Running head: PRISONERS AND MENTAL HEALTH 1

Mental Health Concerns Among Prisoners

Abstract
There is no doubt that the United States has been reported to have among the highest

incarceration ranks throughout the world. Many inmates who have been charged with crimes or

who are currently incarcerated suffer from mental health issues, which has created a huge public

health concern. Offenders with mental health issues are dumped on the criminal justice system,

which is quick just to arrest them and lock them up. Many offenders, who suffer from mental

health issues, lack the proper care and treatment that they should receive because they are

incarcerated. If their mental health issues were addressed and treated accordingly, this could help

reduce the incarceration rate and recidivism rate among offenders in the United States.
PRISONERS AND MENTAL HEALTH 2

Introduction

Offenders with mental health illnesses are being incarcerated for committing crimes due

to their mental health illnesses, instead of being properly assisted and provided with mental

health treatments while incarcerated. Studies show that more than 20,000,000 Americans are

currently or have been incarcerated (Al-Rousan et al., 2017). This is considered to be the highest

rate in the world right now (Al-Rousan et al., 2017). Many problems arise because of this issue.

According to researchers, inmates diagnosed with serious mental illnesses are overrepresented in

United States prisons at a rate from 2-4 times the general population (AlRousan et al., 2017).

Research has also been found that there are now 10 times more individuals who suffer from

Serious Mental Illnesses in prisons and jails as opposed to in state mental hospitals (Al-Rousan

et al., 2017). So, what does this show and mean? This clearly shows and means that inmates in

jails and prisons need more attention, proper assistance, and treatments to cope with their mental

illnesses, so when they are released back into society, they won’t make wrong decisions and

increase the recidivism rate. This also, will help them to adjust and cope better with being

incarcerated and help them treat faculty and staff of prisons and jails a lot better. Although

inmates may have committed violent crimes, they should not just be incarcerated for that. Many

of their mental illnesses drove them to commit violent crimes, which should be addressed and

dealt with accordingly in jails and prisons and not just put to the side because of the criminal act

they committed.

History of Prisoner Mental Health in Social Welfare

The offering of social welfare services has been part and parcel of the prison system for

more than a century, and it all began with the pleas by Kenneth Pray—a former academician.

Kenneth was instrumental in championing for the involvement of social work in prisons and has
PRISONERS AND MENTAL HEALTH 3

adequately enumerated the purpose and need for such professions within the correctional system

(Pray & Towle, 1945). Regrettably, even after the impassioned pleas by Pray, social welfare

within the prison system has taken an ambivalent stance mainly because of the contrasting

opinions between the prison institution and the social welfare profession (Matejkowski, Johnson,

& Severson, 2014). Nonetheless, the unique skill set that students of social welfare possess has

seen increased demand after the explosion of the population in prisons and the increased

jurisprudence from the federal courts (Matejkowski, Johnson, & Severson, 2014).

The interface of social welfare and the promotion of mental health and treatment are

rooted in the first occurrence of social work as a profession. Social workers are involved in all

aspects of humanity’s mental well-being, stretching from the asylum to the establishment of

community-based interventions, counseling both clients and their families. Social welfare

advocates public programs and funding that leads to the alleviation of mental illness in parity

with physical illness. Social workers have collaborated with other professionals to interrogate

and conceptualize theories of interventions and etiology which, have over the years, been tested,

amended and polished through practice and further research on that practice. Social work has had

a contemporary outlook that focuses on the bio-psychosocial—concerned with how the

individual interacts with their environment (Social Work Policy Institute, 2017).

Social welfare within the correctional institutions is primarily concerned with providing

quality care for the incarcerated as is succinctly stated in the policy statement published by

Wheeler and McClain (2015). The publication by Wheeler and McClain (2015) elaborately

codifies the policies applicable to social welfare work for the prison population. It challenges the

social welfare workers to assist the prison population in acquiring culturally competent treatment

for illnesses touching on mental health and substance abuse. Moreover, it champions for the shift
PRISONERS AND MENTAL HEALTH 4

in policy to ameliorate the disproportionate imprisonment of undocumented individuals, women,

juveniles, and racial minorities and the provisioning of improved healthcare, rehabilitation, and

medications for the whole prison population.

