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Erica Moore Erica Moore CJ 510: Mental Health and Justice Policy Prof. Matesanz June 20 th , 2023 Midterm Exam: Option 2 Individuals who struggle with mental illness are among the most marginalized people in our society, and when they encounter the criminal justice system, they frequently have worse outcomes than others. They are more likely to commit suicide, end up in solitary confinement, and have a lower chance of getting out on parole (Roth, 2020). Many people now receive their primary mental health care in jail or prison. The unending restrictions and the harsh way many officials address convicts make jails and prisons dehumanizing environments. In some mental health facilities, where many people are either aggressive or entirely unresponsive, there is a solid division between the prisoners and the officers or, more accurately, the prisoners and the rest of us (Roth, 2020). Not only are prisoners with mental illnesses more likely to experience aggression from others, but they are also more likely to attempt to commit suicide than prisoners without mental illnesses (Slate et al., 2021). Compared to the outside world, prisons, and jails have much higher rates of suicide, with hanging being the most common method (Roth, 2020). This is probably due to a combination of factors, including past treatment failures or treatment rejection, in addition to the refusal to seek care. It is undeniably challenging to deal with this group and disorder combination (Slate et al., 2021). Although many factors contribute to potential suicide attempts in jails and prisons, overcrowding is one of the main ones. The United States has long struggled with a significant capacity issue. Both funding and leadership prepared to prioritize mental health care are 1

Erica Moore necessary for its success in correctional facilities (Roth, 2020). However, in many locations, the reality is far from that due to the constant strain of cost containment, overcrowding, understaffing, and, in some situations, a lack of will. Basic living conditions are exceedingly unpleasant in an overcrowded facility. These pressures might be significantly harsher for those who have a mental illness (Roth, 2020). This can be seen in particular in female detainees. Research has revealed that female inmates are particularly vulnerable to circumstances in jail or prison, and they experience mental illness at even higher rates than their male colleagues across the nation. The shift away from rehabilitation has also been accelerated by overcrowding (Roth, 2020). Too many people in an institution frequently make maintaining even the most basic services impossible. A jail or prison's capacity is determined by more than simply whether there is adequate room for all inmates. There must also have enough staff to care for them. One of the issues in state psychiatric facilities was indeed a persistent lack of skilled staff (Roth, 2020). When there are not enough correctional officers to maintain order, stricter security, and disciplinary measures are required to keep things under control. Issues with overcrowding and understaffing may also make it difficult to manage medications properly, causing patients to receive less frequent or no checks on their drugs (Roth, 2020). Research shows that staff members' regular supervision is the best defense against suicide. It is crucial to keep an inmate under close supervision, especially if they are placed in isolation and especially under dangerous circumstances. However, it is uncommon to be able to maintain proper constant monitoring due to understaffing and increased demands brought on by overcrowding (Slate et al., 2021). Because of this, most jails only do 15-minute checks or, increasingly, camera surveillance. However, a committed convict can commit suicide in just a few minutes, giving them plenty of time between checks (Slate et al., 2021). While it might seem ideal to have camera surveillance, this 2

Erica Moore technology is constrained by blind spots in the isolation room's physical setup, aside from camera operators who get bored or distracted. A case-by-case consideration of risk should ultimately be used to determine the level of monitoring, and video surveillance should never be the only monitoring method (Slate et al., 2021). Another factor that can contribute to potential suicide attempts in jail is stigma. People with mental illnesses are frequently prevented from publicly recognizing their condition due to the stigma placed on them by our culture. Even today, people with severe mental illnesses still confront numerous obstacles to thriving in society (Slate et al., 2021). Sigma plays a role in various difficulties faced by people with mental illness, such as poverty, unemployment, housing, and individuals choosing not to seek mental health treatment. The recurring patterns of abuse and inadequate care towards this population show that mental illness has always been stigmatized (Slate et al., 2021). People who carry the stigma cannot fully integrate into society because they cannot follow the norms that society has established as standards. The people considered normal in society treat stigma-bearers as outcasts and create negative, debunked prejudices about the stigmatized group of people. Experts agree that stigmas towards persons with mental illness are more widely accepted among Americans than stigmas against people with other disorders, such as physical disabilities (Slate et al., 2021). People with mental disorders in the criminal justice system experience a double stigma: they are stigmatized for their diseases and their involvement in the system. Discrimination creates a self-reinforcing, vicious cycle and can be found in employment, education, housing, medical, and mental health care. This creates even more disadvantages for a group of people already at a disadvantage (Slate et al., 2021). Due to internalized structural and societal stigma, people with mental illness fail to explore opportunities and resources. They frequently feel worthless, unable, and hopeless about 3

