will flow socially and economically after their release. If society could look forward and attempt to help mentally ill inmates rather than conjecture beliefs about who they are and their goals in life, those imprisoned would think more highly of themselves, rather than let their mental health issues overtake and define them.


In a similar regard, prisoners develop feelings of shame and guilt about their committed offenses, letting their imprisonment affect their behavior towards other people, including their families and friends. According to Health in Prisons, this, coupled with anxiety, worries inmates about how much of their former lives will remain intact after release.


Prisoners' mental health issues result in the constant overthought of their past actions causing perturbation about how their friends and family will treat them post incarceration. Built up anxiety about the matter could possibly result in an even longer recovery once released from prison, only taking more of a toll on inmates.


Finally, the neglected mental health issues of prisoners coupled with their unjust treatment within the system results in the increased likeliness of recidivism. Individuals with untreated mental health conditions have a higher risk for correctional rehabilitation treatment failure and future recidivism on release from prison.


In a 2014 study from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, those with mental health disorders were 70% more likely to return to prison at least once than were those who were not given a diagnosis. Those with diagnosed mental health issues often recidivate more than those without. Unfortunately, these rates of recidivism and neglect of mental health issues damage the lives of inmates, placing them in a continuous cycle of release and reentry that continues to deteriorate the progress they make in society once released.


Subsequently, in Connecticut's 2014 Criminal Justice Policy and Planning Division’s Annual Recidivism Report, they concluded that 1,514 out of the 16,241 inmates that ended up back in prison obtained a mental illness: “Yet after their release, having been confined in mental hospitals, not prisons, not only are they less likely to reoffend than disordered inmates, but they are even less recidivist than fenders without a recognized mental illness.”


If those with mental health illnesses had proper treatment post incarceration, their rates of recidivism would decrease significantly, making them even less of a threat than those inmates with a recognized illness. These recidivist rates demonstrate the neglect of mental health issues that stem from the American prison system.


If only those in charge acted more carefully and diligently when it came to inmates with mental illnesses, America could create an environment in which the prison system did more to help, rather than hinder an individual’s life. Additionally, offenders with both psychiatric and substance abuse problems were incarcerated more frequently without treatment and then released into a community with no jobs, housing, or recovery treatment.


This ultimately leads to homelessness, mental decline, and chronic reoffending seen today. When inmates immerse back into their community with a weak foundation to flourish within society, they are more susceptible to deeper mental decline as well as higher rates of recidivism. Because these prisoners did not receive adequate treatment when released from prison, it strikes them as almost impossible to fully recover and expect success in society.


Author Dvorak articulates the story of an anonymous man who has experienced a harsh time in prison, constantly fluctuating in and out: “After landing in jail again — this time for a 10-day jag for speeding — the young man broke free from his section of a Northern Virginia detention facility, ran up the stairs to a higher level overlooking an atrium and jumped. It was the second time he tried to kill himself.”

Because of the lack of fair treatment prisoners face, this man faced jail time, once again, for ten days on a speeding charge. This man’s placement in jail comes across as quite an extreme for a mere speeding charge, as this unlawful treatment and sentencing is common among not only prisoners, but those with mental health issues in particular. As a result of this inmate’s recidivist cycle, he tried to kill himself for a second time.


If the criminal justice system attempts to prevent inmates from going in and out of prison and provides them with the attention and medical care they need, rather than continuing to lock prisoners up, society would both reduce rates of recidivism and allow inmates to more smoothly transition back into society.


The American prison system does little to help the cause of growing recidivism rates among inmates: “One million people in the U.S. alone, and the prison system does very little to successfully treat them. As a result, the recidivism rate among released convicts is especially high for those with serious disorders.”


If prisons adopted a more inclusive treatment of those with a mental illness, the recidivism rate would greatly decrease. Prisons often overlook mental illness and fail to treat them accordingly. For example, in “Criminals Need Mental Health Care,” author Robert Byron highlights that he discovered in 2007 that more than 350,000 disordered offenders return untreated to society.


The prison system needs to recognize the larger problems at hand when it comes to prisoners’ mental health. Through society’s assessment of the treatment of mentally ill prison inmates, opportunities for decreased recidivism rates and decreased negative stigmas associated with those with mental health illnesses in prison will arise. If society provided higher levels of support to those prisoners with mental health issues in the first few months of their release, they could start off in a stronger place with more guidance on how to get back up on their feet post incarceration.


The mistreatment of the mentally ill within prison and its harmful effects still prevail in the present day. Although the effects cause great damage, there are groups and organizations that are recognizing these issues and implementing modern reforms. In “Improving Mental Health for Inmates,” author Heather Stringer shines a light on Robert Morgan’s Changing Lives and Changing Outcomes, an organization that seeks to address antisocial thinking and behavior patterns among inmates who have mental illnesses.


The organization, Changing Lives and Changing Outcomes, recognizes that inmates need more than just mental health care to reduce criminal behavior and reincarceration. Dr. Robert Morgan’s program allows for inmates to practice life skills as well as cope with their mental illness. Organizations like these truly allow society to flourish and bring more awareness to the problem of the mentally ill’s poor treatment in America.


Similarly, reformers like Dr. Morgan spread awareness about the treatment of mentally ill inmates, seeking to improve the biased behaviors towards prisoners. Meanwhile, some people in society still do not feel as though the mental health issues of inmates are worthy of their recognition and even affect society at all. An excerpt from “Crime, Punishment, and Mental Illness: Law and the Behavioral Sciences in Conflict,” written by Patricia E. Erickson and Steven K. Erickson, highlights that despite this push to remove these deprecating mindsets from society, they still take shape in life today:


Identifying the criminalization of mental illness as a social construction also means that purposive action by individuals and groups create the social response toward the mentally ill. Consequently, at various times, the social construction of mental illness and the mentally ill changes because of the interpretation given to it by influential labelers—individuals and groups who criticize the current interpretation and offer a convincing rationale for its change.


By educating people more on the matter and treating those incarcerated with mental health illnesses like human beings, society can change for the better. If American communities can reconstruct the outlook those within society have on inmates with mental health issues, their spirits as inmates will be lifted, decreasing rates of recidivism and self harm and providing them with the confidence they need to get back on their feet after their time in prison.


Additionally, society can decrease marginalization within communities by making citizens more aware of the help recovering inmates need and increasing the accessibility of physicians, psychologists, and therapists. Once society can adapt to these changes, emphasizing adequate attentiveness and treatment for inmates once they have been released from prison, the mental illnesses of prisoners will be cared for rather than intensify.