The Prevalence of Incarcerated Individuals who Suffer from Mental Illness Introduction. Oppression has been inflicted upon the mentally ill in the United States. A lack of federal funding for various mental health facilities accounts for fewer treatment opportunities for affected individuals. Legislation has made it difficult to equip facilities to treat violently ill patients, thus resulting in incarceration in state prisons. 1 in 3 inmates in the US are diagnosed with mental illness. After being released many offenders will not pursue treatment and will return to prison.
Often resorting to substance abuse to lessen the symptoms of their illness. However, resolution to this issue is in progress, due to advocacy throughout the country. There has been a steady increase in the number of persons with mental illnesses incarcerated in the United States due to the lack of resources for these individuals in prison, as well as, after being released. Background Information. During the 1950s the United States moved away from the use of psychiatric hospitals to treat the mentally ill. The use of Thorazine was introduced.
Thorazine is an antipsychotic drug that prevents the overactivity of dopamine in the brain, suppressing tendencies for an assortment of mental illnesses such as schizophrenia. During this time, there was approximately one psychiatric hospital bed per every 300 Americans. Towards the end of this decade, nearly 559,000 mentally ill patients were committed to state non psychiatric hospitals. Psychiatric hospitals during this time were likely to experience maltreatment, commonly coinciding with inexperience and underfunding. Some of these patterns occur in state sanctioned mental health facilities today.
However, Medicaid was introduced in 1965 under the Johnson Administration, creating public health insurance accessible for the poor and disabled (Stone 2013). Thereby, providing basic health care for those who can not afford health insurance. Under Medicaid, mental health and substance use disorder services are one category that must be covered. Though there is still a prominent population of individuals with mental illness who lack the resources to be treated or are not provided with said services. A winter study conducted in Maine 2009-2010 discovered that 1 in 3 (34. %) of inmates resided with a mental illness diagnoses, 13. 5% were diagnosed with SMI (Maine DHHS 2009).
Serious Mental Illness includes mental illnesses such as the schizophrenic spectrum, major depression, major affective disorder (bipolar disorders), and other nonorganic psychotic disorders. Of this, females were twice as likely to receive a mental health or SMI diagnosis, as well as, significantly more likely to have a history of substance abuse challenges than men. Psychological disorders are 20 to 40% higher in women than men (Varney 2014).
Women are more likely to be diagnosed with anxiety or depression, for men, substance abuse, and antisocial disorders are common. Social stresses make people vulnerable to mental illness, and research indicates that women’s roles may be especially demanding. Riverview Psychiatric Facility. The Maine Psychiatric Facility, formerly known as the Mental Health Institute is subjected to a history of abuse. Poor conditions and overcrowding resulted in several deaths during an incident in 1990. Consequently, producing a lawsuit. The consent decree required the state to establish and maintain a comprehensive mental health system (Thistle 2014).
Riverview Psychiatric Facility was created from this 1990 investigation. This incident addressed one issue, however, many inconsistencies have prevailed due to the lack of reinforcement of care and safety standards. The facility is “equipped” to house mentally ill criminals. The 92-bed center is the only state-owned facility to house patients who are deemed either incompetent to stand trial or not criminally responsible for their actions. Federal certification was pulled in 2013 once it failed a series of unannounced inspections by the federal Center for Medicare and Medicaid Services.
These inspections revealed safety concerns and abuse within the facility. The use of stun guns, pepper spray, improper records, and medical errors led to the lost federal certification (Miller, 2016). Fewer staff members make it difficult to manage residents. Along with the lack of federal certification, Riverview became ineligibility for an estimated $20 million in federal reimbursements. Further inspections revealed little to no improvement, therefore the facility continues to lack the federal accreditation.
DHHS hasn’t enacted adequate reforms in response to these issues. Riverview has been slow moving to address staffing and safety concerns. Federal reimbursements would lessen the burden put on the state to run the facility and maintain competitive wages for employees. Legislation in Maine. The Lepage administration revived a previous proposal to house the mentally ill in Maine prisons. The move would be an option for people judged by the courts as “incompetent to stand trial” or “not criminally responsible” and are violent or pose danger to others (Miller 2016).
Maine lawmakers signed a bill allowing the transfer of Riverview psychiatric patients to the health unit located at the Warren State Prison. The decision focused more on prisoner management, rather than mental health treatment or recovery. An example of this legislation in action is when a violent, mentally ill patient was transferred to the state prison after attacking staff members at Riverview Psychiatric Center twice. Alternatively, options for a new facility equipped to house these individuals has been discussed.
