severe mental health illness In the United States correction system
In the United States correction system, severe mental health illness has become prevalent. Our jails and prisons are now called the “new asylums.” Most prisons and jails in the country hold more mentally ill inmates compared to any remaining psychiatric hospitals in the US. But how do correction officers handle mentally ill inmates who become arrogant and disturbing to other prison populations? They use solitary confinement as a technique to isolate them from the rest of the prison population. Most prisoners struggling with mental disorders in prisons and jails are held solitary confinement. The monotonous and tedious experience of prisoners who have been locked up in solitary confinement may be stressful and associated with potentially harmful health effects. Prisoners are socially isolated from other people. Their human contacts are reduced. They only interact with prison staff and sometimes infrequent contact with friends and family members. They become dependent on prison staff for the provision of their essential needs. When in prison, movements of inmates are strictly observed and tightly monitored. Placing mentally ill inmates on solitary confinement has significant negative impacts on their deteriorating health. The best solution for American jails is to subject them to rehabilitation centers and work with psychologists to identify suicide patterns, state-funded psychiatric hospitals, or community-based mental health programs to receive care services.
Solitary confinement, also known as segregation or isolation, has been considered as the popular penological thought in the US prisons. In the 19th Century, the United States documented extensive application of solitary confinement in prisons, as well as its impact on inmates, which have been recorded by many medical journals during that period. It was first adopted and implemented in the United States prisons in 1829, primarily at Philadelphia’s Eastern States penitentiary by Quakers (Morris 2016). During this period, inmates were locked in cells and kept there for an extended period. They were only given a chance to talk to priests who frequently visited jails and prisons to preach as well as with the prison wardens. Quaker introduced solitary confinement of inmates as a punishment, believing that the social isolation will help them realize and understand their offense, overcome difficulties, confront their evil disposition and then change their behaviors to be good people in society (Morris 2016). Also, solitary confinement in the United States was applied as a new advancement in various forms of punishments available, such as public physical torture and to replace hanging. The practice was used to deal with difficult and dangerous prisoners who could harm selves or others, mainly to provide direct control over those considered to be uncontrollable inmates and protect or prevent them from accessing or interacting with society and the rest of the prison community.
America’s jails and prisons should provide mental health care services to inmates rather than isolating offenders with mental health from other prisoners. The United States Supreme Courts have set out that inmates have constitutional rights to get mental health and medical care that meets the minimum standards (Ruiz v. Estelle, 1980). In Ruiz v. Estelle (1980), the Supreme Court found that solitary confinement of a mentally ill prisoner constituted unusual and cruel punishment, which violated the prisoners’ Eighth Amendment. The Court has also established that there are no underlying differences in inmates’ rights to medical care for physical injuries and mental or psychological counterparts (Bowring v. Godwin, 1977). As a result, prisons should develop acute psychiatric care units, primarily through collaboration with state-funded hospitals and mental health departments in correction centers, to provide critical mental care to inmates. A prison-based acute psychiatric unit may be more effective than solitary confinement to handle mentally ill inmates because it creates a therapeutic milieu that could be consistent with the mission of the correction center (Washington v. Harper, 1990). The criteria established by Washington v. Harper (1990) advocated for safe and appropriate implementation of specialized inmates’ treatment, including the involuntary administration of medication for mentally or ‘gravely disabled’ prisoners who are considered non-compliant as well as the proper application of seclusion and therapeutic restraints.
However, solitary confinement may cause adverse psychological effects, primarily for prisoners with pre-existing mental illness. In 2017, Jean Jimenez-Joseph, a Panamanian national held under solitary confinement at Stewart Detention Center, committed suicide after being locked up for nineteen days (Voreh, 2019). According to Voreh (2019), the victim was under a suicide watch. He had a history of mental disorders, including suicidal ideation, suicidal attempts, and schizophrenia, and the authority placed him on solitary confinement. Solitary confinement may cause suicides, the persistence of mental illness conditions without improvement, and deterioration of sanity (Voreh, 2019). Sanity deterioration results in emergency psychiatric or medical hospitalization. In the United States jails and prisons, suicide cases are more reported in solitary confinement than anywhere else (Metzner & Fellner, 2010). Therefore, people with mental illness confined in these facilities may experience difficulties coping up with their conditions.
