Improving mental health for inmates (2022)

Jamycheal Mitchell, 24, had not been taking his schizophrenia medication when he was arrested for stealing a bottle of Mountain Dew, a Snickers bar and a Zebra Cake from a 7-Eleven. After waiting more than a month in jail, he was found to be incompetent to stand trial due to mental illness and ordered to go to a state hospital for “competency restoration,” a combination of psychiatric medication, mental health treatment and education about the legal process. But no beds were available, and Mitchell’s condition deteriorated as weeks turned into months while he waited in jail. He refused to eat and take medication. Four months after his arrest, Mitchell was found dead in a cell covered in urine and feces. He had died of cardiac arrhythmia related to wasting syndrome, a disorder characterized by extreme weight loss.

Cases like this are so tragic because they are preventable, say psychologists who advocate for more effective mental health services in correctional facilities. The unfortunate truth is that despite improvements over the past 30 years, the correctional system continues to struggle to meet the vast needs of the increasing number of inmates with mental health conditions, says Thomas Fagan, PhD, professor emeritus at Nova Southeastern University in Florida and a former administrator for the Federal Bureau of Prisons.

About 37 percent of people in prison have a history of mental health problems, according to a 2017 report from the U.S. Department of Justice. More than 24 percent have been previously diagnosed with major depressive order, 17 percent with bipolar disorder, 13 percent with a personality disorder and 12 percent with post-traumatic stress disorder. The numbers are even higher for people in jail, where one-third have been previously diagnosed with major depressive disorder and almost one-quarter with bipolar disorder.

“We lock up people with mental health problems when we should really be treating these people in the community,” says Fagan. “In the absence of that, prisons and jails become de facto treatment centers.”

As a result, psychologists, psychiatrists and social workers have become essential mental health providers in correctional settings, and they can be a driving force for new programs in state and federal facilities, he says. Here is a look at some of the latest evidence-based approaches from psychologists.

(Video) Improving Treatment of People with Mental Illnesses in Our Jails & Prisons

New thinking patterns

Improving mental health for inmates (1)Several psychologists are focused on keeping people with mental health problems out of correctional facilities. Among them is Robert Morgan, PhD, a psychology professor at Texas Tech University in Lubbock who is testing a new prison-based program that helps inmates learn to avoid behaviors that may lead to re­incarceration after they are released. Morgan’s program, Changing Lives and Changing Outcomes, seeks to address antisocial thinking and behavior patterns—which he calls “criminalness”—among inmates who have been diagnosed with mental illnesses. The program is novel because it diverges from the traditional belief that providing better mental health care alone will reduce the chances of criminal behavior patterns. Morgan contends that it’s critical to combine mental health care and treatment for criminalness because inmates can learn not only how to cope with mental illness, but also practical life skills such as how to challenge antisocial thought patterns and to develop healthy connections with others.

“We learned through a series of studies that people with mental illness in the justice system are there in part because they present with criminal risk in similar ways to those who are not mentally ill—they interpret interpersonal situations differently than noncriminals,” says Morgan. For example, this population is more likely to see someone bumping into them as asserting dominance rather than as an accident, Morgan explains.

Morgan’s ideas were born out of years of clinical work in prisons, where he witnessed the struggles people faced, especially those with mental illness. In federal and state prisons at both minimum and supermaximum levels of security, he saw that people with mental illness were at increased risk of victimization, psychiatric rehospitalization and criminal recidivism. They also had trouble adjusting to the institutional environment, and often their psychiatric symptoms worsened.

On the basis of that experience, Morgan wanted to help incarcerated people with mental illness stay out of prison once released; nearly 80 percent of all released prisoners are arrested again within six years, according to the U.S. Bureau of Justice Statistics. In a pilot study, he tested his model of addressing both psychiatric and criminogenic needs with 47 male inmates who were in prison or a residential facility. The six-month program included 155 hours of group and individual therapy sessions in which clinicians taught participants about healthy ways of dealing with anger and fear, how to interpret situations, medication adherence and other skills. He found that participants experienced decreased depression, anxiety, hostility, paranoid ideation, psychoticism and reactive criminal thinking (Criminal Justice and Behavior, Vol. 41, No. 7, 2014).

