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RESEARCH WEEKLY: Inadequate Health Care in Prisons for People with Serious Mental Illness
By Morré Taylor
(November 2, 2022) People with mental illness, especially those with serious mental illness, tend to be overrepresented in the U.S. prison population. This is largely due to the overcriminalization and victimization of this population. As such, many people with serious mental illness are reliant on prisons for their health care.
Prisons were not designed with the intention of serving as health institutions, yet they are some of the largest providers of mental and physical health services in the U.S. In general, prison health care standards are poorly defined and not regulated in the same way that hospitals are. This lack of regulation can have severe consequences for the quality of care provided. For incarcerated people with serious mental illness, in particular, the very nature of prisons can worsen preexisting mental health symptoms, emphasizing a need to provide better health services.
Although there is legislation requiring that incarcerated people have access to adequate health care, the standard for what constitutes as adequate is lacking. A recent study published in Frontiers in Psychiatry investigated the quality of physical and mental health care services provided to incarcerated individuals with serious mental illness. The goal of this study was to acquire knowledge about how to reduce the negative short- and long-term impact of prison on mental and physical health.
Study details
Researchers of this study recruited 43 formerly incarcerated adults (age 27 to 62) with serious mental illness from three community mental health sites in the Midwest and East Coast. Participants engaged in a two-hour, in-person meeting that involved a questionnaire to gather demographic information about participants and an in-depth interview that asked participants about their interactions with prison staff and use of health care services while in prison.
Results
Participants often labeled their interactions with prison staff as dehumanizing and reported that when interacting specifically with prison health care providers, their medical problems were rarely taken seriously. This resulted in their medical needs being neglected. Some of the participants expressed that the poor quality of care they received was likely due to the staff’s stigmatizing beliefs about incarcerated people and people with serious mental illness. There were a few participants, however, who found the opportunity to build a rapport with staff members, which allowed for more humanizing relationships and more positive perceptions of care.
Participants, in general, had varying experiences related to accessing medical services. There were significant differences in the length of time it took to have one’s medical request accepted and to have arrangements made for transportation to a clinic— which, according to participants, was dependent on correctional officers’ attitude and willingness. Participants reported that when they were finally able to see a doctor, visits felt rushed and they were usually given aspirin instead of more effective medications or screening tests because they were too costly, resulting in inmates having to manage their psychical pain on their own.
With regards to mental health services, some participants found the care provided to be useful as it helped them gain a better understanding of their mental illness and receive a proper diagnosis. However, long wait times to receive medication and meet with a psychiatrist, in addition to a lack of privacy as most mental health check-ins were conducted in or near the person’s cell, triggered significant treatment disengagement. Overall, participants did not consider the physical nor mental health care they received in prison to be particularly patient-centered.
Policy implications
Results from this study show that the dehumanizing interactions with prison staff and the ill-equipped healthcare system found in most prisons negatively impact the quality of medical and psychiatric care that inmates receive. The researchers suggest that standards of best practice and proper oversight are needed to ensure that prisons are not only meeting the bare minimum for health care but are promoting effective, patient-centered care. Access to quality medical care is especially important for people with serious mental illness, who often have comorbid physical health conditions and die up to 25 years earlier than those without a mental illness.
To address systemic barriers to care, the researchers advocate for the increased use of preventative medicine in prisons, which would require a reallocation of money from other services into the prison health care system. In the long term, this could potentially reduce prison health care costs and improve the quality of services offered to incarcerated people. Along with proper health care standards, these measures would be particularly influential in reducing barriers to care while in prison and also helping incarcerated individuals with serious mental illness successfully reintegrate back into the community when they are released.
Reference
Canada, K., Barrenger, S., & Bohrman, C., et al. (June 2022). Multi-level barriers to prison mental health and physical health care for individuals with mental illnesses. Frontiers in Psychiatry.
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