|Mental Health Issues in County Corrections vs State Prisons|
|By Joe W. Hatcher, Ph.D., Professor of Psychology, and Shauna Pichette|
A major change in the inmate population over the last twenty years is that they are now much more likely to be mentally ill (see the PBS video The New Asylums for an overview). County correctional populations are also affected by this change, with some reports indicating that mental illness rates in county jails have increased by over 50% in the last five years (Hirschkorn & Mitchell, 2011; Wiener, 2012). In fact, some reports suggest that county correctional populations now carry more symptoms of mental illness than do state correctional populations.
How does the mental health environment for county corrections differ from that of larger state institutions? As I recently transitioned from doing mental health work at a state institution to a rural county institution, I sought articles that would help me prepare for whatever differences exist, but found little that was helpful. This article represents my observations during my first seven months in county corrections, and my conclusion that the mental health environment in county corrections is, in important respects, more difficult for inmates and for staff than it was at the state institution I left.
When I came into the county system I continued the work I was doing in the state prison, mostly running therapy groups and seeing a few individuals for therapy, so I feel that I can make reasonable comparisons between the two settings. My first observation was surprising to me; it seemed that the average inmate in county corrections had more difficulty maintaining mental health than did the average inmate in the state system. They seemed significantly more stressed and more ill at ease, and those with clear mental health issues seemed to struggle more. I have been trying to understand the source of those differences, and have a few ideas to offer. First of all, jail inmates face a situation with many unknowns and much uncertainty. For prison inmates, their environment and their immediate future are fairly predictable. After some initial adjustments, they can settle into a daily routine. Jail inmates, on the other hand, often face uncertainty as to charges, release dates, sentencing hearings, and meetings with probation agents or lawyers, to name a few of the issues that have surfaced in my therapy groups. I have seen this uncertainty breed a strong need for information, and information can be hard to come by in jail. My group therapy sessions are often dominated by inmates talking about probation agents and lawyers who are hard to reach, hearings that are postponed for reasons that are unknown, and charges that are uncertain as to timing and content.
Not having access to the people who actually have the information, inmates often ask security staff for information that staff may not have, and how staff handle the situation can then impact staff-inmate relationships, potentially leaving both frustrated. For example, I have heard inmates say that security staff are “blowing them off” or “don’t care” when staff cannot or do not provide answers to inmate’s questions. On the other hand, I have heard security staff say that inmates “expect too much of us”.
Another source of stress for county inmates is that, while prison inmates may have had time to come to terms with what their imprisonment means to their life, jail inmates may still be experiencing the loss of self-esteem and the embarrassment that often comes with being incarcerated, whether for the first time or “again”. They may also be still transitioning from an environment in which they have a great deal of control (the outside) to one in which they have comparatively little (the inside). My sense is that all of this contributes to the often minute examination that inmates give to how they are treated by staff. I have heard many inmates comment both positively and negatively on interactions with staff that the staff members were later unable to recall. That points to an inmate’s “brittle” sense of self during what can be a difficult time. This may seem to some like it is the inmate’s problem, but an inmate who becomes activated, particularly if they are facing mental health issues, becomes everyone’s problem. It is important to remember the presence of high levels of mental illness in corrections in general and the fact that mentally ill inmates are, according to some reports, involved in up to 80% of inmate attacks on staff. Any issue that impacts inmate-staff relationships is therefore potentially important.
County inmates may also be more stressed because, due to the short-term orientation of county corrections, the institution may offer fewer ways to de-stress. For example, I noticed during my county orientation was that there was no exercise equipment and no exercise area, elements that are standard in state institutions. Inmates sometimes “go for walks” on their unit, but this runs the risk of incurring the ire of other inmates. It is therefore not easy to exercise and “tire oneself out”, which can also affect sleeping. There is also, in our facility, no access to fresh air; only a skylight lets one know whether it is day or night, and I am often asked “what is the weather outside like?” These conditions may seem minor in a stay that lasts a few days to a week, but when stays are for months (and the occasional year-plus), these conditions themselves may lead to increased levels of stress.
Based on my own observations, the difficulties of the county corrections environment are felt especially by inmates already dealing with mental health issues. In general, stress makes whatever problem one faces worse, and I have seen particularly negative outcomes for inmates who have thought disorders such as schizophrenia, or personality disorders such as Borderline Personality Disorder. With some inmates, the latter diagnosis may be associated with the type of hypersensitivity to social interactions with staff that lends itself to activation and behavioral problems.
Finally, the availability of mental health services may also differ between state and county corrections. Although prison mental health departments may be described as understaffed, all prisons have some level of mental health services. Our county facility is fortunate that, due to a grant, we have two and a quarter staff positions devoted to inmate mental health and anti-recidivism efforts. Based on conversations with other staff, however, this is unusual. Most county correctional facilities in our area use their county mental health services to treat jail inmates, and this occurs mostly on an emergency basis. Thus, there may be no non-emergency, on-going mental health treatment for a highly-stressed population that carries high percentages of the mentally ill.
All of this poses a difficult problem for county security and mental health personnel. What should we do? I believe that the first step is to acknowledge that the population of jail inmates has, like the population of prison inmates, become much more mentally ill, and that this state of affairs cannot simply be ignored, especially given the higher rates of staff attacks from this population. A second step is to recognize that the characteristics of county corrections concerning stress and the potential lack of access to mental health services can exacerbate those problems. A third step would be to work toward making changes that would make positive mental health more likely.
What changes would be most helpful? First, I believe it would be beneficial to give inmates better tools for dealing with their stress, perhaps in terms of stress-reduction workshops or organized activities. At our facility we are considering adding donated aerobic exercise equipment such as treadmills to allow inmates to get more physical exercise, which could lead to more positive moods and better sleep. It may also be possible to identify communication bottlenecks to allow inmates better access to the information they need concerning their immediate futures. Finally, better cooperation between available mental health staff and security staff is also important, as awareness of mental health issues facing certain inmates may allow staff to avoid responses that may lead to further activation. To facilitate this cooperation, mental health and security staff must be on the same page; I thus recommend on-site training for all staff on the importance of mental issues within the county corrections environment.
Mental health considerations will be an important concern for county corrections until we come up with better ways to treat our mentally ill local offenders. In the meantime, it is important for staff and mental health workers to work together to deal with the potentially serious stressors of the jail environment, so that inmates and staff can live and work more safely.
Are We All on the Treatment Team? http://www.corrections.com/news/article/28921-are-we-all-on-the-treatment-team-.
The New Asylums, PBS video.
Hirschkorn, P. & Mitchell, R. (2011, January 24). Mentally ill crowd America’s jails. Retrieved from http://www.cbsnews.com/2100-18563_162-7273149.html
Wiener, J. (2012, May 27). Mentally ill inmates on the rise in California prisons and jails. Retrieved from http://www.sacbee.com/2012/05/27/4519117/mentally-ill-inmates-on-the-rise.html
Joe W. Hatcher, Ph.D. is a Professor of Psychology at Ripon College in Ripon, WI, and is a Licensed Psychologist.
Shauna Pichette is a senior at Ripon College majoring in Psychology. Shauna plans a career in corrections mental health.
We would be grateful for any helpful information regarding what any county facilities are doing to address the issues raised in this article. Please address any communications to firstname.lastname@example.org
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