Viewing Scared Straight as a Public Health Failure—Tyler James

Introduction
Public Health interventions have failed to address the adverse health outcomes of adolescents vacillating back and forth between the criminal justice system. Research has documented that adolescent labeled as juvenile delinquents experience higher rates of illicit substance abuse, mental health issues, and higher rates of violent death than non-delinquent adolescents do(1-4). The philosophy behind these efforts suggests that reducing delinquency will improve the health outcomes among at risk adolescents. This paper will focus on the Lifer’s Juvenile Awareness Project captured in documentary “Scared Straight”, a prison-aversion program presented itself during the seventies as a possible method from deterring adolescents from criminal behavior and risky health behaviors. There have been mixed reports about the success of the Scared Straight program, this intervention represents a public health failure.

The Birth of Scared Straight
In 1978, Arnold Shapiro directed a documentary examining the “Lifer’s Juvenile Awareness Project,” implemented at the Rahway State Prison in New Jersey. The “Lifers Juvenile Awareness Program,” was offered as an alternative choice for adolescents who faced prison time for their involvement in criminal activity. The goal of this intervention was to give youth an experience of what life would be like in the prison system. The outcome that this intervention was hoping to achieve was to reduce adolescent’s risk of committing criminal or risky behaviors. The “Lifers Juvenile Awareness Program,” used real prisoners or Lifers to implement the intervention to adolescents. Lifers would “keep it real” and used excessive graphic language, violent images of men and women assaulted in prison, and role-playing to illustrate how engaging in delinquent behaviors ultimately leads to undesirable consequences, mainly landing in prison and suffering through its daily hardships.

Shapiro titled the documentary Scared Straight, and it aired nationally in 1979. In the finale of Scared Straight, Shapiro claimed that there was an 80% deterrent effectiveness among all participating adolescents and that there was 100% deterrent rate among the intervention participants during the filming of the documentary. With the lifer’s graphically demonstrating how their negative behaviors led to their imprisonment and the hardships they face inside of prison, rational thought suggests the intervention would discourage juvenile delinquents from continuing their destructive behaviors (5). This national exposure gave credibility to its effectiveness and it inspired 38 states to adopt prison-aversion programs modeled after the “Lifer’s Juvenile Awareness Project”, which due to the popularity of the documentary the public colloquially referred to as Scared Straight (6). State’s implementation of the program was very similar to the aggressiveness and intimidation tactics employed by the prisoners of the original documentary. Also, states used various criteria to determine eligibility for the intervention. Some juveniles participating in the intervention are first time offenders while others committed several criminal offenses.

Substance Use and Scared Straight
Scared Straight encompasses several of the Health Belief Model constructs used to inspire behavioral change in an individual. The behavioral outcome the intervention seeks to achieve is eliminating recidivism and encouraging adolescents to adopt more socially acceptable behaviors. According to the program, juvenile delinquents should have a high-perceived susceptibility since their behaviors led to their interaction with the criminal justice system. However, juvenile delinquents experience a high likelihood of illicit substance use and have difficulty making and maintaining a rational decision such as avoiding crime or remaining sober without assistance (1). Therefore, the co-occurrence of other issues among juvenile delinquents makes the rational thought process difficult to follow.

The glaring issue that makes this intervention a public health failure is that the intervention fails to recognize the importance of the co-occurrence of other issues among juvenile delinquents. Scared Straight fails to address the negative health outcomes such as illicit substance abuse or mental health needs of juvenile delinquents that cause them encounter the criminal justice system. Research has shown that recidivism coincides with more serious drug use—moving from marijuana to cocaine for instance (1). Studies have also shown that imprisonment negatively affects the health of individuals, particularly mental health (7-8). Solely relying on Scared Straight to address the co-occurrence of issues among juvenile delinquents represents a public health failure and evidence that treatment services need to be involved in reducing recidivism rates.

Scared Straight Fails to Provide an Effective Skills Set
Scared Straight consist of hours of Lifers talking to adolescents in an aggressive manner and use the role-playing exercises of the intervention to humiliate juvenile delinquents rather than help them learn how to perform more socially acceptable behaviors. The Scared Straight intervention fails to provide juvenile delinquents with an appropriate skill set for effectively avoiding recidivism and other delinquent behaviors. The co-occurrence of criminal behavior and illicit substance use suggests that juvenile delinquents need a new set of skills to perform more socially acceptable behaviors in mainstream society. Failing to address these issues will not engender change among juvenile delinquents because they lack the tools/resources to do so. Research supports the use cognitive-behavior therapy to change behavior successfully. Cognitive-behavioral treatment includes problem solving, negotiation, skills training, interpersonal skills training, rational-emotive therapy, role-playing and modeling, and cognitively mediated behavior modification (9).

