Confronting the Challenge with Training: Managing Inmates with Mental Health Disorders
Geiman, Diane, Corrections Today
The number of inmates with mental health disorders in correctional facilities throughout the country is growing at an alarming rate. The American Psychiatric Association found that "as many as one in five [offenders] was seriously mentally ill, with up to 5 percent being actively psychotic at any given moment." (1) The Bureau of Justice Statistics (BJS) reported that "more than half of all prison and jail inmates had a mental health problem." (2) Adding to the problem, these offenders often stay incarcerated longer than other offenders and usually commit crimes upon release, starting the criminal justice cycle again.
The number of inmates with mental health disorders has grown to the point where some experts believe that jails and prisons have taken on the roles played by psychiatric institutions. Judge Steve Leifman, testifying on the subject before the House of Representatives, said that "because of lack of access to community-based care, our police, correctional officers and courts have increasingly become the lone responders to people in crisis due to mental illnesses. In fact, jails and prisons in the United States now function as the largest psychiatric hospitals in the world." (3)
The consequences of placing offenders with mental health disorders in our nation's jails and prisons are not surprising. While some of these offenders can function adequately in the general population with outpatient treatment and occasional crisis intervention, most of them cannot. Kenneth Favor, author of Health Care Management Issues in Corrections, calls these latter offenders the "misfits" in the general population of jails and prisons. Because these vulnerable offenders may be traumatized by the stressful environment of corrections (e.g., crowding, constant noises, lack of privacy and strict rules) their symptoms may worsen. E. Fuller Torrey, a well-known research psychiatrist, said this of the plight of offenders with mental health disorders in correctional institutions:
Being in jail or prison when your brain is working normally is, at best, an unpleasant experience. Being in jail or prison when your brain is playing tricks on you is often brutal ... These institutions have rigid rules, both explicit and implicit, and a major purpose of incarceration is to teach inmates how to follow such rules ... Because of illogical thinking, delusions or auditory hallucinations, many of the mentally ill cannot comprehend the rules of jails and prisons and this has predictable, and sometimes tragic, consequences. (4)
The "predictable consequences" are the ones that correctional staff face on a daily basis, especially correctional officers on the front line. Mental illness can impair a person's ability to think, feel and behave normally. Consequently, offenders with mental health disorders may exhibit inappropriate behaviors such as annoying other offenders; bizarre behaviors such as having hallucinations or talking incoherently; and even life-threatening behaviors such as attempting suicide. Compounding the problem, offenders with mental health disorders may have difficulty understanding directions and rules and the consequences for failing to follow them. As Jeffrey Metzner of the University of Colorado's Health Sciences Center notes, "... prison rules don't mean much to someone hearing voices ... [he] may view a request to abide by that rule as part of a conspiracy directed against him." (5) Sometimes, the reactions of offenders with mental health disorders can create problems for staff and, in some cases, pose a risk to their safety. BJS found that offenders with mental health disorders are more likely to commit rule violations such as verbal abuse and physical assaults than other offenders. (6)
The Council of State Governments responded to the situation by undertaking a national, two-year effort to develop recommendations that local, state and federal policy-makers and criminal justice and mental health professionals could use to "improve the criminal justice response to people with mental illness. …