Morgan’s team then tried the program with a larger sample of 169 participants in residential facilities. This time, they wanted to determine how much of the program content the inmates retained. “This is important for improving community outcomes,” says Morgan. “Simply reducing distress during the course of treatment is a positive step, but that can be very temporary. We wanted to assess if participants were able to learn and retain the information to be applied in their everyday lives.”

The team found that most participants increased and retained their knowledge, but those who had lower scores on the quizzes after each module were more likely to drop out of the program (Psychological Services, in press). In these cases, clinicians may need to provide more sessions to reduce the risk of dropout. The next step,Morgan says, will be to investigate whether the program reduces recidivism rates.

(Video) Improving Mental Health in Jails and Prisons

The program has also been adapted for mentally ill inmates in solitary confinement who can’t participate in group sessions. Participants receive written material and worksheets, and clinicians provide brief feedback during mental health rounds. “The goal is to help them learn how to manage their mental illnesses and identify issues that put them at risk of continued segregation,” says Morgan, who is evaluating the program.

Influencing correctional policies

Improving mental health for inmates (2)University of California, Santa Cruz psychologist Craig Haney, PhD, is exploring ways to reduce the number of people placed in isolation. Through interviews with hundreds of inmates in isolation, many of whom have mental illnesses, Haney has shown that people living in solitary confinement—defined as the absence of meaningful social contact and interaction with others—frequently experience depression, memory problems, difficulty concentrating, irritability and anger. Studies have also shown that stress-related reactions are common, including decreased appetite, heart palpitations and a sense of impending emotional breakdown, as well as sleeplessness, heightened levels of anxiety and paranoia. Over time, isolated inmates can also lose the ability to feel comfortable around people (Annual Review of Criminology, Vol. 1, 2018).

“Longing for the presence of other people and feeling that absence is painful, so these inmates adjust by learning to cope in a world without other human beings,” says Haney. “Once they are released, the presence of other people can create anxiety, so paradoxically many self-isolate.”

Through his work as an expert witness in numerous court cases, Haney has advocated for reforms that would lead to more humane conditions, including increased mental health care and decreased use of solitary confinement. In 2017, his testimony in a federal case against the Alabama Department of Corrections helped to influence the court’s decision to order the state to improve practices and conditions in its prisons. In Georgia, Haney was invited to inspect a prison where he discovered that inmates in solitary confinement were only allowed outside their cells for five hours a week, and some were in darkened cells for months. His report documenting the conditions helped inmates win a settlement in January that allows prisoners to spend four hours outside their cells each day, and to eventually have access to educational classes.

Haney recently turned his attention overseas to find innovative correctional models that could inspire prison reform in the United States. Through the U.S.-Norway Correctional Culture Exchange Program sponsored by the Criminal Justice & Health Consortium at the University of California, San Francisco, Haney regularly travels with a contingent of U.S. correctional officials to Norwegian prisons, where the prisoners’ routines mimic normal daily life as much as possible. Inmates have more freedom of movement, can access rehabilitation programs and rarely experience solitary confinement.

“They also place a tremendous amount of emphasis on the interactions between correctional officers and prisoners,” notes Haney. “The officers are more like social workers who get to know inmates rather than enforcing punishments.” If a prisoner acts out, officers try to understand what led to the outburst and to address the problem or concern rather than punish the individual.

(Video) How can we improve mental health in the criminal justice system?

The results of this positive prison culture in Norway are clear: low turnover among staff and decreased recidivism because inmates are better prepared to re-integrate into society. Visiting prison officials from Alaska, Idaho, North Dakota, Oregon and Rhode Island were so impressed that they have started adopting the Norwegian philosophy in their own prisons by increasing the rehabilitation programming and training their staffs to relate differently to inmates, says Haney.