Scared Straight Does not involve the Community or Positive Role Models
Research has shown that interventions seeking to combat recidivism prove to be more effective when the interventions are conducted in a community setting rather than institutions such as a prison (9-10). Lifers encourage juvenile delinquents to become socially responsible members within their community, yet the intervention excludes the community environment. There is a great disconnect between the goal of the intervention and the actual environments of juvenile delinquents. Not only does the intervention fail to incorporate the community within the program, juvenile delinquents do not receive information about the resources their communities or nearby communities have to offer. This is critical since the treatment services within the public sector are not easily available (1).

Evaluation
Unlike adolescents not labeled as at-risk or delinquent, juvenile delinquents have not experienced a decrease in illicit drug use. Prison-aversion programs such as Scared Straight have been unsuccessful in their attempts to decrease recidivism rates and negative health outcomes among juvenile delinquents due to their reliance on Health Belief Model constructs. Juvenile delinquents need additional resources and therapy to address co-occurring issues in conjunction with intervention leaders illustrating the negative consequences of their behaviors. This is the reason why independent evaluation of the Scared Straight intervention suggests the program is not effective. The intervention emphasizes the consequences of criminal behavior but fails to instruct juvenile delinquents from performing such behaviors. Once juvenile delinquents encounter the criminal justice system, they are aware of the consequences of their criminal behavior. Since states implemented the program with the same criterion and with the same expected outcomes stated in the “Lifer’s Juvenile Awareness Project,” they have not achieved their desired target goals in the reduction of youth coming into prison and reduction of recidivism among those that have been in the incarceration system.

Conclusion
Despite the promoted effectiveness of Scared Straight this interventions has failed to reduce recidivism effectively among juvenile delinquents. The structure of Scared Straight lacks the critical elements identified by research on efficacious methods of reducing recidivism. The major flaws of the intervention are it is not continuous, it inadequately addresses co-occurring issues such as substance abuse, it fails to provide juvenile delinquents with appropriate skills set for maintaining socially responsible behaviors, and it does not involve the community environments of juvenile delinquents.

With the dearth of public treatment services, linking juvenile delinquents with positive role models is critical to assist them in becoming socially responsible members of their communities. The Lifers serve as models of behavior for juvenile delinquents not to adopt, but, since the prisoners are removed from society, they fail to serve as an effective model for adolescents to emulate when they return to their communities. Positive community role models are imperative because not only do they serve as effective models for juvenile delinquents, but they also provide long-term assistance for juvenile delinquents as well. Juvenile adolescents need to interact with mentors who have reformed their criminal behaviors or maintained sobriety, and now behave as socially responsible individuals.

Since the program does not employ these crucial components, Scared Straight fails to combat recidivism and it reiterates what juvenile delinquents learned upon their first encounter with the criminal justice system; that is, their delinquent behaviors will result in negative consequences. Without this intervention teaching juvenile delinquents how they can combat recidivism and other co-occurring issues, Scared Straight will remain a public health failure.

References
1. Dembo R, Williams L, Schmeidler J, Drug Abuse among Juvenile Detainees Annals of American Academy of Political and Social Science 1992; 521: 28-41
2. Lennings CJ, Copeland J and Howard J Substance Use Patterns of Young Offenders and Violent Crime Aggressive Behavior 2003; 29:414-422
3. Teplin L, * McClelland GM, Abram KM, and Mileusnic D, Early Violent Death Among Delinquent Youth: A Prospective Longitudinal Study Pediatrics 2005; 115: 586-1593
4. Wiesner, M; Michael Windle Young Adult Substance Use and Depression as a Consequence of Delinquency Trajectories During Middle Adolescence Journal of Research on Adolescence 2006; 16:239-254
5. Petrosino, A; Carolyn Turpin-Petrosino, James O. Finckenauer Well-Meaning Programs Have Harmful Effects! Lessons From Experiments of Programs Such as Scared Straight Crime & Delinquency 2000; 46: 354-379
6. Buckner JC, Chesney-Lind M Dramatic Cures For Juvenile Crime An Evaluation of a Prisoner Run Delinquency Prevention Program Criminal Justice and Behavior 1983;10:227-247
7. Freedenthal, S., M.Vaughn, J. Jenson, and M. Howard Inhalant Use and Suicidality Among Incarcerated Youth Drug Alcohol Depend. 2007; 90:81-88
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10. Greenwood P, Zimring F One More Chance: The pursuit of Promising Interventions Strategies for Chronic Juvenile Offenders Santa Monica, CA:RAND, 1985)

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

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