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

Conclusion: Implications for Practice

Current Efforts to Reduce Recidivism

Although it is hard to compare, the most common programs that have led to recidivism reduction have been substance abuse treatment, education, and employment services. However, there are an abundance of programs in action.

The Bureau of Prisons philosophy is that preparation for release begins the first day of imprisonment. It is a responsibility of the Bureau to provide inmates with skills needed to lead crime-free lives after release. Structured programs such as education, vocational training, institutional jobs, substance abuse treatment, parenting, anger management, counseling, recreation, faith-based offerings, and other programs teach inmates essential skills necessary for successful community reintegration.

The goal of inmate programs is to assist in rehabilitating convicted felons into law-abiding citizens in order to decrease rising costs associated with recidivism. Research has demonstrated that these programs play a major role to improve public safety. Of note, inmates enrolled in the Bureau's Federal Prison Industries (FPI) program, where inmates are employed in factories and are compensated, has 1) significantly reduced recidivism in comparison to study control group members, 2) demonstrated that inmates are more likely to be employed during their first year after release, and 3) demonstrated that the inmates earn higher per average wages than counterparts not enrolled in the program. Inmates enrolled in education programs demonstrated a significant decline in recidivism rates. Those enrolled in the residential drug abuse treatment programs (RDAPs) (an intense half-day treatment program 5 days a week, for 9 months followed by enrollment and another inmate program for the remainder of the day) were significantly less likely to recidivate or relapse to drug use for at least three years as compared to similar non-participating inmates. These programs do not typically enroll a high population of mentally ill inmates. However, it is likely that these programs would be beneficial as research has demonstrated that reasons for recidivism were similar among general population and mentally ill inmates. (Federal Bureau of Prisons, 2011).

Other community efforts aim to reduce recidivism by diverting nonviolent mentally ill individuals away from correctional institutions and towards community based mental health services. There are two major types of diversion programs, prebooking and postbooking. Prebooking programs are based on formal liaisons between law enforcement and mental health personnel that are designed to resolve psychiatric emergencies without resorting to arrest. One example of prebooking is crisis intervention teams. These teams include specially trained officers who redirect individuals to treatment rather than through the justice system.

Postbooking programs, on the other hand, aim to divert mentally ill offenders to community resources after they have been arrested. One promising postbooking program is the mental health court. The mental health court is utilized to transition nonviolent mentally ill individuals from prison to supervised treatment programs. Evidence reveals participation in a mental health court is correlated with longer periods without criminal recidivism (Baillaregeon et al., 2009).

Additional Implications for Mental Healthcare

To address mental health concerns for prisoners, health providers need to educate the public about mental illness in general, and in this population. National movements, such as the National Alliance on Mental Illness, that encourage mental health public awareness should also provide information pertinent to the inmate population and their challenges.

Parole officers should receive specified training about mental illness to support their efforts as a resource to avoid recidivism in released prisoners. Parole officers are often inundated with inmate caseloads beyond what they can handle. For inmates with mental health concerns, parole officers assume a role similar to that of a hospital case manager. These officers would likely benefit from smaller caseloads with time assist parolees to access appropriate services, such as day programs and home services.

National level emphasis on mental health concerns remains a necessity and should include specific directives that address the inmate population. Community programs that provide housing and employment opportunities could supplement national initiatives. Healthcare providers can advocate for funding and emphasize the financial relief correctional facilities would likely gain by providing a stable environment to support inmate mental health needs and decrease costs associated with decreased recidivism.

Despite correctional challenges (segregation, suicide, drug abuse), inmates are provided housing, employment, psychiatric treatment, and a controlled environment inhibiting substance use while behind bars, thus eliminating social risk factors that may contribute to both the primary incarceration and recidivism. Healthcare providers can and should continue to educate the public to reduce the stigma of mental illness. Mental health concerns and high recidivism is a self-made public health crisis that can be transformed. Use of current evidence to support community level mental healthcare can lead to initiatives to avoid incarceration and decrease recidivism.