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Why Are Mentally Ill in Prison Instead of Treatment?

27 May

By Stephen A. Ragusea, PsyD, ABPP, from Ethics & Risk Management: Expert Tips VII

Recently on one of my psychology listservs, one colleague posted the following:

“I witnessed an inmate in a county jail who was acutely psychotic and was kept in solitary confinement for almost two years, naked, lying in his/her own urine and feces. There was no heat in the cell, and the human wastes leaked into adjoining cells. Numerous official and professional persons were aware of this poor person’s plight and no one did anything (or at least anything that was within their ability and authority) to end the inmate’s suffering. Apparently, this is acceptable practice here in Florida, as all persons were found to be practicing appropriately.”

Ethics, Psychology and the Prison MessUnfortunately, the situation described above by one of our colleagues is not uncommon. In my many years of work in prisons I’ve observed similar scenarios many times. I too have seen naked prisoners lying in their own filth. I’ve seen prisons where an entire block of 40 men was on suicide watch. I’ve seen a prisoner who was elderly, demented and paranoid sent to prison repeatedly after being prosecuted for making “terroristic threats.” I’ve seen a psychotic bipolar prisoner tied to a metal chair and drenched with a fire hose to make him “behave.”

As has been true for more than two decades, the United States incarcerates a higher percentage of its population than any other nation in the world. Most prisoners are under the age of 30 and approximately 15 percent are people who meet the DSM criteria for a mental illness. About half of that 15 percent are diagnosable as seriously mentally ill, suffering from problems like schizophrenia and bipolar disorder.

According to a 215-page report (ISBN: 1564322904) by Human Rights Watch, “One in six U.S. prisoners is mentally ill. Many of them suffer from serious illnesses such as schizophrenia, bipolar disorder and major depression. There are three times as many men and women with mental illness in U.S. prisons as in mental health hospitals.” One of the report’s authors, Jamie Felner, observed, “Prisons have become the nation’s primary mental health facilities.”

How did we get into this mess? Some of it started when politicians decided that they could get elected and stay elected by being “tough on crime.” They voted for mandatory minimum sentences, taking discretion away from the judiciary. And, although approximately half of these prisoners were convicted of non-violent, drug-related offenses, rather than voting for funding to pay for alcohol and drug treatment, our elected officials decided to spend our hard-earned tax dollars on building more prisons. The result of this national movement was that we currently incarcerate approximately 1 percent of our population. More than 2.5 million Americans now live behind bars. That’s the equivalent of every man, woman and child in the cities of Philadelphia, Columbus and Seattle.

A few years ago the Tallahassee Democrat reported, “Florida’s law enforcement and corrections systems are rapidly evolving into the state’s de facto mental health treatment providers. More often than not, our law enforcement officers, prosecutors, defense attorneys, judges and parole officers are being forced to serve as the first responders and overseers of a system ill-equipped to deal with an underfunded treatment system that’s stretched beyond capacity.”

To a large degree, the tax money for building and operating prisons was stolen from our public mental health system. Part of John Kennedy’s vision for Camelot included a national system of well-funded community mental health centers that would serve the mentally ill in their own hometowns, thereby permitting the closing of a well-developed system of state mental hospitals that had provided inpatient treatment for the severely mentally ill.

Those of us old enough to remember the 1970s recall an era of widely available, well-funded mental health care provided through local Community Mental Health Centers. Oddly enough, the systematic under-funding and disempowering of our Mental Health Centers coincided with the increase in funding of the prison system to support the “Get Tough on Crime” movement that spread like a well-intentioned plague from sea to shining sea.

Psychologists should lead the battle for prison reform. I would argue that we have an ethical obligation to do so. Specifically, I reference the preamble of our ethical code, which states:

“Psychologists are committed to increasing scientific and professional knowledge of behavior and people’s understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations and society. Psychologists respect and protect civil and human rights and the central importance of freedom of inquiry and expression in research, teaching and publication. They strive to help the public in developing informed judgments and choices concerning human behavior.”

As doctors of behavior, academic psychologists should be researching new solutions to our social problem of crime and punishment. Clinical psychologists who work in the system should be developing and implementing alternative treatment models for the imprisoned mentally ill. And all psychologists should be demanding government action to correct this inhumane, ill-conceived, foolishness. Can you imagine a hundred thousand psychologists remaining passively silent as 275,000 mentally ill Americans are mistreated? We are. Can you imagine psychologists saying nothing as prisons are turned into “the nation’s primary mental health facilities?” We have.

If you think these issues are important, say so to the leadership of your state and national psychological associations. Talk to your elected representatives. Contribute your time and energy to make things change. We can do better. It is our ethical responsibility to do better.

For more information, please read The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey

Ethics and Risk Management: Expert Tips VII is a 3-hour online continuing education (CE/CEU) course that addresses a variety of ethics and risk management topics in psychotherapy practice in the form of 22 archived articles from The National Psychologist and is intended for psychotherapists of all specialties.

Professional Development Resources is approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the California Board of Behavioral Sciences; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board; the South Carolina Board of Professional Counselors & MFTs; and by theTexas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners.

 

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