Challenging Dogma - Fall 2007

...Using the social and behavioral sciences to improve the practice of public health.

Sunday, December 9, 2007

The Criminalization of the Mentally Ill: A Detrimental and Costly Mistake - Kate Wenrich

Although mental illness is a topic that is often avoided, mental illness affects many Americans. Every year, approximately one in four adults, or 57.7 million Americans, suffer from a mental health disorder (9). However, mental health disorders exist on a continuum; not all mental health disorders have the same level of seriousness. Almost 25% of adults suffer from a mental health disorder every year, but only one in seventeen suffers from a serious mental illness, such as schizophrenia, depression, and bipolar disorder (9). Despite the high prevalence of mental health disorders in the American population, “fewer than one-third of adults and half of children with a diagnosable mental disorder receive any mental health services in a given year” (9).

Throughout history, the mentally ill have been unjustly treated by society. Until the 1960s, the seriously mentally ill were often treated in psychiatric hospitals; since then, there has been a progressive movement to deinstitutionalize the mentally ill and turn towards community based programs (4, 201). However, while the deinstitutionalization of the mentally ill may have prevented the mentally ill from being exploited in psychiatric hospitals, deinstitutionalization, in combination with a weak mental health system, has caused an increase in the number of people with mental illness who are being incarcerated rather than treated in a psychiatric facility (2, 26). By no means, however, are prisons an ideal place for offenders with mental illness.

Despite that prisons are not the ideal place for mentally ill offenders, the prevalence of serious mental illness with the prison population greatly exceeds the presence of serious mental illness within the general population by four or five times (4, 201). Within the prison population, approximately 16% of males and 24% of females have mental illnesses (3, 164). However, many of these prisoners are not identified as mentally ill (11, 138). Despite that prisons have a legal obligation to provide prisoners with mental health services (11, 138), many mentally ill offenders are not recognized as mentally ill and therefore, do not receive treatment.

Correctional Officers are Improperly Trained to Handle Mentally Ill Prisoners

By placing offenders with mental illness in prisons, the responsibility for the offenders is placed largely upon correctional officers. Unfortunately, correctional officers are not likely to be educated about mental illness, which causes the prison setting to contribute to mental illness by exacerbating existing mental illness. Despite the large population of prisoners with mental illness, 84 percent of jails provide either no training or less than three hours of training to their correctional officers about the problems of people with severe mental illness (12). Since correctional officers are not trained in mental illness, they are forced to rely on other factors determine how they respond to these inmates.

Two well-known psychological experiments suggest that correction officers may abuse their position, ignoring the needs of mentally ill prisoners. Stanley Milgram performed an experiment on obedience (8, 335-40), which may be useful in explaining the behavior of correctional officers. In Milgram’s experiment, volunteers were assigned to the role of the teacher in a learning experiment in which the learners were confederates. The volunteers were instructed to punish the learner by shocking him if he answered a question incorrectly. For each incorrect answer, the teacher was instructed to increase the level of shock. Although there were no shocks administered, the teacher believed that the learner was receiving shocks that the teacher controlled. Although some subjects expressed interested to stop the experiment, 65% continued the experiment to the end when the experimenter told them that they must continue even though the subject could stop the experiment at any time (8, 337).

In analyzing this experiment, Milgram thought that the transfer and diffusion of responsibility was largely responsible for the experiment’s results (8, 338). Because the subjects were acting on orders, they felt that they were not actually performing the actions. The subjects viewed the experimenters as responsible for the pain and suffering of the learners rather than themselves.

An alternative explanation is that the subjects dehumanized the learners. In an attempt to preserve his own psychological wellbeing, the subject convinced himself that the learner was somehow less human so that the subject did not feel as though his actions could hurt the learner. At least one of the subjects in Milgram’s experiment expressed that he had learned to ignore the learner by concentrating primarily on the task (8, 338).

Milgram’s experiment suggests that it is possible that correctional officers feel as though they are forced to comply with the regulations of the prison. A correctional officer may feel that he must treat all prisoners the same in order to maintain control and power within the prison. Like in the experiment, the correctional officers may be urged by their superiors to comply with the regulations. Even though the correctional officer may feel that a mentally ill offender should be treated differently, he may feel unable to do so. The guards feel that they lack the knowledge to question the authority of their superior; they are “reluctant to disrupt the smooth flow of their interaction with the authorities and risk the consequences of such disruption” (7, 155). To justify his behavior, the correctional officer convinces himself that he is not responsible for his behavior because he is following the orders of his boss to control the prison population.

