Mental Illness and Prisoners: Concerns for Communities and Healthcare Providers

Samantha Hoke, MSN, PMHNP-BC, RN


Online J Issues Nurs. 2015;20(1) 

In This Article

Brief Overview of Healthcare in Corrections

Many people assert that the "right to health" is a fundamental human right, in which any person, regardless of legal status, is entitled to receive adequate healthcare. This right is the driving force behind establishing standards and protocols in the treatment of inmates (Burns, 2011). The World Health Organization (WHO) used this basic right to establish a guide detailing conditions that governments must generate to promote optimum health for their peoples, specifically stating that healthcare in prisons must be improved to better serve inmates. The integration of structured programs to serve populations endemic to corrections, such as persons with substance abuse issues and/or mental illness, is one bridge to provide quality healthcare (Eytan et al., 2010). The goal of these programs is for healthcare providers to ultimately contribute to the rehabilitation of inmates and thus reduce recidivism.

The U.S. prison system often falls short of meeting acceptable standards of care. Reasons may range from lack of resources to conflicts of interest between healthcare providers and security protocols (Exworthy et al. 2012). The U.K., considered more advanced in prison healthcare, strives to improve prison healthcare based on the concept of equivalence. Improvements in prison mental health care are driven by the idea that, whenever possible, healthcare should be equivalent to care available in the community. This concept of equivalence has underpinned efforts in the U.K. to improve prison healthcare (Exworthy et al. 2012).

Both the U.S. and U.K. face limitations in prison settings. The supply of resources and treatment facilities is continuously challenged with the high demand and overcrowding of prison systems. Rates of mental illness and the lack of a clear legal framework for treating inmates with severe mental illness are other challenges to implementing the equivalence model. Identical services provided in the community may not be acceptable levels of care for the complexity of psychiatric cases present within the prison system. Healthcare providers are often restricted by policies and security protocols that limit interventions they may prescribe. These limitations and restrictions suggest a great need for improvement in prison mental healthcare. The next section will explore several factors that affect mental healthcare in prison settings, such as characteristics of the prison population and the impact of politics Box.