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

Research and Recidivism

Four of 10 inmates released from prison are re-incarcerated within three years (Bureau of Justice, 2013; Stephan, 2004). Recidivism rates amongst general population inmates are well studied. Only a few studies have examined the association between psychiatric disorders and the risk of having a single repeat incarceration. State prisoners with a mental health problem (61%) were more likely than state prisoners without a mental health problem (56%) to have a current or past violent offense (James & Glaze, 2006). Among those who were repeat offenders, 47% were violent recidivists (compared to 39% without a mental problem) (James & Glaze, 2006). More recent statistics have indicated that 81% of mentally ill inmates currently in state prisons, 76% in federal prisons, and 79% in jails have prior convictions (FRONTLINE, 2013). There are several hypotheses related to recidivism.

Criminalization of Mental Illness

When the above statistics are considered in context, we see that individuals with mental illness are disproportionately represented in corrections and more likely to fail under correctional supervision (evidenced by rule violation records, longer sentences, and higher recidivism rates). These facts suggest that the mental health community has failed these individuals or that the perceived root of the problem is "criminalization" of mental illness. Criminalization of mental illness refers to the belief that if the mentally ill that are incarcerated had received the psychiatric services they needed, they would not be in trouble with the law (Skeem, Manchak & Peterson, 2010).

The perception of this criminalization as the sole problem has guided the corrections industry to the most logical solution: provide psychiatric treatment as a way of decreasing recidivism. In support of the criminalization hypothesis, one study of 113 jail arrestees with a dual diagnosis of a psychiatric disorder and substance abuse disorder concluded that approximately 8% of their study population had been arrested as a direct or indirect result of their psychiatric symptoms (Junginger, Claypoole, Laygo & Christiani, 2006). These results suggest that the criminalization hypothesis should not be completely discarded (Skeem et al., 2010). However, the hypothesis does not fully account for the link between mental illness and crime. The fact that the strongest predictors of violence and crime are the same for offenders with and without mental illness (substance use), and there being a common third variable of increased social risk factor leading to crime, suggests an alternate hypothesis. Additional study of these predictors may yield a more successful solution.

Social Hypothesis

The social hypothesis is related to lifestyle factors. Supporters of this hypothesis assert that people with mental illness engage in deviant behavior not because of a mental disorder, but because they are poor. Offenders with mental illness are more likely to live in disadvantaged neighborhoods (or are homeless); be under or unemployed; have a history of victimization; and/or abuse substances (James & Glaze, 2006). Poverty situates them socially to live in settings that are rife with illicit substances, unemployment, health burdens, and many similarly marginalized citizens (Skeem et al., 2010). Although each of these variables has been linked with criminal behavior, the extent to which they play a role in this behavior has not been established with research (Skeem et al., 2010).

In support of this social hypothesis, as already mentioned previously, results showed that major predictors of recidivism were the same for mentally disordered and for non-disordered individuals. Yet, mentally ill prisoners had higher recidivism rates or were more likely to reoffend. The social hypothesis suggests this is because, statistically, these prisoners have more risk factors than their healthy counterparts. Further supporting the potential impact of lifestyle choices on recidivism was the finding that psychiatric symptoms have not demonstrated strong correlations with repeat arrests (Callahan & Silver, 1998; Monson, Gunnin, Fogel & Kyle, 2001; Phillips et al., 2005). The strongest predictors of recidivism were prior history, employment problems, and antisocial personality (Skeem et al., 2010). Moreover, studies found that illicit substance abuse was the strongest risk factor for violence; mental illness was not an indicator of violence.