By: Faith Maelzer
More than 10 million people are imprisoned worldwide at any given time, with more than 30 million circulating through prisons each year (1). Meanwhile, 450 million people experience mental and/or behavioural disorders across the world (2). At the intersection of the two, rates of mental illness are disproportionately high amongst the prison populations. Mental illness is 4 to 7 times more common in prison than it is in the community, and in some countries, there are more people with severe mental illness in prisons than there are in psychiatric hospitals (1, 2). The reasons for this are complex and deeply ingrained in social constructs . In Western society, we tend to categorize those with mental illness as “the other” and “a danger” to the public. This is coupled with a tendency to respond to mental illness with punishment instead of rehabilitation, resulting in greater incarceration of individuals experiencing mental illnesses (5). Many mental illnesses present prior to incarceration and are further exacerbated by the stress of imprisonment (6). However, it is also possible for psychological effects to develop over the course of imprisonment as a consequence of the conditions (6). Both cases suggest that we need to take a better look at how we respond to crime and perpetuate mental illness at a societal and systemic level.
Mental Illness and Incarceration
In extreme cases, the symptoms of the mental illness may cause an individual to commit a crime. Some examples of mental states that can motivate criminally aggressive behaviour include paranoid delusions, where people experience heightened fear and suspiciousness, or manic episodes, where cycling between irritability and exaggerated feelings of well-being can occur (5). However, there are complex instances, such as physical and emotional abuse, broken families, poverty, and substance abuse in the home, that are associated both with criminal behaviour and the risk of suffering from mental illness (5, 6). Thus, those who are incarcerated may suffer from mental illness due to problems related to their personal development, but their mental illness is not necessarily the cause of their criminality (5). These life events and the symptoms of a mental illness itself may result in higher rates of unemployment and poverty (7). Financial struggles might force individuals to live in lower socioeconomic neighborhoods that are often overpoliced and report a higher prevalence of crime and substance abuse (7). These living conditions can lead to conflict with the law and perpetuate over-representation of those with mental illness within the criminal justice system (7).
Psychological Effects of Prison
There are harmful aspects of the prison environment itself that negatively affect the mental health of inmates: overcrowding; violence; enforced solitude; lack of privacy; lack of meaningful activity; isolation from social networks; insecurity about future prospects; and inadequate health services, particularly mental health services (2). In some cases, this may be stressful enough to ignite subclinical mental illnesses, but more longitudinal studies are needed following entry into prison to establish this causality (6). Regardless, adaptation to the prison environment is almost always difficult and creates habits of acting and thinking that can be dysfunctional during post-prison adjustment (7). Not everyone who is incarcerated is psychologically harmed by it, but few leave completely unchanged or unscathed by the experience (7). These psychological effects, in combination with the lack of support and stigmas that follow an individual after their release ultimately set post-prison populations up for poor mental health outcomes that likely become echoed in their personal life (7).
Based on The psychological impact of incarceration: Implications for post-prison adjustment. Prisoners once removed: The impact of incarceration and re-entry on children, families, and communities (7)
Is there a solution?
While there is no singular solution, a multi-pronged approach that targets different levels of the intersection of mental illness and incarceration may better serve this population. We need effective and easily accessible mental health services, income support, good housing, and a clear plan for addressing poverty (5,8). Importantly, we must ensure that once someone with a mental illness gets involved with the criminal justice system, they are supported throughout their encounter and after their release. This begins with mental health training for police, continues with adequate mental health care during incarceration, and ends with active planning to support the individual’s release and reintegration into society (5, 8). These solutions are by no means easy, but they are achievable. Getting educated on the topic, checking your own biases, and evaluating how you can incite change within your own community are just some of the first steps you can take today.