Introducing trauma-informed care

Like Haney, Dave Stephens, PsyD, believes that interactions between correctional staff and inmates significantly influence the mental health of prisoners, and he’s improving conditions for inmates by teaching correctional employees about the brain’s response to trauma. Through the National Institute of Corrections’ training center in Colorado, Stephens has trained more than 100 jail and prison wardens, mental health professionals, caseworkers and nurses on how to communicate with inmates in ways that minimize the chances of retraumatizing individuals who have a history of trauma.

He helps staff understand that many inmates, especially those with mental illness, have histories of physical, sexual or emotional abuse that lead to distrust and a sense of worthlessness. Stephens explains how to halt this cycle by being respectful to inmates and by teaching them what to expect when they encounter new situations.

Correctional officers who conduct pat-down searches, for example, can explain beforehand what they will be doing to the inmate. “This can reduce anxiety and the risk of retraumatizing people who are expecting violation and abusive behavior,” Stephens says. He also encourages facilities to provide inmates information at the time of booking about what they might experience psychologically once they are incarcerated and steps to take if they are having symptoms of anxiety, depression or other types of mental illness.

Stephens sometimes encounters resistance from staff who believe it is not their job to “make things easy for inmates,” he says. “But with some explanation and discussion, staff become more open and positive, especially because these strategies create a safer environment for both inmates and employees.”

Alternatives to hospitalization

Forensic psychologist W. Neil Gowensmith, PhD, is taking another tack to improve care for mentally ill offenders: community-based treatment. Rather than relying on overcrowded state hospitals to provide competency restoration services for people with mental health problems who have been accused of misdemeanor offenses or nonviolent felonies, Gowensmith has been advocating for outpatient competency restoration. Through such programs, offenders receive these services from private contractors, outpatient treatment centers or community mental health systems.

(Video) Correcting Corrections: Why I am In Prison | Lefford Fate | TEDxCharleston

To study the feasibility of using these programs in lieu of inpatient programs,Gowensmith, an assistant clinical professor of psychology at the University of Denver, collected data from 16 states that were using outpatient methods of restoring competency. He found that 70 percent of the participants in the outpatient programs achieved competency restoration, compared with roughly 80 percent in state hospitals. The duration of treatment was also comparable between the two settings (Psychology, Public Policy, and Law, Vol. 22, No. 3, 2016). “This early research shows that outpatient community restoration programs produce similar outcomes to inpatient programs at a fraction of the cost, and without compromising public safety.”

In the study, Gowensmith also found that allowing people to have competency restored in the community did not pose a risk to the public, as measured by the number of negative incidents such as re-arrest or violence, which were very low. “Outpatient programs can also allow individuals to keep their housing and stay more connected to community support systems,” he says.

Identifying suicide patterns

Psychologists are also working with correctional systems to develop better ways to identify inmates who may be at risk of suicide. In 2014, the Bureau of Justice Statistics reported that suicides accounted for 7 percent of state prison deaths. Reducing these numbers has become a high priority, says Sharen Barboza, PhD, vice president of mental health at MHM/Centurion, a company that provides health-care services to state correctional systems and large county jails.

To better understand who is at risk of suicide, Barboza and her colleagues conducted a study of 925 state prison and jail inmates, comparing those who had attempted with those who had completed suicide. The researchers found that those who had died by suicide tended to be male, older, more educated, married or separated/divorced, at the pretrial stage, committed for a violent crime, not on suicide precautions and not previously on close observation (Suicide and Life-Threatening Behavior, Vol. 48. No. 5, 2018).

Although Barboza was not surprised by those characteristics, she was concerned that those who had died by suicide had not previously been identified as at risk. “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,” Barboza says.

In an effort to change that, she is working with the National Commission on Correctional Health Care and the American Foundation for Suicide Prevention on a national initiative to improve assessment, training and interventions for inmates who may be at higher risk of suicide. The two organizations are partnering as part of an effort to reduce the nation’s annual suicide rate for all people by 20 percent by 2025. So far Barboza has participated in three Suicide Prevention Summits, where she leads the assessment group that is working to develop better suicide-risk screening tools.