Philip Zimbardo’s Stanford Prison Experiment may also explain the behavior of correctional officers towards mentally ill prisoners (14). In the experiment, college students who had volunteered were randomly assigned to be either prisoners or guards in a simulated prison environment. The guards were not given any training, but were instructed to do whatever they believed necessary in order to maintain control and command the respect of the prisoners. Even though they were normal college students, the guards quickly became brutal and the experiment had to be ended early.

The Stanford Prison Experiment suggests that correctional officers may be influenced by their power. The main task of a correctional officer is to maintain order within the prison. One correctional officer must be able to control a group of prisoners. To fulfill his duty, the correctional officer may gain power through the dehumanization of his prisoners. The officer dehumanizes the inmates in order to gain control of the inmate population; the inmates feel that they deserve to be treated badly because they are somehow less than human. Therefore, they accept the abuse as the officers because they think they it is deserved. As both the inmates and the correctional officers begin to see the inmates as inhuman, the officers are able to justify their behavior because they are not mistreating humans. The officer’s desire to effectively control the prisoners is of higher priority than his desire to treat the prisoners humanely. If the guard treats mentally ill prisoners differently, the guard will not be able to maintain control within the prison population. As the guard must maintain control in order to fulfill his duties, he is likely to lose his job if he is unable to do so. To keep his job, the guard feels required to treat the mentally ill inappropriately.

To maintain order, correctional officers often treat mentally ill prisoners in the same way that they treat the general prison population. Unfortunately, mentally ill offenders often have difficulties in adapting to the prison environment, especially if their mental illness remains untreated (11, 138). In prison, disciplinary problems are most often punished by the removal of inmate privileges, solitary confinement, or segregation (3, 165). However, these punishments can be extremely harmful for mentally ill prisoners. Often, the typical prison punishment exacerbates a prisoner’s mental illness. The exacerbation of mental illness can lead the prisoners to need hospitalization (3, 174). Mentally ill prisoners are at increased risk for suicide, disciplinary actions, and being victimized by other prisoners (11, 138). Also, once a person with a serious mental illness has been placed in the criminal justice system, it is more difficult for him to exit the system if he does not receive treatment because it is more difficult to comply with the requirements (10, 54).

The Labeling of Mentally Ill Offenders Produces Negative Effects

The labeling theory may have a very important effect on the actions of offenders with mental illness. When a person is incarcerated, society labels that person as a criminal. However, society has preconceived notions of what a criminal should be like, despite that many people who are incarcerated may not be characteristic of society’s expectations. The generally accepted practice of processing those who break the law through the criminal justice system is assumed to reduce crime (6, 105); however, this method of labeling offenders as criminals may actually increase the deviant behaviors that the system was designed to inhibit.

Society, often using false stereotypes (6, 112), defines offenders as criminals; they identify law-breaking with the person, rather than with the action. Most offenders are falsely defined as criminals (6, 111). However, the label instills a self-fulfilling prophecy. Because society defines the offender as a criminal, the offender shapes his behavior to conform to society’s expectations. According to the labeling theory, “offenders are likely to forfeit their self-concepts as conformists or ‘normal’ persons and to increasingly internalize their public definitions as deviants. As this identity change takes place, the offenders’ self-concepts lose their power to encourage conformity; the pressure to act consistently with their self-concept now demands breaking the law” (6, 112).

Unfortunately, the criminal justice system reinforces the offender’s new self-concept. By incarcerating the offender, the offender’s self-concept is reinforced because he is forced to associate with other lawbreakers, who have similar values (6, 112). Therefore, the number of offenders may actually be increased because of the labeling theory.

Labeling is not limited to mentally ill offenders. Rather, mentally ill offenders are labeled as both offenders and as mentally ill. Being labeled as mentally ill is also detrimental. “In essence, labeling theory postulates that unusual beliefs and behaviors that are innocuous in themselves are labeled as pathological by psychiatrist, condemning the individual to un unmerited career as a patient” (5, 33). Although the individual may view himself as normal, the label now creates a pathological state within the person. The person’s view of himself has changed; he views himself as one of the “crazy” people that society looks down upon. His self-esteem is severely damaged because he has become that which he fears.

