Approximately 2 million times per year, individuals who have serious mental illnesses are incarcerated across the nation. According to the Stepping Up Initiative, it is estimated that three-quarters of these adults also have problems with drugs and alcohol.
Once individuals with these conditions are incarcerated, they tend to stay longer in jail and are at higher risk of recidivism once released; and so, the cycle of incarceration begins.
The “New Asylum”
Serious mental illness or “SMI” diagnoses have become so common across the nation in the corrections system that jails and prisons are frequently viewed as “the new asylums.” Countrywide, an estimated 20% of inmates in jails and 15’% of inmates in prisons are diagnosed with an SMI (Steadman et al, 2009).
Why are so many jails becoming the de facto home for those with serious mental illness?
Some experts point to deinstitutionalization in the 1970’s, when state psychiatric hospitals, many with unacceptable living conditions, closed their doors. Mental health care was expected to shift to community-based settings.
However, many of these community resources did not materialize, leaving many former psychiatric patients without adequate access to care and treatment.
Experts have also pointed to law enforcement policies as having an exacerbation on the problem. For example, individuals who are homeless and arrested for such offenses as trespassing often see the correctional system as a revolving door. Moreover, seriously mentally ill inmates may remain in jail longer because they often can’t afford even low bail amounts, without access to adequate resources.
The Crisis at Hand
Based on a survey conducted between 2011 and 2012 by the US Department of Justice, it was reported that 44 percent of inmates in jail had a history of mental health problems, including depression and bipolar disorder. This is a staggering number. Not only with implications for mental health care, but also for correctional staff.
Many small jails in remote areas do not have access to adequate staffing levels and resources to train their staff. For many correctional staff who have been on line for over a decade, the idea of “treating” individuals with mental illness and their role in the matter may be foreign and even a bit undesirable. How can correctional staff, who have not been trained to work with mentally ill offenders, step up to the challenge?
Training, training…and more training. Research suggests that advanced training in “Crisis Intervention Techniques” or “CIT” training for staff involved in law enforcement and corrections leads to improvement in overall attitudes towards work and a reduction of stigmatization towards those with mental illness (Compton, et al 2006).
CIT training may involve topic such as non-verbal communication skills and de-escalation techniques as well as understanding signs and symptoms of mental illness. Mental illness may affect how a person communicates and perceives different situations. A person who is under the influence of drugs may present with erratic behavior and have a difficult time following rules and interacting with others. It is estimated that 90% of all emotional information and over 50% of the total information in spoken English is communicated not through words, but by body language, especially tone of voice (Elgin, 1999).
By providing correctional staff with education and training, regarding crisis intervention techniques, we are decreasing the likelihood of a “use of force” and increasing the likelihood for a less confrontational outcome. CIT trained staff not only perceive themselves as less likely to escalate to the use of force in a hypothetical mental health crisis encounter, but report improved job satisfaction (Compton, et al 2006).
Arming correctional staff with these necessary communication skills not only provides education, but empowers them to choose which tool to use from their toolbox in any given situation. When we educate and empower staff, we increase overall job satisfaction and safety.
Afterall, isn’t custody and care for all, what we are striving for?
Compton, M.T., Esterberg, M.L., McGee, R., Kotwicki, R. J., Oliva, J.R. (2006). Brief reports: crisis intervention team training: changes in knowledge, attitudes, and stigma related to schizophrenia. Psychiatric Services 57:1199–202. Retrieved from: https://ps.psychiatryonline.org/doi/full/10.1176/ps.2006.57.8.1199?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
Elgin, S.H. (1999). Language in emergency medicine: A verbal self-defense handbook. Bloomington, IN : XLibris
Rogers, M.S., McNeil, D., Binder, R. (2019). Effectiveness of Police Crisis Intervention Training Programs. Journal of the American Academy of Psychiatry and the Law Online, 47(3).
Steadman, H.J., Osher, F.C., Robbins, P.C., Case, B., Samuels, S. (2009). Prevalence of serious mental illness among jail inmates. Psychiatric Services, 60(6), 761—765.
The Stepping Up Initiative (2019) . Retrieved from: https://stepuptogether.org/the-problem
U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics (2017). Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12. Retrieved from: https://www.bjs.gov/content/pub/pdf/imhprpji1112.pdf