During our nation's extraordinary increase in incarceration rates over the past 30 years, and the increased presence of the mentally ill behind bars, our understanding of what occurs inside our nation's prisons and jails decreased profoundly.
The recent reports of abuses of mentally ill prisoners on Rikers Island have brought this issue to the forefront of the agendas of New York City policy makers and correctional administrators. Over $47 million has now been allotted to security measures and specialized programs for mentally ill inmates.
But these abuses, which in some cases resulted in the deaths of inmates, highlight how little we understand correctional institutions.
During a press conference in which he discussed the city's response to the abuses at Rikers Island, Bill De Blasio, New York's mayor, summed up the lack of understanding by stating: “For most people, (jail is) an abstraction, literally isolated from the rest of the city.”
But research I began nearly a decade ago suggests a policy approach that can address this isolated correctional culture.
In 1996, I walked into a walled city, where 2,000 men lived in massive five-story cell blocks, housed together in 5×8-foot cells, and managed by 500 staff members. This city was Oregon State Penitentiary, the state's maximum security institution.
Along with a team of mental health professionals, I had been hired to implement a mental health program to treat severely mentally ill inmates. I was to provide intensive outreach within the cell blocks, engaging with inmates and correctional officers.
It was to be the first comprehensive mental health program in the institution's history.
I learned that effectively providing mental health treatment in prison was dependent on establishing collaborative relationships with front-line correctional officers. This could only occur by establishing my credibility among staff and prisoners—through demonstrating, case by case, that our mission would benefit not only the inmates who needed treatment, but also the safety and security of the prison.
We had to integrate our treatment programs into the culture of the prison by learning about the work of officers, the lives of inmates, and the culture of the prison.
By engaging officers and inmates, the culture of the institution changed.
Staff were less likely to assume that inmates were faking symptoms, that treatment didn't work, or that disciplinary segregation or supermax placement was the only suitable solution for special needs inmates. Officers were more receptive to our presence on the cell blocks and more willing to engage in collaborative approaches to managing inmates.
And inmates were more likely to ask for help when they needed it. Inmates who had formerly been locked down in segregation were allowed to join the general population, working, programming and receiving treatment.
After leaving state service, I returned to Oregon State Penitentiary in 2008 to conduct federally funded research. The goal was to identify institutional factors that can be leveraged by staff and inmates to ensure the psychiatric stability of mentally ill inmates. I returned to the cell blocks, observing and interviewing prison staff and severely mentally ill inmates for nearly a year to identify what worked within this particular prison.
As a result of this research, here are some suggestions for approaching correctional policy in the treatment and management of mentally ill inmates:
- Institutional safety and security and ensuring mentally ill inmates receive appropriate services are not contradictory missions. Correctional officer must learn to identify symptoms of mental illness, establish collaborative relationships with mental health staff, and manage and maintain institutional safety and security. Psychiatrically stable inmates are less likely to be suicidal, homicidal, or security risks.
- Mental health professionals must learn the culture of corrections, and identify how best to implement evidence based treatments such as psychiatric medications, cognitive behavioral therapy, and psychosocial rehabilitation within the structures of prison rules, and regulations.
- Each mentally ill prisoner's management must be approached collaboratively through security, mental health and medical services. Collaborative efforts necessarily include multi-sector participation to ensure that severely mentally ill inmates' treatment and management is conducted effectively.
- Mentally ill inmates' psychiatric stability is dependent on safe and appropriate housing, interactions with non-predatory inmates, supportive interaction from staff, supervised employment, and access to institutional programming. All aspects of mentally ill inmates' institutional lives must be leveraged by staff to ensure psychiatric stability and subsequent institutional functioning. This can only occur through collaborative efforts across institutional staff.
Mayor de Blasio has urged a “culture change” in his city's correctional institutions; but unfortunately, we don't know enough about our nation's prisons or jails or the work of officers and mental health staff to even characterize the prevailing cultures in these institutions.
More public discourse, research, and transparency within our nations' correctional institutions is necessary to ensure appropriate treatment and management of the incarcerated mentally ill.
Engaging in targeted and policy-driven research on effective management of mentally ill prisoners is critical, along with disseminating that research across state systems. Most importantly, training of front line staff in how to collaboratively and effectively manage mentally ill inmates is desperately needed before more abuses and deaths occur within our correctional institutions.
Institutional cultures that prioritize safety and security for inmates and staff through appropriate training, access to evidence based treatments, and pro-social interactions within the institution are the foundations of effective correctional management.
If we want to ensure safe institutions that effectively treat the incarcerated mentally ill, the culture of corrections must change.
Joseph Galanek, PhD, MPH, is a Research Associate at the Begun Center for Violence Prevention Research & Education at Case Western Reserve University's Jack, Joseph, and Morton Mandel School of Applied Social Sciences. Dr. Galanek's research and evaluation activities have been funded by the National Science Foundation, the National Institute of Mental Health, and the Ohio Department of Mental Health. He welcomes comments from readers.