Once a person is labeled, he is subjected to society’s response to this type of person because he is recognized as abnormal. The labeling of a person allows for the consequent stigma, which may in turn worsen mental illness and encourage poor outcomes. Even though a person may recognize that mental help may be useful to him, some people with mental illness will not seek treatment because they fear the label.

Mentally Ill Offenders are Often Detrimentally Stigmatized by an Ignorant Society

Within society, the mentally ill are often stigmatized. Society largely believes that people with mental illness are dangerous (4, 204); when asked directly 71% of the public endorses that the mentally ill are dangerous (5, 25). While some illnesses such as schizophrenia, substance abuse, and antisocial personality disorder are significantly associated with violence, only a small minority of people with mental illness are dangerous (5, 25). However, society generalizes the most severe mental illness to all people with mental illness. Society assumes that these people are dangerous because they are being incarcerated, but they remain unaware that this placement may be unjustified, and probably worsens mental illness.

Many people are not familiar with mental illness. Although schizophrenia is the mental illness that is most recognized by society, many people think that it means split personality (5, 22). In fact, many people do not know what a mental illness is: between one-third and one-half of people in UK studies could not distinguish between mental illness and a learning disorder (5, 22). In addition 51% of surveyed UK adults think that people with schizophrenia never recover and 15% thought they do not improve with treatment (5, 22). Society believes that mental illness cannot be managed despite advances in medications (Hartwell, 201).

It is possible that society stigmatizes people with mental illness in order to protect the image of the general population. Every member of society feels urges at times that do not comply with social norms, such as violence (5, 23). To rid themselves of these urges, people often, attribute feared parts of their own personality to the mentally ill, leading to the fear of the mentally ill (5, 23). In response, society possesses a desire to exclude the mentally ill from the community and to isolate the mentally ill so that their desires cannot affect the population.

Unfortunately, stigma is reinforced by the media. Because many people do not have significant, direct experience with people with mental illness, society depends largely on the media to tell them how they should view people with mental illness. Often, the media reinforces society’s misperception that people with mental illness are dangerous by making us aware that the mentally ill are being placed in prisons (4, 204). The media imposes a connection between mental illness and violence by “reporting that ‘a rapist or murderer was once a mental patient’ but seldom [describes] the positive accomplishments of former mental patients” (13, 66).
In fact, stigma may actually cause an increasing in the number of mentally ill offenders who are incarcerated. Given the same level of criminal activity as someone who does not have mental illness, the police, as part of society, may perceive a mentally ill offender as more dangerous, making them more likely to be arrested (1, 101).

Stigma affects offenders with mental illness both inside the prison and in society. As a former part of society, prisoners are not exempt from society’s misconceptions of the mentally ill; rather, prisoners often hold a stigmatized view of the mentally ill as well (3, 164). Therefore, mentally ill offenders are subjected to stigma within prison, which often causes difficulties in adjusting and socializing within the prison population (3, 164).
Stigmatization can be detrimental to an individual’s ability to cope. Because mentally ill offenders must endure two doses of stigmatization, their ability to cope is largely damaged. Once an offender with mental illness is released back into the community, they must adapt back into society. However, their double stigma requires adapting to a less structured environment while prevailing over stigma (4, 200).

Potential Alternatives to Incarcerating the Mentally Ill

It is difficult to find an acceptable solution. While it is clear that incarceration is not the best method of dealing with mentally ill offenders, it is not as easy to find workable alternatives as one might expect. The mental health system lacks the money to treat all of the mentally ill that have been wrongly placed into the criminal justice system. Ideally, the money that is being spent to incarcerate offenders with mental illnesses should be transferred to the mental health care system so that the offenders can be treated more effectively and in a more appropriate setting, such as community-based treatment or a psychiatric facility. Because health professionals are carefully trained in mental health, they will be sensitive to the special needs of mentally ill offenders so that their conditions are not exacerbated in the way that they might be in prison.

Conclusion

The mentally ill experience great disadvantages within the criminal justice system. The mentally ill have special needs that differ from those of the general population. However, their needs are misunderstood by both the correctional officers and by society. Mentally ill offenders are forced to endure a system that is not meant for them and often worsens their situations. If society understood mental illness, mentally ill offenders may be spared from the torture of incarceration. However, society remains ignorant.

