MENTAL HEALTH WITHIN CRIMINAL JUSTICE

Abstract

To a large extent, prisons and jails continue to be relied upon by the criminal justice system as an ideal mechanism for locking away offenders in efforts to deter, punish, reform, and ensure victims/aggrieved are restored in some way. This is what this particular system is designed for, and thus far, it has been effective in ensuring that the safety and wellbeing of law abiding citizens of this great nation are secured. The problem arises when this same system is used as a substitute for mental health institutions i.e. by taking offenders who need mental health services through it. A review of available literature clearly demonstrates that there is no doubt whatsoever that the U.S. criminal justice system does not handle persons suffering from mental illness in an appropriate or ideal manner. Various studies conducted in the past have demonstrated that conditions in correctional facilities often end up worsening symptoms of mental illness among inmates suffering from various mental health disorders including, but not limited to; anxiety, depression, PTSD, bipolar disorder, etc. It therefore follows that the relevance of formulating and implementing policies meant to rein in this concern cannot be overstated. Ideal interventions ought to be founded upon proper understanding of the root problem.

Mental Health within Criminal Justice

Introduction

Various researchers and analysts in the criminal justice realm have in the past made an observation to the effect that a disproportionate percentage of mentally ill individuals are incarcerated in U.S. jails and prisons. Further, assessments of the countrys criminal justice system indicates that it fails to meet the treatment demands of the mentally ill individuals who happen to interact with the system at one point or another. What we have in place at this moment is a criminal justice system that is rigged against persons with mental illness. With ineffective arrest and detention policies, we send a disproportionate number of mentally ill persons to prison, only for their conditions to be worsened by an unconducive jail environment. Further, when these persons are released from jail, they lack access to treatment and therapeutic services that would decrease their chances of interacting with the criminal justice system. This essentially results in the creation of a vicious circle of sorts. For this problem to be addressed in an effective manner, there is need to not only trace its genesis, but also explore the current state of affairs. Further, there is also need to consider the consequences of inaction. It is only then that we can make recommendations that are meant to ensure that our nations criminal justice system is responsive to the unique needs of mentally ill persons.

From the onset, it would be prudent to note that symptoms associated with various mental health conditions are subject to the interpretation of mental health experts. However, for purposes of this discussion, there will be need to assign a concise and definitive definition to mental illness. Thus, mental illness, as Remch et al., (2021) indicate, could be conceptualized as any diagnosed mental disorder (excluding substance abuse disorders) currently associated with serious impairment in psychological, cognitive, or behavioral functioning that substantially interferes with the person's ability to meet the ordinary demands of living (621). This is the definition that will be embraced in this discussion.

Background

Various theorists and experts have in the past indicated that there is need to ensure that the criminal justice system treats offenders presenting with symptoms of mental illness differently than sane offenders. For instance, as Scully (2021) as cited in a National Alliance on Mental Illness (NAMI) piece - points out, in the mid-1800s, Dorothea Dix first advocated for the creation of a system of care for people with mental illness after she witnessed deplorable conditions in a Massachusetts jail. Previous studies have also indicated that incarceration could worsen mental health disorders (Remch et al., 2021).

Montross (2020) indicates that various decisions made by the government in the past have brought us to where we are at present in terms of the inappropriate handling of mentally ill persons or offenders by the criminal justice system. For instance, according to the author, the increase in the number of mentally ill persons in our prisons was originally triggered by the systematic closure of various state psychiatric hospitals. This has largely occurred over the last five decades, and more specifically as the authors specifically indicates, in the 60s, 70s, as well as 80s (Montross, 2020). To a large extent, the said move was well-intentioned in the sense that it followed findings that some long-term psychiatric institutions were notorious for the promotion of cruel and egregious treatment of patients. Thus, it was established that asylums were in some instances worsening the very problem they were meant to solve and hence the need to defund and shut them down, and shift care to community settings. However, according to Montross (2020), the gains intentioned were never realized. This is more so the case given that amongst other things, the relevant social support systems were never established. Further treatment needs as well as vocational training needs were never addressed as originally intentioned. Thus, in what accurately captures the onset of the problem, Montross (2020) makes an observation to the effect that without funds, without treatment, and suddenly also without housing, our nations most vulnerable citizens fell out of health care and into the realm of the legal system the criminalization of mental illness had begun.

Current Issues and Status

Montross (2020) indicates that in her opinion, the criminal justice system is not designed to address the unique needs of persons presenting withmental illnesses. The problem, according to the author runs deep starting from law enforcement policies in place to the incarceration environment. Montross (2020) is uniquely qualified to comment on an issue of this nature owing to the fact that she has in the past served as a forensic evaluator for the courts. Indeed, in her own words, the criminal justice system runs counter to every principle of human flourishing that she is aware of (Montross, 2020). In as far as the law enforcement policies in place are concerned, it is important to note that Montross (2020) is categorical that law enforcement encounters often call for a great deal of attention and obedience. This is to say that failure by a citizen to obey police instructions could be interpreted as a deliberate attempt to defeat the course of justice or challenge their mandate to maintain law and order. Persons who suffer from various mental illnesses may not be able to obey police directions and/or instructions. This places them on a confrontational course with law enforcement officers significantly increasing their chances of being arrested, detained, and charged. This, in my opinion, is where the problem begins. The situation then further worsens.