Community Profile of Cook County Jail

The prisoner mental health issue under investigation would be focused on the Cook

County Depart of Corrections. It is located on about 90 acres of land and is one of the largest

single-site pre-detention centers in the United States. The Cook Jail holds pre-trial offenders and

is said to turnover more than 100,000 male and female offenders every year. The prison

population, in a day, averages about 9,000 detainees. The Cook County Department of

Corrections has ten departments: four on-site Sheriff departments, commissary agency, a private

food service, two departments of education, and a health services facility. And in each of the ten

divisions, there are living units for offenders, a staff office, a multi-purpose room, a law library,

a dispensary and a detainee visiting section (Cook County Sheriff, 2017). Its demographic

consists of detainees who are either mentally ill, belong to a gang or are poor. One in three of the

Cook Jail inhabitants suffers from a mental health condition. With about 400,000 inmates in the

United States suffering from mental illness Cook County leads the way with about 30% of

mentally ill residing in the County Jail. If these numbers are anything to go by, the jail may be

considered as the largest mental health facility in the United States.

Description of Service Techniques Used to Resolve the Prisoner Mental Health

Problem

The social worker has many roles when it comes to offering services in the correctional

facilities. Social workers are the people who assess new inmates or detainees; they create a plan
PRISONERS AND MENTAL HEALTH 5

for treatment and support, they provide psychosocial educational support groups and

individualized therapy, assign referrals to mental health institutions, and monitor the treatment

progress of detainees and inmates. Above these main functions, they are also tasked with writing

progress reports, documenting health progress of detainees, and using this information, they

present their findings in social work forums (Matejkowski, Johnson, & Severson, 2014).

Many world prison systems have an initial assessment of incoming detainees and

inmates. It comprises a battery of interview and psychological tests by social workers and other

medical professionals to establish if there are any acute mental problems —that is, suicide

ideation, depression, psychosis—or chronic mental problems —that is substance abuse,

manifestations of trauma both current and history. During this step, the social worker must

determine if the new prisoner is eligible for mental health treatment. It is imperative that the

social worker also plans for the prisoner’s discharge. The latter task is a rather hard endeavor

considering that a majority of inmates in the United States who are released find their way back

to prison (Durose, Cooper, & Snyder, 2014). And the number of inmates released per day totals

to over 1,600 prisoners (Travis, Solomon, & Waul, 2001).

After the assessment, the data collected aids social workers in developing treatment and

intervention plans. It is imperative that the intervention plans be considerate to the unique needs

of an individual. Nonetheless, the strategies may include an amalgamation of case management

services, participation in a specialized treatment group, and counseling. Evidenced-based

research by Bauserman et al. (2003), Hesse, Vanderplasschen, Rapp, Broekaert, and Fridell

(2007) and Wilson (2013) looked at case management strategies reviewing the interventions

developed for prisoner instances of substance abuse, HIV prevalence and mental illness and

discovered that the application of case management initiatives had a moderate effect on linking
PRISONERS AND MENTAL HEALTH 6

prisoners to the appropriate treatment plans. Case-management has been found to be an excellent

alternative in aiding inmates in handling mental health issues as well as other incarceration-

related illnesses and shortcomings.

An overriding theory that assists social workers to treat mental health cases is the

psychodynamic theory. It applies Freud’s mode of treatment referred to as psychoanalysis. The

theory posits that social workers should focus on the processes within an individual; but in

reality, the focus goes beyond this framework. The context and the surroundings of the

individual are part of the process. Social workers are fond of applying this framework since most

of its approaches emphasize on the surrounding a person is exposed—a key technique necessary

for treating mental illness. The theory enables social workers to identify an individual’s

relationship with others and the demands placed on the individual from their surroundings. The

theory has aided in the conceptualization of psychosocial interventions. The application of this

informational and interpersonal intervention plan guarantees that the social worker is able to

target the environmental, social, interpersonal, emotional, cognitive, behavioral, and biological

factors that affect the inmate and consequently aim at improving their mental well-being

(Institute of Medicine, 2015).