(Video) Prison Mental Health (Correctional Mental Health) Prison Psychiatry [Correctional Psychiatry]

“We are seeing more completed suicides in both corrections and the general population nationally, and that is alarming,” says Barboza. For her, each suicide is a reminder that finding ways to provide better mental health care to more than 2 million incarcerated people in the United States has the potential to improve—and sometimes save—thousands of lives each year.


What of prisoners have mental health issues? ›

Around 10% of prisoners were recorded as receiving treatment for mental illness with one suggestion that as many as 70% may have some form of mental health need at any one time.

What is the most important function for effective jail management? ›

The most fundamental goal of every jail and prison is to maintain a safe and secure environment for staff, inmates, and visitors.

What are the 4 biggest challenges facing correctional institutions today? ›

Some major contemporary issues resulting from these social, economic and environmental changes facing correctional administrators include the changing trend in prison population, overcrowding in correctional facilities, improvement of prison conditions, increase of drug-related offenders, shortage of effective ...

What is the most common mental illness among incarcerated persons? ›

In fact, according to the American Psychiatric Association, on any given day, between 2.3 and 3.9 percent of inmates in state prisons are estimated to have schizophrenia or other psychotic disorder; between 13.1 and 18.6 percent have major depression; and between 2.1 and 4.3 percent suffer from bipolar disorder.

Why is mental health important in prisons? ›

People with mental illness often face challenges to navigating life in a jail or prison. Behaviors related to their symptoms can put them at risk for consequences of violating facility rules, such as solitary confinement or being barred from participating in programming.

What challenges do prisons face in dealing with mentally ill inmates? ›

Lack of Services to Address Mental Illness

Providing mental health, substance abuse, and medical treatment for these offenders is challenging, particularly when most prisons and jails are poorly equipped to appropriately deal with those with mental illnesses.

How do you manage the inmate's behavior? ›

The implementation of a behavior-management plan includes setting goals for improving inmate behavior; developing a method to measure goal achievement; having clear directives in the form of written policies and procedures; ensuring adequate staffing levels; conducting staff training; monitoring staff to ensure ...

What are the most successful methods of rehabilitating prisoners? ›

1. Education Rehabilitation for Inmates. It has been proven time and time again that education programs in prison help to give inmates a second chance. In fact, inmates who participated in educational programs were 43% less likely to commit a crime and return to incarceration within three years than those who did not.

What measures can be taken to improve the conditions of our prisons? ›

The most obvious example for an integrated strategy is the combination of legislative and practical measures to reduce imprisonment rates and overcrowding in prisons, with training and capacity building in prison management to improve conditions and services in prisons.

What are the major issues that prisoners face today and why? ›

Some common conditions include depression, anxiety disorders, schizophrenia and bipolar disorder. Recent research by the Bureau of Justice Statistics shows that more than half of all people in prison have mental health issues. In fact, around 1.25 million inmates live with mental health conditions.

What are five common health problems found in prisons? ›

People in prisons and jails are disproportionately likely to have chronic health problems including diabetes, high blood pressure, and HIV, as well as substance use and mental health problems.

What are some of the major issues that prisoners face today? ›

Millions of Americans are incarcerated in overcrowded, violent, and inhumane jails and prisons that do not provide treatment, education, or rehabilitation. EJI is fighting for reforms that protect incarcerated people.

How do you mentally prepare for jail? ›

Jail can be stressful, but plan to distract yourself by working out and learning new things. Choose some books you want to read inside as your jail's library will probably be small. Learn to keep to yourself and hide your emotions from other people, so you don't make yourself vulnerable in jail.

Why is it so difficult to deal with the mentally ill who are incarcerated? ›

Often denied time outside their cells and opportunities for communication with others, the SMI population endures conditions that can be harsh for any person who is incarcerated. In the end, the typically noisy and claustrophobic conditions of confinement can exacerbate pre-existing mental illness issues.