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Erica Moore accomplishing their goals after years of being indoctrinated with the same mental disease stereotypes that the rest of the population is subjected to (Slate et al., 2021). Without a doubt, these events and the related internalized stigma have a significant role in self-destructive behaviors, including associated drug abuse and increased suicide rates. The creation of effective programs, including those that improve cooperation between the criminal justice and mental health systems, is hampered by such institutional and public stigma. There are. Nevertheless, some intriguing approaches and additional study is required (Slate et al., 2021). I think more inclusive policies based on evidence-based practices can be implemented as organizations like NAMI and Florida's Partners in Crisis (2012) fight to promote modifications in behavioral health treatment and tear down the stigma-created walls. While many of the solutions may very well be found in government-sponsored programs, lasting change can only be achieved by community involvement, which includes private sector commitments, which have a crucial role to play (Slate et al., 2021). The challenge of treating mental diseases is frequently brought to the public's attention by news coverage of incidents involving people with mental illnesses. Creating and maintaining collaborative partnerships is critical to finding solutions to the problems affecting people with mental illness (Slate et al., 2021). While no precise prevalence figures are given, several academics have examined a range of psychological traits of those who commit jail suicide, including confinement. Some prisoners are merely unprepared to deal with the typical stresses of incarceration. When someone is first locked up in jail, their stress may only be associated with their fear of the unknown and their separation from their family (Slate et al., 2021). However, as time goes on, this stress may worsen, including loss of outside relationships, conflicts within the institution, victimization, additional legal frustration, physical and emotional breakdown, and difficulties adjusting to life 4

Erica Moore in jail. Suicidal thoughts, attempts, or completion might occur if the inmate experiences an emotional breakdown. Severe mental illness causes people to serve lengthier sentences in prison for various reasons, the most obvious of which is that these conditions are detrimental to their ability to function (Slate et al., 2021). First off, while incarceration is stressful for everyone, it is incredibly challenging for people with major mental illnesses, especially those who enter jail in a crisis, have been off their meds for an extended period, and have used drugs and alcohol excessively soon before being arrested. Those with severe mental illness are especially vulnerable to irregular eating and sleeping schedules and excessive sensory stimulation (Slate et al., 2021). Although isolation used to be the recommended course of action in jails for dealing with suicidal ideation, Hayes (2000) and others have argued against it since it frequently leads to more suicide attempts, especially in the first 48 hours. However, this type of intervention is still regularly utilized in American prisons, often just as a place to confine mentally ill inmates. It is well recognized that solitary confinement, administered as punishment at the discretion of the jail or prison personnel, can aggravate or even cause mental illness (Slate et al., 2021). As a type of further punishment for inmates who have broken regulations or are otherwise regarded to have misbehaved, it is typically utilized at the discretion of corrections officials because someone determined that the prisoner was a danger to the facility (Roth, 2020). Because of this, solitary confinement disproportionately attracts inmates with mental illnesses while also making many regular convicts unwell. Additionally, solitary is expensive, costing states up to two or three times as much per prisoner as regular confinement. However, since the early nineteenth century, when the modern US jail system began, convicts have been housed in isolation cells (Roth, 2020). Administrators should consider employing more officers or putting other prisoners in isolation cells with inmates when staff-to-inmate ratios are at their lowest to prevent suicides. 5

