Mental Illness and Prisons: A Case for an Epidemiological Criminology Framework

Prison can be viewed as a social microcosm of people, who, in many situations are often: psycho-socially delayed, morally impaired, and run the risk of compromising their safety by confronting their mental illness. Due to the paramilitary structure of the prison setting, many inmates experience pressures to mask their mental illness for fear of peer rejection, and often learn to cope with their issues by engaging in a variety of unhealthy behaviors (i.e. substance abuse, unprotected sex, and violence). To compound this issue further, the symptoms of some mental illnesses can serve as protective mechanisms in a prison setting (e.g. hypervigilance, destructive attention seeking behavior, and impulsivity) whereby making it difficult to provide appropriate clinical intervention. In addition, many psychologists were not trained to address the unique nuances of a correctional setting. Such issues include: differential diagnosis between psychosis and malingering, substance-related crisis management, characterological maladjustment, and environmentally/medically-induced mental health issues. The enmeshment of mental health accommodations with secondary gains, sought by many criminals (i.e. psychoactive medication, provisions to living spaces, and increased attention from staff), invariability impede the delivery of mental health services in a prison setting. The need for a comprehensive paradigm that incorporates mental health and criminological theories to a controlled setting, such as prisons, is necessary if specially designed behavioral interventions are to continue evolving scientifically. This presentation will address such issues.