Mentally ill patients are over-represented in penitentiary systems of many countries. This is a frightening tendency as despite there are huge numbers of mentally unstable patients in jails and prisons, they do not receive necessary treatment at the same time. As a result, the state of these criminals gets only worse and thus the number of crimes committed by mentally ill patients only increases. This research work focuses on a number of aspects that have to be reviewed while studying the place of mentally ill patients within the justice system taking into account modern tendencies, treatment, and consequences of the imprisonment.
At the beginning of the research, focus is on the definition of “mental illness” by different scientists and complications that come with defining the phenomenon. Later on, tendencies of the representation of mentally ill criminals in the penitentiary system are presented as well as reasons for the current situation are analyzed. Lastly, there is an analysis of the place of mentally ill criminals within the criminal justice system and changes that scientists offer in order to improve the current situation.
Definition of Mental Health
Modern scientists state that the term “mental health” has a very broad definition. There are numerous academic discussions that present various arguments and reasoning behind the definitions of mental health and illness. Taslitz (2007) believes that not a single definition of mental health can be purely scientific because not a single one of them can be free of moral assessment (p. 2). Therefore, taking into consideration ideas presented by Taslitz (2007), this research focuses on a common-sense definition of mental illness and defines a person with a mental disease as a one that “demonstrates, either temporarily or for more protracted periods, cognitive or emotional deficiencies sufficiently beyond that of “normal” (p. 1).
Some may argue that this definition is still too vague to provide clear understanding of mental illness because it is impossible to define the meaning and features of “normal”. However, it can also be perceived as an on-going complication that exists in the system of medical treatment of mental illnesses. Without the ability to define clearly what mental illness is, it is very difficult to tell if a person can be considered as “normal” or not.
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Sometimes, mental illness is perceived by people as equal to personality disorder and behavioral disorder, which are often recognized in criminals (Henderson, 2006, p. 3). This is a common mistake, which creates the perception of mentally ill people as dangerous potential criminals.
Mentally Ill in the Criminal Justice System
The incarceration of mentally ill people is a common trend throughout the world. In the United States, the national study conducted from 2002 to 2004 has shown that 56 percent of state prisoners, 45 percent of federal, and 64 percent of jail inmates suffer from different forms of mental illnesses (Fact Sheet, 2008). The same high levels of mental illnesses in inmates have been recognized in Australia, New Zealand, Ireland, Canada, and the United Kingdom (Ogloff et al., 2007, p. 2). The statistics in Great Britain is even more dramatic as reports say that around 90% of the inmate population in the country suffers from various mental illnesses (Rayner, 2011). Therefore, all parts of the developed world are facing the same problem – the increasingly high rates of mentally ill people within the criminal justice system.
Despite the common perception that mentally ill offenders are dangerous criminals, the actual situation presents a completely different one. In 2008, 70 percent of mentally ill prisoners were sentenced for nonviolent offences (Fact Sheet, 2008).
There is a very dangerous tendency, which shows the constant decrease of mental institution patients while the number of convicted criminals serving terms in prisons constantly increases. Despite the fact that some countries have noted the problem and tried to impose governmental measures and inquiries in the mental health system, the situation has only been deteriorating (Henderson, 2006). While in 1972 there were around 200,000 people in the US prisons, in 2000 this number has increased to 1,4 million. At the same time, while in 1955 the population of mental institutions was more than half a million, which can be contrasted to the 70 thousand left in institutions by the beginning of the new millennium (The Sentencing Project, 2002). The same tendencies are clearly seen in the development of institutions as while forty mental hospitals have closed in the late 20th century, ten times more penitentiary institutions have been opened in the United States (The Sentencing Project, 2002, p. 5). The same tendencies of the constant growth of the amount of prisons and their inmates and the contrasting decrease of mental institutions and their patients in the past couple of decades can be defined throughout the United States.
Still, the level of mentally ill patients is much higher among prison inmates than among the rest of the population (Berry, 2007). Some major mental illnesses, such as schizophrenia and depression, are at least three times higher within the penitentiary system (Ogloff et al., 2007, p. 1). In Australia, the appearance of psychosis among the inmate population was thirty percent higher than among entire population (Berry, 2007). It might seem that mentally ill people are in fact more violent than the rest of the population. This study is aimed at improving this misperception and explaining the actual reasoning behind the unequal numbers of the mentally ill within the penitentiary system and the rest of population.
The Dangers of Penitentiary System
Without appropriate support and help, mentally ill inmates receive additional traumas while staying in prisons. This comes from the very nature of the penitentiary system and has significant effects on mentally unstable patients.
The main problem of mentally ill offenders is that they do not receive proper treatment while being in the penitentiary system. The fact that treatment and medical help are among the constitutional rights of mentally ill inmates is constantly ignored. There is a constant lack of specialists on mental health in penitentiary institutions. According to the National Alliance on Mental Illness, appropriate treatment is received by 1 in 3, 1 in 4, and 1 in 6 inmates in state and federal prisons and jails respectively (Fact Sheet, 2008). At the same time, researches show that more than a half of mental disorders are treatable and the majority of the rest can lead to significant improvement, if not to the return to the “normal” state (Lewis, n.d.).