In our society, the criminal justice system largely focuses on punishing offenders. The rehabilitation of offenders is ignored. Criminals are viewed as hopeless failures. However, mentally ill offenders do not benefit from the punishment of incarceration; they are not deterred by punishment. Even though punishment is not effective and rehabilitation might be more useful in treating this subpopulation of prisoners, society continues to deal with mentally ill offenders within the punishment-focused criminal justice system.

Often, society separates knowledge into different disciplines that seldom work together. However, it is important that this knowledge is combined in order to take full advantage of the knowledge. Without social science research, it seems appropriate to use a single system to punish all criminal offenders. However, the offenses of people with mental illness are often influenced by their mental illnesses. Therefore, the treatment of mental illness will be more beneficial in reducing offenses than will punishment. Instead of discouraging criminal activity, social science research suggests that incarceration does not decrease criminal activity in mentally ill offenders. Rather, it may even increase criminal activity in this population.

REFERENCES

1. Desai, Rani A. Jail Diversion Services for People with Mental Illness: What Do We Really Know? (pp. 99-121). In: Fisher, William, ed. Community-based Interventions for Criminal Offenders with Severe Mental Illness. Boston, MA: Elsevier Science, 2003.
2. Fisher, William H., Nancy Wolff, and Kristen Roy-Bujnowski. Community Mental Health Services and Criminal Justice Involvement Among Persons With Mental Illness (pp. 25-51). In: Fisher, William, ed. Community-based Interventions for Criminal Offenders with Severe Mental Illness. Boston, MA: Elsevier Science, 2003.
3. Gagliardi, Christine. The Impact of a Residential Treatment Unit on the Prison Adjustment of Mentally Disordered Inmates (pp. 163-178). In: Hartwell, Stephanie, ed. The Organizational Response to Persons with Mental Illness Involved with the Criminal Justice System. Boston, MA: Elsevier Science, 2005.
4. Hartwell, Stephanie. Prison, Hospital, or Community: Community Re-entry and Mentally Ill Offenders (pp. 199-220). In: Fisher, William, ed. Community-based Interventions for Criminal Offenders with Severe Mental Illness. Boston, MA: Elsevier Science, 2003.
5. Leff, Julian & Warner, Richard. Social Inclusion of People with Mental Illness. Cambridge, MA: Cambridge University Press, 2006.
6. Lilly, J. Robert, Francis T. Cullen, & Richard A. Ball. Criminological Theory: Context and Consequences. Thousand Oaks, CA: Sage Publications, 2002.
7. Kelman, Herbert C. & Hamilton, V. Lee. Challenging Authority (pp. 136-166). In: Crimes of Obedience: Toward A Social Psychology of Authority and Responsibility. New Haven, CT: Yale University Press, 1989.
8. Mook, Douglass. Stanley Milgram on Obedience to Authority (pp. 335-40). In: Classic Experiments in Psychology. Westport, CT: Greenwood Press, 2004.
9. NAMI. 2007. NAMI: National Alliance on Mental Illness-The Nation’s Voice on Mental Illness. Retrieved November 9, 2007 from
http://www.nami.org.
10. Solomon, Phyllis. Case Management and the Forensic Client (pp.53-71). In: Fisher, William, ed. Community-based Interventions for Criminal Offenders with Severe Mental Illness. Boston, MA: Elsevier Science, 2003.
11. Swartz, James A. and Arthur J. Lurigio. Screening for Serious Mental Illness Among Criminal Offenders (pp. 137-161). In: Hartwell, Stephanie, ed. The Organizational Response to Persons with Mental Illness Involved with the Criminal Justice System. Boston, MA: Elsevier Science, 2005.
12. Treatment Advocacy Center. Fact Sheet: Criminalization of the Severely Mentally Ill. Retreived November 10, 2007 from
http://www.psychlaws.org/GeneralResources/Fact3.htm.
13. Wolfson, Charles. Social Deviance and the Human Services. Springfield, IL: Charles C. Thomas, 1984.
14. Zimbardo, Philip G. The Stanford Prison Experiment: A Simulation Study of the Psychology of Imprisonment. Retrieved December 1, 2007 from http://www.prisonexp.org.

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