Erica Moore Suicide is effectively prevented by simple social interaction. Convicts are less likely to attempt suicide if housed in a dormitory or a shared cell with other convicts. However, jail officials should never rely on other inmates to protect a suicidal inmate, as this does not replace qualified staff surveillance (Slate et al., 2021). Additionally, having good working connections with officers and employees can undoubtedly act as a deterrent to inmate suicide. Jail employees who know each inmate personally and are aware of significant life events are better equipped to recognize when an inmate's attitude or conduct changes. For jail officials to learn how to identify and deal with suicide inmates, jails should implement a thorough training program with ongoing instruction. At the very least, officers should be educated on crisis intervention tactics, de- escalation strategies, theories of jail suicide, and risk factors for suicide (Slate et al., 2021). Many people get their initial or primary mental health treatment in jail or prison. There is a clear separation between the inmates and the general populace. Prisoners with mental diseases are more likely to attempt suicide than prisoners without mental illnesses, and to encounter hostility from other inmates. Overcrowding is one of the primary causes of probable suicide attempts in jails and prisons. The prison’s success depends on leadership prioritizing mental health care and enough financing. The ongoing pressure of cost containment, overcrowding, and understaffing means that the reality is far from that goal. The correct management of pharmaceuticals may also be troubled by issues with overcrowding and understaffing, resulting in patients receiving fewer or no drug screenings. The stigma that people with mental illness experience contributes to several of the challenges they confront. In the criminal justice system, people with mental illnesses face two types of stigma: for their illnesses and for their involvement with the criminal justice system. Discrimination exists in employment, education, housing, and medical and mental health care, and it breeds a vicious circle that reinforces itself. 6

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Erica Moore These incidents and the associated internalized stigma unquestionably significantly influence self-destructive behaviors, including related drug misuse and elevated suicide rates. More inclusive policies built on evidence-based practices may be implemented to support changes in behavioral health care and knock down stigma-induced barriers. In addition, imprisonment increases the risk of suicide attempts in jails and prisons. While being in jail is unpleasant for everyone, persons with severe mental disorders find it even more challenging, especially if they enter jail in a crisis, have been off their meds for a long time, or have used drugs and alcohol excessively just before being arrested. Solitary confinement is known to exacerbate or possibly cause mental illnesses. Additionally, isolation is more expensive than regular imprisonment, costing states up to two or three times as much per prisoner. When staff-to-inmate ratios are at their lowest, administrators should place additional prisoners in isolation cells with inmates to prevent suicides as a potential strategy to reduce the risk of suicide. Although several improvements have been done in the last couple of decades, a lot still has to be done in order to adequately support people with mental illnesses within the correctional system. Even though there should be other institutions in place to house the mentally ill, jails and prisons for the time being still have to provide adequate care and support through medications and therapy to it’s most vulnerable inmates. 7

Erica Moore References: Baillargeon, J., Binswanger, I. A., Penn, J. V., Williams, B. A., & Owen, J. (2009). Psychiatric disorders and repeat incarcerations: The revolving prison door. The American Journal of Psychiatry, 166(1), 103–109. Florida Partners in Crisis. (2012). Justice, treatment, safety. Merritt Island, FL: Author. Retrieved from http://flpic.org/ . Hayes, L. (2000). Suicide risk despite denial (or when actions speak louder than words). Jail Suicide/ Mental Health Update, 10(1), 1–6. Hendrickson, B. A. (2012). What’s at stake in the 2012 elections? NAMI Advocate, 10(3), 16–19 Roth, A. (2020). Insane: America’s criminal treatment of mental illness . Basic Books. Slate, R. N., Frailing, K., Johnson, W. W., & Buffington, J. K. (2021). The criminalization of mental illness: Crisis and opportunity for the justice system . Carolina Academic Press. 8

Erica Moore Midterm Exam: Part 2 Question 2. Galton first used the phrase "eugenics" in 1883. It is intended to be a branch of research devoted to categorizing people into eugenic and cacogenic groups. The most unfit people had severe mental illness in this new eugenic perspective of humanity (Whitaker, 2019). In 1926, the American Eugenics Society (AES) became a legal entity. By putting eugenics textbooks and brochures into schools and running educational campaigns to increase support for sterilization legislation, the organization concentrated on spreading eugenics to the American public (Whitaker, 2019). States would have to forbid mentally ill people from getting married, separate them into asylums, and only let them out after sterilizing them. Eugenic sterilization was accepted in America as a progressive health measure, and this also impacted the mentally ill in other nations. Eugenics was not nearly as popular in Germany before World War I as in the US (Whitaker, 2019). However, the German population developed a new interest in eugenics after the war. In Mein Kampf, published in 1925, Adolf Hitler praised eugenics as the science that would reshape the country. Germany enacted a comprehensive sterilization law after Hitler took office in 1933 (Whitaker, 2019). Eugenic views on those with mental illness inevitably increased the likelihood of more drastic action. In January 1940, Nazi Germany started gassing its mentally ill. It did so based on a eugenics justification: Four months earlier, it had invaded Poland, and eliminating the mentally ill promised to free up hospital beds for the injured and save the state the cost of feeding them (Whitaker, 2019). Following World War II, American society began adding all types of "misfits" into institutions, including alcoholics, people with epilepsy, nomads, the elderly and senile, drug addicts, syphilitics, and the mentally ill. Asylums were progressively managed more like prisons than hospitals where patients received medical attention (Whitaker, 2019). Eugenics gave asylum medicine a social framework, and that context significantly 9