The environment of prisons and jails is generally perceived to be inappropriate for those with mental illnesses taking into consideration the fact that no special attention is usually given to the needs of such inmates. The mental state of ill patients can only get worse in the penitentiary system. Berry (2007) states numerous examples of patients with severe mental illnesses who have been “locked up for 23 hours a day in solitary confinement” (p. 2). Therefore, mentally ill patients-inmates the same way like the rest of criminals are not only deprived of the constitutional right for medical assistance, but are also constantly punished, which only worsens their mental state.
Mentally ill people constitute rather a danger to themselves than to others. Due to the lack of treatment and unfriendly conditions in prisons, mentally ill inmates tend to hurt themselves. In the state of New York, the majority of suicides are committed within prison walls (Taslitz, 2009, p. 2). According to Lewis (n.d.), the high level of suicides is one of the major effects of prison life on inmates, and especially – the mentally ill ones. Statistics show that almost everyone attempting to commit a suicide has some kind of a mental disorder (Lewis, n.d.). The danger remains even after the person leaves the system as, according to Rayner (2011), those who leave prisons and jails are 36 times more likely to kill themselves than the rest of the population.
Whilst many patients enter the penitentiary system with some kind of mental disorder, there are some who develop a disease while being in prison. According to Lewis (n.d.), depression is among the main disorders that is developed after institutionalization. Therefore, the penitentiary system is not only unable to support existing mentally ill inmates, but it also stimulates the development of disorders in those who have been healthy at first.
Reasons for the Prevalence of Mentally Ill People in the Penitentiary System
Henderson (2006) presents modern policies for mental illnesses in Australia. In fact, these can be used to describe global attitudes to mental illnesses and governmental position towards it. Instead of the policies for support and management of mental diseases, countries choose the options of “control and containment” (Henderson, 2006, p. 2). Therefore, people with mental disorders are not able to receive appropriate support and the policy of alienation is the basic one in the treatment of people with such diseases. Moreover, the growing amount of mentally ill inmates serves the main goal of the existing policies – isolation (Taslitz, 2009, p. 2).
One of the reasons why numbers of criminals with mental illnesses constantly increase is the attitude to them shown by the society and decision-makers in the criminal justice system. Even though mental illness is a quite common problem of the modern world, it is still highly stigmatized and misunderstood by the society. Mentally ill people are often feared and avoided even if they have never done anything wrong. The media play a significant role in this process by presenting mentally ill people as dangerous offenders and those who cannot be cured.
While there is no direct connection between crime and mental illness, there is a definite link between incarceration and criminal punishment. Henderson (2006) states that people with mental illnesses are generally more often convicted of felonies than mentally healthy ones (p. 2). Taking into consideration the fear of mental illnesses and the desire to separate people with such diseases, the reasons of such biased attitudes to misdemeanors conducted by mentally unhealthy people are clear. As a result, a kind of circle is created: people are stigmatizing mentally ill and thus more often convict them of crimes, which leads to the idea that this part of population is more criminalized than others.
Moreover, many assume that the rate of criminal activity is generally higher among mentally ill than among the rest of the population, which in fact does not correspond to the real situation. A study of 500 mentally ill patients has shown that the prevalence of crime among them was around 4%, which is compatible with overall measures of the population (Henderson, 2006)
Many people view mental illnesses only as a possibility for criminals to escape punishment. In fact, this perception is false. Statistics in Australia shows that only one percent of charges are dismissed when the patient is defined mentally ill. The Mental Health Criminal Procedure Act is thus responsible only for 555 charges dismissed in the history of Australia by 2006 (Henderson, 2006). Even those found not guilty on the basis of mental illness are not able to freely leave the criminal justice system. This type of mentally ill is named “forensic patients”. Despite being not guilty, these people are detained within the corrections system. This is made because mentally ill patients are sometimes perceived to be “too unwell to be released (Berry, 2007, p. 2).
The Negative Influences of the Existing Tendency
The main consequence of the large amount of mentally ill people who do not receive adequate treatment within the penitentiary system is the constant increase of the “unhealthy” population. Despite the fact that a large part of people with mental diseases is kept isolated, they still form a part of the society. Moreover, after leaving prisons and jails, mentally ill offenders find themselves on the streets and they are not usually adjusted to the rules and requirements of the society. Therefore, instead of decreasing the number of mentally ill and potentially dangerous people, the penitentiary system only keeps them away for quite a while. Furthermore, it has been already stated that jails and prisons stimulate the development of mental illnesses. As a result, more mentally unstable people leave the penitentiary system than those who have entered it. It means that instead of decreasing the number of potentially dangerous people the current criminal justice system only increases it.