Factors Affecting the Delivery of Services

Traditionally, correctional services and social work have had an uneasy alliance (Reamer,

2004). The uneasy alliance is attributable to the varying philosophies, principles, and values

(Mazza, 2008; Patterson, 2012). Kita (2011) additionally observed that the ideology or

philosophy governing the prison system is not compatible with social work’s emphasis on

enhancing the prisoner’s fit to their environments. As a result, there is some friction between

social workers and the correctional institutions. And as Patterson (2012) concluded, the friction
PRISONERS AND MENTAL HEALTH 7

is exacerbated by the strict philosophical adherence by some prison wardens that social work

values are irreconcilable with prison values. Such divergent values and principles create conflict

situations between the social workers and the correctional institutions. The strain on the social

workers limits the efficacy of the mental health interventions and hence the deteriorating mental

health of inmates experienced across the United States prison system and particularly the Cook

County Jail.

However, even with all these drawbacks the Cook County Sheriff has gone against the

grain and hired a professional psychologist to head the institution. This has in effect brought

about a change in philosophical leanings, and the new warden has relied on social workers to

improve the mental well-being of the detainees. The location of the Cook Jail in a state with one

of the highest murder rates promotes mental strategies to reduce recidivism. Moreover, they have

incorporated technology into the proposed interventions improving the mental outcomes of the

correctional facility, albeit still below the intended target. Notwithstanding, the differing staff

roles as both a correctional and clinical staff member comes with its own strain. Johnson (2008)

commented that role conflict, ambiguity, and incongruity defocus’ the mental health initiatives.

Types of Professional Training and Licenses/Certifications Required

A social worker working in the justice system requires a master’s degree in social work.

But a bachelor’s degree provides one with an opportunity to work in the correctional institution

although under the supervision of a social worker with more credentials. For individuals focused

on providing clinical services for mental patients, they will need to be licensed. Licensing is

regulated at state level, with each state having its licensing board that determines the

requirements. However, a Master’s in Social Work from an accredited program is a prerequisite

for being licensed. It may also require one to sit for a licensure exam and completing a required

number of professional experience hours.

A typical day for a social worker start early in the morning and ends early. The first tasks

involve filling out paperwork like signing prisoner notes and filling out treatment plans.

Thereafter, new detainees are evaluated and processed into the system. After the administrative

part is done, now comes the hard part of dealing with mental health clients. Clients either come

in groups or as individuals. This is done in sessions: the morning session and the afternoon

session up until 3:00 pm when the count is done.

Summary of Impressions

Daniel (2007) remarked that this is the age of mass incarceration and prisons have taken

up the responsibility of mental hospitals since they diagnose more mentally ill individuals than

the psychiatric hospitals across the United States. Consequently, social workers come into

contact with detainees and inmates that may require better mental health alternatives than the

ones presently offered at most Jails. It is advisable that today’s prison systems approach the

mental problem from a community perspective model, whereby the family members and

community are engaged in treating the mentally ill prisoners particularly when they are released

back to the society.

The Cook County Jail has taken a positive step forward in promoting the mental health of

its detainees. The shifting of philosophy and the hiring of a psychology major as the head of the

prison indicates that the correctional facility is ready and willing to deal with the mental health

problems. The Chicago society has also offered positive support to ameliorating the problems by
PRISONERS AND MENTAL HEALTH 9

being involved in the re-integration of released offenders to ensure that they do not suffer from

shocks—that is, interventions that reduce anxiety and provision of income-generating activities.

Social Justice and its Relation to Prisoner Mental Health

The provision of mental health care in prisons like the Cook County Jail has a direct

causal effect on the mental health outcomes of the incarcerated population (Smith & Braithwaite,

2016). Additionally, effective connections to a variety of services after the release of a prisoner

and helping them to reintegrate back into the community are essential to reduce the rate of

recidivism. Even with all these measures in place, the mass incarceration practice in the United

States appears to be disproportionate with more of the inmates coming from the minority groups.

This in effect means that the minority groups are more susceptible to mental illness. Although

there might be some form of interventions to deal with these mental issues when incarcerated,

the same is not availed upon release which brings with it an increased risk for the former

offenders and the community in which they are released (Smith & Braithwaite, 2016). On the

other hand, at the core of social work is social justice which is codified under the NASW code of

ethics. It envisions a promotion of human well-being and the achievement of basic needs for all.

It pays particular attention to vulnerable groups and looks to empower and ensure the provision

of their needs.
PRISONERS AND MENTAL HEALTH 10

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