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Erica Moore impacted the kind of medical therapies used in the 1930s for psychotic diseases. At that time, psychiatry accepted four different brain-damaging treatments, including insulin coma, metrazol convulsive therapy, electroshock, and prefrontal lobotomy. Eugenicists had advocated for the long-term institutionalization of mentally ill people, and that is precisely what was taking place (Whitaker, 2019). Insulin coma treatment was the first to show up. Sakel had found that low insulin dosages reduced withdrawal symptoms in morphine users. However, on numerous occasions, his patients had succumbed to the often-lethal condition known as a severe hypoglycemia coma (Whitaker, 2019). Immediately after Sakel's insulin treatment began, metrazol convulsive therapy was soon implemented in American asylums. A minute or so after receiving the medication, the patient might experience a violent seizure that could result in fractures. Like insulin, multiple doses of metrazol shock therapy were required to provide the intended long-lasting impact (Whitaker, 2019). In some ways, the stress experienced also led to a shift in behavior akin to what was observed with insulin. When electroshock was first used in American hospitals in 1940, it was not seen as a revolutionary new treatment. The electrical shock traveled to the temporal lobes and other memory-processing areas of the brain with the electrodes positioned at the temples (Whitaker, 2019). Patients spasmed into convulsions and instantly lost consciousness as the cerebral cortex's brain waves stopped. When patients regained consciousness, they were frequently confused about their identity and occasionally ill with headaches and nausea. It would take weeks, even after only one treatment, for a patient's electroencephalogram (EEG) readings to recover to normal (Whitaker, 2019). The most distinctive aspect of the human brain is its frontal lobes, which are surgically removed during prefrontal lobotomy. It was evident with lobotomy that this procedure permanently destroyed a brain region that was believed to be the seat of human intelligence (Whitaker, 2019). The 10

Erica Moore majority of those he decided to operate on had emotional problems like depression and others, and many of them had only been ill for a short time. Those who had lobotomies suffered varied stages of change. According to Freeman and Watts, patients frequently showed incontinence in the first several weeks after surgery and showed little desire to get out of bed (Whitaker, 2019). Question 4. With 2.2 million people incarcerated, the United States has the highest adult incarceration rate among developed nations. Inmates with mental illnesses have been behind bars more frequently during the past three decades, most likely due to the state mental health system being deinstitutionalized. More people are significantly and persistently mentally ill in prisons than in all the state hospitals in the United States (Daniel, 2007). Numerous people had anxiety disorders, such as post-traumatic stress disorder (PTSD), organic disorders, short- and long-term effects of traumatic brain injury (TBI), suicidal thoughts and behaviors, distress related to all types of abuse, attention deficit hyperactivity disorder (ADHD), and other developmental disorders. Most of those incarcerated came from underprivileged backgrounds, had subpar educations, and had adequate vocational or employment skills (Daniel, 2007). More than half of all prison and jail inmates have a mental health problem, compared to 11% of the general population, according to a recent study by the U.S. Department of Justice (2006). However, only one in three and one in six inmates receive mental health treatment. Historically, prisoners received direct access to mental health and medical care through the departments of prisons, which employed their personnel and clinics (Daniel, 2007). More and more states have privatized their mental health and medical services because of rising healthcare expenditures, staffing costs, a shortage of trained medical experts to serve in prisons, the absence of innovative correctional leadership, and rising lawsuits. The benefits of the university-state-corporate relationship in Massachusetts have been outlined by Appelbaum et al. (2002). In this model, the 11