A lot of mentally ill patients create additional financial complications for the state and national budgets of the United States. Each year, fifteen billion USD are spent to house those with mental illnesses in prisons and jails throughout the country (Fact Sheet, 2008). With the increase of the mentally ill inmates, the budget on the penitentiary system keeps growing as well. Without adequate treatment, the time spent in prisons increases and the number of crimes committed by mental patients left without adequate support grows bigger. The experience of the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services has shown that a proper treatment program for mentally ill patients can save more money that there is invested in the program. When the pilot program started in 2006, by 2007 it has saved up to 2.5 million by freeing hospital and jail beds (Fact Sheet, 2008). Therefore, the decrease of the numbers of mentally ill patients in prisons will lead to a more effective allocation of costs and decrease the amount of unnecessary expenditures that currently exist in the penitentiary system.
The large amount of mentally ill inmates also raises the question about the purpose of the penitentiary system. A separate discussion has to be on the questions if the current role of jails and prisons as the main place accommodating the mentally ill really serves the goals and tasks of the penitentiary system and if the treatment of mentally ill patients should be among the system’s main goals (Taslitz, 2009). Maybe, after giving negative answers to both of the mentioned questions, policy-makers will be able to introduce changes in the criminal justice system and try to allocate mentally ill patients in institutions that are more appropriate and that will be able to provide necessary care and treatment. In fact, nowadays jails and prisons bear the responsibility that used to belong to community-based institutions (Lewis, n.d., p. 4).
Treatment is perceived as a necessary and adequate response to the large amount of mentally ill criminals in the justice system. Only appropriate care will reduce the cases of recidivism and thus will decrease the number of mentally ill inmates within the penitentiary system. However, the main question is if the treatment has to be provided within the penitentiary system or mentally ill offenders should go to special institutions. Both theories have their supporters, which are united by one common idea of the necessary treatment of mental diseases among criminals.
All the proposed programs have a number of features that unite all of them. Firstly, more attention should be paid to the diversion of mentally ill offenders from the criminal justice system (The Sentencing Project, 2002). Rayner (2011) states that currently these opportunities are often missed. Thus, more attention should be paid to methods and techniques that are used to divert.
Secondly, a more systematic screening procedure has to be created in order to define if a criminal is ill. Ogloff et. al. (2007) state that formal screening procedures have to be improved and should replace screenings based upon opinion. The authors also identify a number of levels that can be used in the screening procedure: assessment by police, in court, and in corrections (Ogloff et. al., 2007, p. 3). Police officers should be given a special training in order to be able to cooperate with mentally ill offenders and treat them in a safe way.
For those offenders who cannot be diverted from the criminal justice system, it is essential to provide appropriate services within the system in prisons and jails. It can be done through the overall improvement of the healthcare system in penitentiary facilities, which will require the involvement of new staff members and mental health professionals. (Lewis, n.a.)
Along with the treatment within the penitentiary system or medical facilities, mentally ill criminals will require a separate attention from specialists in the field of adjusting to the community. According to Rayner (2011), many mentally ill people still suffer from the influences of the penitentiary system even after they leave prisons and jails. Therefore, suicide levels among this part of population are much higher than among the general public. It means that special approach to the transition process is required for the mentally ill.
Overall there are four main elements that are required for the improvement of the penitentiary system and its adjustment to the needs of the mentally ill. Screening procedures will improve the understanding of the person’s disease. While some offenders would be diverted to specialized institutions, others should be able to receive proper treatment within the penitentiary system. Lastly, a set of special programs should assist mentally ill criminals in the process of adjusting to the community.
This research has shown that within the penitentiary system the amount of mentally ill inmates is much higher than in the rest of the community. The number of prisons has significantly grown over the past decades, which has happened along with the decrease of the number of healthcare institutions specializing on mental health. As a result, many of those spending time in healthcare facilities have entered the penitentiary system. Currently, the prevailing part of the civilized world faces the same problem – the dramatic number of mentally ill people locked in prisons and jails.
One might think that the criminal justice system has developed a special approach to people with mental illnesses. In fact, neither of the “special features” is beneficial for the mentally ill. In prisons, they usually receive the same treatment as all other inmates and proper support of the mental health specialists is rarely provided. While entering the criminal justice system, the mentally ill do not get softer treatment. In many cases, they even receive harsher punishments. This happens because this group of population is widely criminalized due to the inaccurate beliefs of the wide public.
Within the criminal justice system, the state of mentally ill inmates usually gets worse due to the lack of adequate treatment and support of specialists. This leads to the increased number of suicide attempts in prisons. As a result, instead of improving mentally ill offenders, the system only creates negative consequences for the inmates’ health.
The current approach of the criminal justice system to the mentally ill convicts is neither economically nor morally justified. As a response to the current situation, researchers have developed a number of approaches, which unite the improved prison healthcare facilities with the possibility to divert the majority of the mentally ill from the system. These programs also propose special preparation trainings for the period of transition back to the community.