According to Scully (2021), a huge percentage of persons incarcerated in our prisons today are suffering from a particular mental illness. Indeed, the author indicates that the percentage of mentally ill patients in prison could be as high as 37%. According to Remch et al. (2021), the standard practice in our criminal justice system happens to be sending inmates presenting with symptoms consistent with mental health illnesses to solitary confinement or other restrictive housing. This often ends up aggravating the situation. As a matter of fact, according to the author, this approach has been known to result in worsening state of mental health. This, as Remch et al. (2021) observe, is more so the case given that the conditions of solitary confinement in most cases worsen anxiety and could result in poor outcomes for persons with other mental health conditions such as depression. More specifically, according to the authors, a recent study in Washington state correctional facilities found that people in restrictive housing had more symptoms of depression and anxiety and more psychiatric distress than peers in the general prison population (Remch et al., 2021, p. ).

As indicated, persons presenting with mental illnesses are more likely to be sent to solitary confinement as a consequence of behavioral concerns brought about by their condition. This appears to go contrary to rational expectations in which case Montross (2020) makes an observation to the effect that in hospital settings, patients who are assaultive are not locked away in worse conditions. Instead, more effective interventions are implemented to address their states, i.e. via easement of their hallucinations or delusions. However, it is important to note that as Montross (2020) indicates, in correctional facilities, those who assault their colleagues or correctional officials are likely to incur additional charges, i.e. for a felony....

In addition to the recommendations highlighted above, there is also need to ensure that the chances of mentally ill persons being detained by law enforcement officers and being subsequently charged for a host of offenses are minimized. This, to a large extent, is a crucial step in efforts to ensure that the entire criminal justice system is responsive to the unique needs of mentally ill persons. One strategy that could be embraced towards this end is ensuring that all police officers are be equipped with effective de-escalation skills and capabilities. This is especially important given that as Montross (2020) indicates, they are often the first to respond to distress calls involving mentally ill persons. As has been indicated elsewhere in this text, a mental illness may interfere with a persons ability to make logical decisions, which effectively means that a mentally ill individual is less likely to respond to orders or instructions issued by law enforcement officers. This is one factor that makes encounters between law enforcement officers and mentally ill persons fatal. Indeed, as Montross (2020) indicates, persons presenting with various symptoms have a significantly high likelihood of being killed in such encounters. This is in comparison to sane individuals. However, the main concern in line with the subject matter of this discussion happens to be ensuring that persons or offenders who need psychiatric care are not given the same level of treatment as their sane peers.

The move to equip police officers with de-escalation skills and capabilities should, however, be backed up by an effective and efficient mental health crisis response mechanism. This is especially important given that as Montross (2020) points out, even when police are able to safely de-escalate a psychiatric emergency, their presence at the front lines of mental health crises means that theynot cliniciansdecide whether a person should be taken to jail or to the hospital. Thus, the move to ensure that law enforcement officers work closely with mental health experts in engagements of this nature is crucial. To a large extent, this is the best approach in efforts to ensure that persons who are mentally ill do not get to interact with the criminal justice system in the first place.

f) Timely Interventions

Available research indicates that the risk of a person committing a crime is significantly increased by specific psychiatric conditions. Joyce (2013), for instance, point out that research suggests that patients with mental illness may be more prone to violence if they do not receive adequate treatment, are actively experiencing delusions, or have long-standing paranoia (213). For this reason, there may be need to reach out to those in the society who present with symptoms consistent with mental illness. When interventions are instituted early enough, the chances of such persons interacting with the criminl justice system are greatly reduced. Christensen and Levi (2019) indicate that at present, very few individuals with mental illness receive effective and prompt interventions when needed.

Further, as has been pointed out elsewhere in this text, over the last 50 years, there have been sustained efforts to embrace a community approach in the treatment of various mental health issues. The said approach has, however, been poorly coordinated and funded. This is an assertion further backed by Scully (2021) who indicates that budget overruns and cuts in funding for public health and mental health in many cities further put people with mental illness in situations where they are involved in criminal activity. Towards this end, there is need for all stakeholders on this front to come together and collaborate in efforts to ensure that there is a mechanism in place for the identification of persons who could be suffering from various mental illnesses, as well as advancement of equitable and accessible treatment to such persons.

Conclusion

In the final analysis, it would be prudent to note that the discussion above clearly indicates that our criminal justice system is rigged against persons presenting with various mental illnesses. Failure to take action would be akin to the perpetuation of the problem. Both short-term and long-term consequences could be catastrophic. It would however be prudent to note that for the interventions highlighted above to be effective, the relevance of stakeholder collaboration cannot be overstated. This is more so the case when it comes to consultations across the…