What are some common psychological treatment options for offenders that are incarcerated? ›

Examples of Interventions Currently Used in Incarceration Settings. Individual and group psychotherapy. Psychological therapies provided in jails, prisons, or forensic hospitals may include cognitive behavioral therapy (CBT, with or without criminal thinking curriculum) and dialectical behavior therapy (DBT).

Why is treatment important in prisons? ›

“To be effective for this population, treatment must begin in prison and be sustained after release through participation in community treatment programs.” Care on an ongoing basis helps former prisoners avoid relapsing and committing crimes. Those two outcomes are big pluses and potential lifesavers.

How do prisoners change people? ›

Incarceration can lead to significant psychological difficulties. However, individuals react in their own way to the prison environment. Some inmates may turn inward and even become more or less paranoid, while others may become depressed. Still others will adopt what is called a "prison identity".

How does the criminal justice system help the mentally ill? ›

Individuals with serious mental illnesses convicted of serious crimes are provided with humane and appropriate treatment while incarcerated. And, these individuals are provided with appropriate linkages to needed services and supports upon discharge to enable them to successfully reenter their communities.

Can prisoners with mental health problems benefit from psychological therapy? ›

Psychological therapies based on CBT or mindfulness approaches can improve mental health outcomes for prisoners when compared with providing no intervention. The strength of the improvement is similar to that seen in the community, although more difficult to sustain and so developments are clearly needed.

What are the three major issues within jail management? ›

Many problems are commonly found in jails, such as violence, vandalism, and unsanitary conditions.

What is key in controlling inmates behavior? ›

These elements are: assessing risk and needs; assigning inmates to housing; meeting inmates' basic needs; defining and conveying expectations for inmate behavior; supervising inmates; and keeping inmates productively occupied.

What are 5 ways you can encourage or support someone who is incarcerated in jail? ›

  • Suggestion #1: Send Money if Possible. ...
  • Suggestion #2: Answer Your Loved One's Phone Calls. ...
  • Suggestion #3: Write Letters to a Loved One in Prison. ...
  • Suggestion #4: Visit Your Loved One in Prison. ...
  • Suggestion #5: Visit Your Loved One's Friends in Prison. ...
  • Suggestion #6: Communicate Positive Messages to Your Loved One in Prison.
14 Feb 2018

How prisoners should be treated? ›

All prisoners shall be treated with the respect due to their inherent dignity and value as human beings. There shall be no discrimination on the grounds of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.

What kinds of efforts should we make to rehabilitate prisoners? ›

Correction and Rehabilitation of Penitent Offenders
  • Individual and group counseling. ...
  • Moral, Spiritual, Values Formation. ...
  • Work or Job Placement/Referral. ...
  • Vocational/Livelihood and Skills Training. ...
  • Health, Mental and Medical Services. ...
  • Literacy and Education. ...
  • Community Service. ...
  • Client Self-Help Organization.
26 Oct 2022

What do you think can help prisoners rehabilitate and reconnect with society? ›

By providing practical programs such as vocational training, we make it possible for these individuals to leave prison with marketable skills for good steady jobs. One way to help individuals is to reduce unnecessary occupational licenses. Many states have a wide variety of occupations which require licenses.

How effective is rehabilitation of offenders? ›

There is evidence that rehabilitation (including within prison) reduces crime and can be cost effective. Economic analysis therefore, reinforces the idea that punishment is not the best solution for reducing the harmful impact of crime.

What is the solution to the prisoners dilemma? ›

So the solution would seem to be that each prisoner does best to confess and go to jail for five years. Paradoxically, however, the two robbers would do better if they both adopted the apparently irrational strategy of remaining silent; each would then serve only one year in jail.

