Incarceration And Psychosis

‘I can hear the shouting before I’ve even cleared the gate. Disorganized obscenities and threats mix with stern warnings. There’s fear in everyone’s voice. A patient with mental illness, scared and yelling, is resisting the orders of the correction officers to leave his cell. The exchanges become more heated and tense. The risk of violence rises.’

Is this harrowing quote describing the historic ‘madhouse’ Bedlam, or the early years of Broadmoor prison when it a hospital for the “criminal insane”? Sadly not. These are the observations of Elizabeth Ford when she visited a New York City prison in 2017. Although the openness of discussing mental health issues has definitely improved in the last few years, many members of society – particularly those on the margins, are ignored. This article will look at one of the greatest social outcasts – the incarcerated. 

The World Health Organisation argues that due to prevailing stigmas about the effects and signs of psychosis, as well a lack of services, ‘Prisons are sometimes used as dumping grounds for people with mental disorders.’ According to a study by the Prison Reform Trust, 26% of female and 16% of male prisoners said that they had received treatment for a mental health problem in the year before committing a crime – they point out that this doesn’t account for those who had a mental health problem but were not diagnosed and/or seeking treatment. 

DISCLAIMER – By no means am I suggesting that all prisoners have committed crimes because of a mental health problem, that would be counter-productive as it would not only omit blame from those who consciously break the law, as well as perpetuating the stereotype that people with mental health issues are inherently criminal. However, this piece aims to highlight the lack of resources and heightened stigma projected onto those who do suffer from a mental health problem and commit a crime, and how the environment of prisons can cause others to commit crimes too. In addition, even those who do not enter prison with a mental disorder, may end up forming one during their incarnation. The WHO concludes that this can be caused by a variety of reasons, 

‘overcrowding, various forms of violence, enforced solitude, lack of privacy, lack of meaningful activity, isolation from social networks, insecurity about future prospects (work, relationships, etc.).’

Overall, the PRT’s study found that ‘25% of women and 15% of men in prison reported symptoms indicative of psychosis’ – for a point of comparison, the rate among the general public is about 4%. Hence, the crucial question is, are these people receiving the correct welfare and psychiatric support? Rethink Mental Illness argues that ‘when you are in prison, you should get the same sort of healthcare as people outside prison.’ And yet, the figures seem to paint a picture of opposition.

Firstly, the WHO stipulates that, on average, the suicide rate in prisons in ten times higher than the population. As well as this, a recent investigation by the Prisons & Probation Ombudsman found even more shocking results:

  • Nearly one in five of those diagnosed with a mental health problem received no care from a mental health professional in prison.
  • 70% of people who died from self-inflicted means whilst in prison had already been identified as having mental health needs. However, the Prisons and Probation Ombudsman (PPO) found that concerns about mental health problems had only been flagged on entry to the prison for just over half of these people.
  • No mental health referral was made when it should have been in 29% of self-inflicted deaths where mental health needs had already been identified.

Sadly, these findings are not new, in October NHS Watchdog found that England’s jails were providing inadequate medical care to inmates; in particular, mental health services for the 40% of inmates who had psychological or psychiatric problems was particularly weak. Furthermore, in January of this year, The Guardian reported that self-harm has skyrocketed, in 2018 there were 52,814 cases – 23% higher than 2017. Hence, it is not surprising that activists are angry, Deborah Coles, the director of Inquest, which provides support to people affected by state-related deaths, said to The Guardian,

“The government have long been on notice about the perilous state of our prisons, and yet historically high numbers of deaths are allowed to continue. This is a national scandal. How many more deaths will it take before the government and prison service face up to their duties of care for the health, safety and welfare of prisoners?”

Her opinions were backed by Richard Burgon, Shadow Justice Secretary. The WHO perfectly sums up the situation, prisoners mental health goes ‘unnoticed, undiagnosed, and untreated.’

The next question that must be answered is why? WHO obviously points to underfunded and badly funnelled resources, for instance, ‘the building of separate psychiatric prison hospitals in particular is not cost-effective.’ They are expensive to run, do not allow a large capacity, have low release rates and show no long term signs of benefit. In addition, the CQC, the Care Quality Commission, blames it on ‘chronic understaffing, problems getting to medical appointments and guards knowing too little about ill health to recognise problems.’ This latter point leads to the next, stigma and a lack of understanding. This is epitomised by David Gauke’s, the Justice Secretary, comments in January:

“Violence and self-harm in our prisons is unacceptably high and these figures underline why we are spending an extra £70m to fight the drugs plaguing prisons and boost security, while also training over 4,000 new prison officers in handling the complex offender population.”

Oh yes, why bother investing in services like counselling and rehabilitation when you can just use pepper spray and restraints? 

Although figures show the extremity and scope of the problem, it can be easy to forget that each statistic is a person. All I say is look up the cases of Katie Allen, Jamie Osborne, and Wayne Hurren. Yes, they had all committed crimes, so deserved to be “punished”, however the conditions and lack of care they were subject to was inhumane and led to their deaths.

Not to end on a bad note, what are the solutions? The WHO suggests, 

“Divert people with mental disorders towards the mental health system: Prisons are the wrong place for many people in need of mental health treatment, since the criminal justice system emphasizes deterrence and punishment rather than treatment and care.”

And Deborah Coles argues, 

“Quick fixes have not worked. Bold and decisive action is needed to tackle sentencing policy, reduce the prison population and redirect resources to community services. This is the only way to stem the rising toll of deaths, self-harm and assaults that detrimentally impact on everyone in the prison estate.”

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