Correctional systems in the US should collaborate and work with psychologists to identify suicide patterns and develop better techniques to determine those inmates who may be at high risk of committing suicide. Most prisoners under solitary confinement and isolated from others may be at risk of suicide (Boren et al., 2018). According to Boren et al. (2018), “inmates may not be inclined to share with staff that they are at risk of suicide because we respond by putting them alone in cells for close monitoring, which can be very isolating.” The best solution to prevent suicide in prisons is the collaboration of the American Foundation for Suicide Prevention and the National Commission on Correctional Health Care (Roth, 2018). They should develop a national prison initiative that can improve mental health assessment, training, and interventions for prisoners who are at risk of suicide. According to Kupers (2017), the main “adverse factor of solitary confinement is the reduction of socially and psychologically meaningful contact is to the absolute minimum. Contact is reduced to the point that it is insufficient for most detainees to remain mentally well-functioning.” Addressing these detrimental effects, a federal Supreme Court Judge equated placing a mentally ill person in solitary confinement to “the mental equivalent of putting an asthmatic in a place with little air” (Madrid v. Gomez, 1995). Locking up mentally ill people in solitary confinement isolates them from everything, which may exacerbate their signs or symptoms, and in some cases, provoke recurrence.
As a result, mentally ill offenders should be subjected to community-based mental treatment if the state has failed to provide mental health services in prisons. Instead of relying on overcrowded hospitals to offer competency restoration services for inmates struggling with mental health issues, prisons and jails should adopt an outpatient competency restoration approach. Such programs can help prisoners receive mental health treatment services from private contractors, community-based systems, or outpatient treatment services (Gowensmith et al., 2016). According to Gowensmith et al. (2016), some states in the US have identified Outpatient Competency Restoration Programs (OCRPs) as viable alternatives for inpatient restoration of inmates with mental illness. They do not pose any risks to the public, and “outpatient programs can also allow individuals to keep their housing and stay more connected to community support systems” (Gowensmith et al., 2016). OCRPs can also be more effective methods of handling mentally ill offenders compared to solitary confinement.
In conclusion, America’s jails and prisons should provide mental health care services to inmates rather than isolating offenders with mental health from other prisoners. Mentally ill prisoners have constitutional rights to receive medical care and mental health care programs. Solitary confinement may cause adverse psychological effects, primarily for prisoners with pre-existing mental illness. It may cause suicides, the persistence of mental illness conditions without improvement and deterioration of sanity. Prisons and correctional centers should collaborate and work with psychologists to identify suicide patterns and develop better techniques to determine those inmates who may be at high risk of committing suicide. But relying on state hospitals in the provision of mental health care services in prisons seems not to be effective. As a result, mentally ill offenders should be subjected to community-based mental health treatment programs if the state has failed to provide mental health services in prisons.
References
Boren, E. A., Folk, J. B., Loya, J. M., et al. (2018). The suicidal inmate: A comparison of Inmates who attempt versus complete suicide. Suicide and Life-Threatening Behavior, 48(5): 570-579. https://doi.org/10.1111/sltb.12374
Bowring v. Godwin, 551 F.2d 44, 47 (4th Cir. 1977).
Gowensmith, W. N., Frost, L. E., Speelman, D. W., & Therson, D. E. (2016). Lookin’ for beds in all the wrong places: Outpatient competency restoration as a promising approach to modern challenges. Psychology, Public Policy, and Law, 22(3), 293–305. https://doi.org/10.1037/law0000088
Kupers, T. A. (2017). Solitary: The inside story of supermax isolation and how we can abolish it. Oakland, California: University of California Press.
Madrid v. Gomez, 889 F.Supp. 1146 (N.D. Cal. 1995).
Metzner, J. L. & Fellner, J. (2010). Solitary confinement and mental illnesses in U.S. prisons: A challenge for medical ethics. Journal of the American Academy of Psychiatry and the Law, 38(1): 104-108.
Morris, R. G. (2016). Exploring the effect of exposure to short-term solitary confinement among violent prison inmates. Journal of Quantitative Criminology, 32(1), 1-22.
Roth, A. (2018). Insane: America’s Criminal Treatment of Mental Illness. United States: Basic Books.
Ruiz v. Estelle, 503 F.Supp 1265 (S.D. Tex. 1980).
Voreh, E. (2019). The United States’ Convention against Torture Ruds: Allowing the Use of Solitary Confinement in Lieu of Mental Health Treatment in U.S. Immigration Detention Centers. Emory International Law Review, 33(2), 287–310.
Washington v. Harper, 494 U.S. 210 (1990).