Erica Moore medical school expands its revenue source while providing much-needed public service and opportunities for engaging in correctional research. In contrast, the state correctional program receives improved services, recruits high-quality professionals, and expands training programs (Daniel, 2007). Numerous mental health and corrections state departments have agreements to provide acute care. This method results in costs for the round-trip transportation of offenders, security issues, interdepartmental disputes, and communication issues brought on by the distinction between treating patients and criminals. Conflicts could also occur when the offender is sent back to jail on how to handle conduct infractions (Daniel, 2007). Suicide is one of the leading causes of death in state and federal prisons in the United States. As they work to rehabilitate offenders, mental health professionals, correctional administrators, and healthcare providers are increasingly emphasizing comprehensive suicide-prevention programs in prisons. A thorough analysis of domestic and foreign data indicates unequivocally that a complex web of interconnected and self-reinforcing risk factors underlies inmate suicide (Daniel, 2007). The chronic stresses of incarceration, substance addiction, prior significant suicide attempts, mental illness, professional mistakes or oversights, acute psychosocial stressors, and chronic stresses from incarceration are some risk factors. Traditionally, mental health personnel have been solely responsible for suicide prevention in prisons (Daniel, 2007). These correctional staff members are jointly responsible for maintaining the health and safety of jail inmates, and they are becoming more and more held accountable, individually and as a group, when they fall short of this obligation. The World Health Organization recommends a coordinated effort between administrators, medical and mental health experts, and custodial staff to identify at-risk inmates and intervene accordingly (Daniel, 2007). 12

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Erica Moore Question 6. The understanding of those with mental illness that was given throughout the 19 th century completely vanished from American society at the start of the 20th century. It was supplanted by the idea that people with serious mental illness carried damaged "germplasm" and, as a result, represented a dangerous threat to the long-term health of American civilization (Whitaker, 2019). Indiana was the first state to enact a statute requiring forced sterilization in 1907. Sterilization came to be seen by doctors as offering patients a therapeutic advantage, one that most patients responded to with appreciation (or so they told the rest of the population). One of the first interventions which dehumanized the mentally ill was hydrotherapy (Whitaker, 2019). The patient would be pounded with pressurized water during the needle shower, also known as a jet douche. It was said to be especially helpful for reawakening depressed patients. The wet pack was the water therapy that patients detested the most (Whitaker, 2019). Attendants would dip linens in either cold or hot water before wrapping the patient. Patients would frequently be left in that way for several hours or even days. The sheets would constrict tightly around the patient as they dried (Whitaker, 2019). They would feel terrible burning and suffocation due to the tight retention of their body heat. Many people made an effort to flee, and "cardiac collapse" was considered possible (Whitaker, 2019). A second intervention was gynecological procedures, which gained popularity in the 1890s and the first decade of the twentieth century. Measuring a woman's genitalia may occasionally provide clear proof that she was being mentally deceived, and women with "hypertrophy" of the clitoris were assumed to be chronic masturbators (Whitaker, 2019). Some people tried clitoridectomy as a treatment for insanity because masturbating was thought to be the cause. Till at least 1950, this operation was still performed in American asylums (Whitaker, 2019). A third intervention was focused on endocrine therapy. Early in the 20th century, as new information about the functioning of numerous hormonal 13

Erica Moore glands became available. There was concern that psychotic diseases might be related to the dysfunction of these glands (Whitaker, 2019). Psychiatrists in the US and overseas experimented with injecting animal ovaries, testicles, pituitaries, and thyroid extracts into the mentally ill as a treatment. Other doctors attempted to treat their insane patients by injecting poisonous chemicals and other foreign substances into their veins, muscles, and cerebrospinal fluid while equipped with theoretical hypotheses of various kinds (Whitaker, 2019). Metallic salt injections were tried and shown to be beneficial. Robert Carroll, the medical director of Highland Hospitals in Asheville, North Carolina, discovered that schizophrenic patients might be successfully brought back to lucidity by receiving repeated injections of sterile horse serum into the spinal fluid, which resulted in aseptic meningitis. Carroll's patients had physical discomfort for this treatment, including backaches, headaches, and vomiting, much like those who received sheep extract (Whitaker, 2019). 14

Erica Moore References: Appelbaum KL, Manning TD, Noonan JD: A university-state-corporation partnership for providing correctional mental health services. Psychiatr Serv 53:185–9, 2002 Daniel, A. E. (2007, December 1). Care of the mentally ill in prisons: Challenges and solutions . Journal of the American Academy of Psychiatry and the Law. https://jaapl.org/content/35/4/406 James DJ, Glaze LE: Mental health problems of prison and jail inmates. Washington, DC: Department of Justice, Bureau of Justice Statistics Special Report, September 2006 Whitaker, R. (2019). Mad in America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill . Basic Books. 15

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