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Mental Health Issues in County Corrections vs State Prisons
By Joe W. Hatcher, Ph.D., Professor of Psychology, and Shauna Pichette
Published: 08/13/2012

Mentalhealth s 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.

Articles consulted:

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 hatcherj@ripon.edu

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    The article provides an introduction to the jail / prison differential in mental health issues. However, there are several points that were not included. Every state has its own unique population demographics and the impact of those factors on the correction population can also be unique. None the less, estimates of the number of inmates with mental illness are often inaccurate. These inaccuracies have variable sources: definition of mental illness, political climate, motivation for funding, etc. The first consideration is how mental illness is defined (Axis I vs. Axis II). The Axis I diagnoses self-declare fairly clearly and usually do not provide any difficulty in assessment (treatment being another issue). The Axis II problems are much more of a difficulty as they do present with ‘symptoms’ prompting assessment and potentially a need for intervention. These are also the individuals who provide the most difficulty for correction staff. On assessment, Axis II clients often have little or no consistent community treatment history other than non-compliance. Another issue is the number of individuals who are withdrawing from a variety / combination of substances. These people (post initial withdrawal) present with a variety of affective symptoms because they lack coping skills. The same type of adjustment reaction actually occurs with many individuals (with / without mental illness). People who are removed from their usual activities, housed with others they don’t know, at risk from the legal system, unable to interact with their family and distressed by inadequate information. During my exposure to correctional health care (now approaching 21 years) the number of individuals with mental illness does not reach 50% (as often reported). The actual number seems closer to 30 – 35% (about three times the community rate) of the population with a verifiable established diagnosis of mental illness. Inclusion of those with true Axis II issues may add another 5 – 10%. Law enforcement, at least in our area, trends towards bringing an individual with unusual behavior to the jail – let them (corrections) sort it out. They are intent on returning to community patrol rather than staying in the ED for hours. Correction officers are frequently unaware of any mental illness concern (or pressured into accepting the arrestee). Once incarcerated, access to community facilities for mental health care becomes quite restricted for these individuals. Most jails are short stay facilities (excepting facilities in some states that are ‘House of Corrections’ and may hold individuals for longer periods). The staffing and services are based upon a transient population that has an 11 – 14 day average length of stay. Therefore, interventions are focused on medication stabilization, suicide risk reduction and focused therapeutic interventions – groups and individual therapy are infrequently available / effective. Additionally, the length of time required to access records of community care results in the individual being released before the records received. All in all, providing care for individuals incarcerated in jails is an exciting and challenging prospect.

  65. afbjab on 08/24/2012:

    I concur with the statements of Mr. Kehoe. The Criminalization of Mental Illness is a fact of life for correctional administrators both at the jail and prison. Large detention facilities are more adept in managing the mentally ill, but there are a myriad of issues, one of the most significant is that correctional personnel for the most part have not been trained and/or educated to handle the mentally ill. There are two books which might provide some insight for those interested. The first is Pete Earley's book entitled, Crazy, which describes his trials and tribulations when a family member who is mentally ill gets involved with the CJS. The second is a book by Carolina Press (sorry can't remember the authors) entitled, The Criminalization of Mental Illness. As usual, education institutions are behind the times in presenting information to students entering the field of how to manage those whom are mentally ill and confined. Thanks for the article. It is a well written piece.

  66. Fred Davis on 08/14/2012:

    Empathy: 1903, from Ger. Einfuhlung (from ein “in” + Fuhlung “feeling”), coined 1858 by German philosopher Rudolf Lotze (1817-81) as a translation of Gk. empatheia “passion, state of emotion,” from en “in” (see en-(2)) + pathos “feeling” (see pathos). A term from a theory of art appreciation that maintains appreciation depends on the viewer’s ability to project his personality into the viewed object. (www.etymonline.com) What I find interesting here is the left out fact that empathy is merely projecting one’s own personality into the subject. This is dangerous indeed since empathy requires an individual to take on the personality or ideology of another. Empathy is just as dangerous as sympathy. Sympathy enables the wrong in another person, and empathy robs another person of grace or being his own self through conforming or rebelling. How awful is that! They must be proselytized into another’s religious beliefs or secular ideology through another’s passion, state of emotion, or feelings. This is dangerous indeed for an inmate! It negates the other individual from thinking for his self, just as a drug keeps one in a hypnotic state. Just as AA or false religions that can become cultish keep the sheeple controlled and following the leader, empathy does the same thing and blocks one from thinking for themselves. I deliberately put the definition at the beginning of this post for a reason. Those on medication are so strong because of pent up resentment and anger, and this anger projects an aura or miasma that is like a magnet that draws in everything that is wrong. When I was in prison, I had to share a cell with a Seventh-day Adventist, and he zapped on me and started banging on the door of the cell for a guard to get him out of my cell or he would kill me. I knew he was hot air. It was the projection of an ideology that was placed in him, and his anger was not really him. I told him that he needed to calm down, and that no guard was going to move him around, and he would have to live with me and deal with life. This guy was really getting crazy, and the crazier he got, the more I began to laugh at his anger and he was just turning red. He had these religious items in the cell, and a couple of the idols fell over as he was yelling at me. I told him I am sorry that his gods fell over and he didn’t take that lightly. The reason he was angry was because he could not place his personality or use empathy to cause me to take on his ideology or bitterness. I knew he was sick and that it was not him that resented me but what was in him through ideology. He finally settled down and still they would not let him move. I was glad they didn’t because I was able to tell him that I couldn’t forgive him because I am not God and that only God has provided for forgiveness and I had never made a judgment against him. Empathy is active projection and can be more dangerous in a long run than sympathy for a time. If a person uses empathy then the one using that concept is projecting their own personality and belief systems into another and people are not objects to be controlled by intimidation or false love. Empathy is a form of intimidation and sympathy is feeling someone else’s pain which is impossible unless one has been down that same road of incarceration. A guard cannot have sympathy because most shake their wooden heads at inmates as if they are less human than themselves. There is some self-righteousness here and drugs inhibit spiritual growth and allow an opening for projection through empathy.