The agency has identified internal funding for the new building, which will cost between $3 million and $5 million and house 22 beds for forensic patients. Approval for said project typically comes through a budget appropriation, bond issue or other legislation. Forensic patients would include those deemed not guilty of criminal acts or unfit for trial. If DHHS has enough funds to build the facility it will still require approval from legislators. The committee can not review specific proposals concerning this since there aren’t any under consideration (Cousins, Shepherd 2017).
Self Medicating. Coinciding mental illness and substance abuse are commonly referred to as “dual diagnosis”. Significantly, 60% of persons with a severe and persistent mental illness abuse substances. When these individuals abuse drugs, they may feel less anxious or depressed temporarily. Though, when the individual is not high, the symptoms of their mental health issue return, oftentimes stronger than they were before. Substances can create mental health symptoms like paranoia, delusions or depression while the person is under the influence of the drug.
When these symptoms last after the drugs wear off, it can indicate a co-occurring mental health disorder (Dual Diagnosis 2017). The intention of the user is to medicate the mental health symptoms that they find are disruptive or uncomfortable by using alcohol and drugs. A few examples of an individual using alcohol and drugs to self-medicate could be; Using marijuana to numb the pain of depression, consuming alcohol to treat social anxiety and feel more comfortable in social situations, or low energy and a lack of motivation equating to taking Adderall or meth to increase the drive to get stuff done.
Chronic drug and alcohol abuse increase the chances of becoming a victim of various traumatic events. These can create mental health issues like PTSD, eating disorders, depression, etc. Poor decision-making is also common under the influence, users may break the law or make other choices that cause them to struggle with anxiety. Depression is a frequent effect of drugs like crystal meth and alcohol as they begin to wear off. The misuse and diversion of pharmaceutical accounts for an increase of over 400%, from 34% in 1997 to 176% in 2005 (Muskies 2007).
Abuse of heroin, cocaine, and methamphetamine have all risen during the same time period. Substance abuse makes effective treatment of mental illness more difficult. Depression and anxiety disorders are relatively more common among persons with chronic health problems, including cardiovascular disease, diabetes, and cancer. This demographic aligns with the population that struggles with health care. With Maine’s aging population, chronic health issues increase with age, depression and anxiety problems are eminent with said health problems.
Drug deaths in Maine have continued to rise over the decade. Advocacy. The cost to imprison individuals with mental illness is greater than the estimated cost for treatment. A common prison is estimated at $150/day to incarcerate, while someone with SMI is about $450/day. The cost to treat someone with SMI outside of a correctional facility is around $10,000/year.
Many organizations and correctional facilities are changing the way mental illness is handled. Chicago? Cook County Jail is the nation’s largest mental health care provider (Vice 2015). Public mental health care facilities in the surrounding area experienced a cut in funding, resulting in closing their doors. Deinstitutionalization was insisted upon because of abuse and with the intent that individuals could live in their homes and seek community-based treatment. Only an insufficient amount of help centers reside in the Chicago area, these centers lack psychiatrists.
Poor support and resources for people suffering from mental illness have flooded Cook County Jail. Arrestees are screened at the intake center to determine mental health state before they see a judge. Self-medicating is commonly observed among incoming prisoners, the screening allows for decisions to be made on a case by case basis. Anger management and symptom support services are provided as well. However, due to few facilities in the community, support isn’t always provided once an arrestee is released.
Commonly, they become repeat offenders, thus continuing the cycle. Amplifying Voices of Inmates with Disabilities is an organization that monitor, outreach, and perform investigations. The AVID Jail Project advocates for timely and effective access to psychiatric medications, liberate inmates with serious mental health conditions from being confined in their cells for often times all 24 hours of the day, and to devise release planning for inmates with SMI (AVID Jail Project 2015).
Attempting to connect those being released with outside support groups, treatment facilities, medication, and counselors. Conclusion. Jails are correctional settings, not psychiatric facilities. Inadequate mental health services provided in the majority of US correctional facilities, along with the depleting help centers across the country lead to recidivism. The cost to incarcerate these individuals is significantly more expensive than a general detainee.
Deinstitutionalization replaced psychiatric hospitals with community based mental health services. A lack of education and failed legislation impact the closure of these care facilities, also negatively impacting state sanctioned psychiatric facilities. Solutions to these problems such as the AVID Jail Project and the work being conducted at the Cook County Correctional Facility are advocating for the integration and support of inmates during incarceration as well as after they are released.