What are the 3 biggest challenges that inmates face when returning back to the community? ›

The 4 Biggest Challenges Facing Those Newly Released From Prison
  • Challenge #1: Not Knowing Where to Begin.
  • Challenge #2: Family Strain.
  • Challenge #3: Finding Employment.
  • Challenge #4: Mental Health Issues.

What do you think is the biggest problem in corrections today? ›

Prison overcrowding is one of the key contributing factors to poor prison conditions around the world. It is also arguably the biggest single problem facing prison systems and its consequences can at worst be life-threatening at best prevent prisons from fulfilling their proper function.

What are the 4 main purposes of prisons? ›

Four major goals are usually attributed to the sentencing process: retribution, rehabilitation, deterrence, and incapacitation.

Do most prisoners have mental health issues? ›

Percent of people in state prisons who have been diagnosed with a mental disorder: 43% + In locally-run jails: 44% + Number of people experiencing "serious psychological distress" in jails: 1 in 4 + Percent of people in federal prisons who reported not receiving any mental health care while incarcerated: 66% +

What happens to prisoners mentally? ›

Mental Health Concerns Among Incarcerated Individuals

Quite often, mental health issues and substance abuse issues occur alongside one another. Many other incarcerated individuals may experience depressive disorders, anxiety disorders, or PTSD. 5 For some, these issues may be pre-existing conditions.

How do you cope with stress in jail? ›

Prison is a stressful place and exercise provides a better outlet than fighting to relieve your stress.
Instead of lying around your cell all day, participate in a sport, non-lethal card game, or join a club.
  1. Idleness in prison only results in trouble. ...
  2. Activities are stimulating and social.

What problems do mentally ill inmates cause? ›

Mentally ill inmates create behavioral management problems that result in their isolation. Because of their impaired thinking, many inmates with serious mental illnesses present behavioral management problems.

What are the four most common mental health conditions that inmates suffer from? ›

In fact, according to the American Psychiatric Association, on any given day, between 2.3 and 3.9 percent of inmates in state prisons are estimated to have schizophrenia or other psychotic disorder; between 13.1 and 18.6 percent have major depression; and between 2.1 and 4.3 percent suffer from bipolar disorder.

What kind of therapy is best for offenders? ›

Cognitive behavioral therapy has been found to be effective with juvenile and adult offenders; substance abusing and violent offenders; and probationers, prisoners and parolees.

What mental disorder is most common in inmates? ›

VariableFederal (n = 3686), % or Mean (SE)State (n = 14 499), % or Mean (SE)
Prevalence of mental health conditions among prisonersa
27 more rows

What percent of prisoners incarcerated in the US suffer from a mental illness? ›

Data compiled and published by The Marshall Project in November 2018 indicated that 30 percent of California state prisoners suffer from a psychiatric condition serious enough to require regular treatment. The number in New York is 20 percent, while in Texas it's 21 percent.

Why do mentally ill people end up in jail? ›

Mass incarceration, poverty and a drug epidemic—coupled with lack of access to treatment—have resulted in criminalization of the mentally ill in a system often unprepared to properly deal with the problem.

How does the criminal justice system deal with mental illness? ›

The first choice of most courts when a criminal case involves a defendant with a serious mental illness is to refer the person to a residential psychiatric care facility, where they can undergo treatment intended to restore their competence.

How does imprisonment affect you emotionally? ›

There are also more general difficulties: experiences of 'fear, anxiety, loneliness, trauma, depression, injustice, powerlessness, violence and uncertainty' have been identified as common to prison life (Liebling & Maruna, 2005, p.


1. Prison warden hopes to improve mental health of inmates with addictions
2. Mental Health in Jail
(BBC London)
3. PeaceLove's Mental Health Workshop - Prison Reform (3 minute version)
(PeaceLove Foundation)
4. Working as a mental health professional in prison
(I’m Free! Now What? Michelle Fortier)
5. Mental health and criminal justice | Crystal Dieleman | TEDxMoncton
(TEDx Talks)
6. Belton teen aims to improve mental healthcare in prisons
(25 News KXXV)

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