  67. jamestown0509 on 08/14/2012:

    Good topic and article. Unfortunately most facilities, county, city, local lockups cannot afford professional psychiatric services unless it is provided through a mental health program. What we have seen in corrections is a huge influx of mental health patients who have been released from state mental health hospital closures. This trend is going nationwide due to the costs of providing mental health care. As a result these mental health patients end up on the streets un-medicated and very dangerous to the general public. As shown in the article some of these mental patients when incarcerated are extremely violent due to them not being on meds for a long period of time. This creates problems for officers who have to book them in, move them to units and supervising them. The true statement about these inmates is their ability to be physically stronger than normal persons thus it takes quite a few officers to subdue them when they get upset. When a facility has a mental health forensic unit it greatly improves the safety for the officers and staff working there. Again when these inmates are released from such facilities they go into the public forgetting or refusing to take meds and the cycle continues.

  68. Fred Davis on 08/13/2012:

    Removing stress can remove healing. Stress can "heal" if handled properly or it can "kill" through disease manifesting at a later interval. This is why cancer rates are climbing among females with breast cancer. Setting goals creates stress in a negative way instead of learning to deal with "life" as life sees fit to test us. There is nothing that can come to someone in life by "accident." There is no "good luck" or "bad luck". Everything has a hidden agitator or irritant that will bring forth a pearl of great price or kill the oyster. That depends on how resilient the oyster or the human being is in the test. This is exactly why our veterans are in such trouble today. They are taught the "run" or "fight" options but not the "rest of the story". They become "bitter" at the enemy and take on the enemies' "traits" or the could be healed or "better" by not "resenting" the enemy no matter what. The "bitterness" locks one into "bondage" as the fulfillment in the Stockholm syndrome as the ideological spore of the adversary begins to grow in the veteran as a “seed”. Drugs help that spore to grow. This is "not good." Circumstances cannot stress one unless one is sensitive to environmental storms. We need "de-sensitivity" training and learning how to stay calm and do what needs to be done. The socialist deliberately agitates and creates division among groups on purpose and he gets elected by that very principle. Fifty years ago we "as Americans" once "resented" a socialist/communist and look what has been happening as of late. We as a collective DESERVE what is over us. The Stockholm Syndrome manifested today. What we once resented as Americans we now "appease" the individuals propagating that exact same ideology. Resenting our government is the problem today. We are blaming them for what we as a collective did just as the other officer blamed his senior for the issue of porn on the computer

  69. Fred Davis on 08/09/2012:

    A friend of mine, Professor Robert Herrmann PhD. once told me that part of his job was to use statistics to prove a point. He told me that he was an expert at such, and he was. He proved that Einstein's theory of Relativity was not accurate and he could verify such with his mathematical model. He made enemies among his own "brethren" in his field, because he had a different view. Sometimes the status quo is wrong.

  70. Fred Davis on 08/09/2012:

    Maybe we could redefine mental health facilities as insane asylums. That is the way to do it. If we arbitrarily put new names on things or politically correct titles that changes the reality.

  71. Fred Davis on 08/09/2012:

    One must also take into consideration that a mental illness boils down to "wrong a belief system" or imprinting not based in reality in a partial way or totally.As those on the top of this pyramid in the legal drug trade "redefine" different "illnesses" and multiply these "illnesses with various definitions" on a daily basis, there surely will be a "new legal drug" presented as a "cure all" while keeping the "healing" suppressed. Illegal drug dealers can do the same thing.Using drugs whether "illegal" or "legal" because of addiction causes the "victim" to look up to his master as sort of a "mother with a PhD" who comforts the "pain" or "anxiety." Those "legal" drug industries would rather the "useful idiot"stay sick. By "multiplying" new illnesses by definition arbitrarily everything that the status quo believes in right now as an illness the "victim" will need someone with a PhD to "help". In Virginia at the present time the Governor may be heading into massive "costs" through "lawsuits." Trial lawyers will be "fatter" economically and the mental health industry has many individuals as well as political groups that would NOT praise how no "due process" is being used in some of these facilities right now in Virginia. Just a "thought". Virginia will be "blessed" now but wait until the governor foots this bill. He will be "cursed" and gone from office then.

  72. charleskehoe on 08/09/2012:

    This is an interesting and well written article. I think it is one that should be shared with correctional trainers and mental health professionals. I would say, that for the purpose of clarity, instead of saying "county jails," we may want to use the term adult local detention facilities or local detention facilities since some cities across the United States operate jails, as well. Virginia is a good example of a Commonwealth (state) that has many city jails. Richmond, Virginia is a city that is blessed to have an excellent Mental Health Agency that is deeply involved in the criminal justice system.

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