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An Analysis and Critique of Mental Health Treatment in American State Prisons and Proposal for Improved Care Shelby Hayne

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An Analysis and Critique of Mental Health Treatment in American State Prisons and Proposal for Improved Care Shelby Hayne Claremont Colleges Scholarship @ Claremont Scripps Senior Theses Scripps Student Scholarship 2019 An Analysis and Critique of Mental Health Treatment in American State Prisons and Proposal for Improved Care Shelby Hayne Recommended Citation Hayne, Shelby, "An Analysis and Critique of Mental Health Treatment in American State Prisons and Proposal for Improved Care" (2019). Scripps Senior Theses. 1256. https://scholarship.claremont.edu/scripps_theses/1256 This Open Access Senior Thesis is brought to you for free and open access by the Scripps Student Scholarship at Scholarship @ Claremont. It has been accepted for inclusion in Scripps Senior Theses by an authorized administrator of Scholarship @ Claremont. For more information, please contact [email protected]. AN ANALYSIS AND CRITIQUE OF MENTAL HEALTH TREATMENT IN AMERICAN STATE PRISONS AND PROPOSAL FOR IMPROVED CARE by SHELBY ALEXANDRA HAYNE SUBMITTED TO SCRIPPS COLLEGE IN PARTIAL FULFILLMENT OF THE DEGREE OF BACHELOR OF ARTS FOR A MAJOR IN ORGANIZATIONAL STUDIES AT PITZER COLLEGE PROFESSOR JEFFREY LEWIS PROFESSOR MARC KATZ DECEMBER 14, 2018 Hayne 1 Abstract Mental health treatment in state prisons is revealed to be highly variable, under-funded, and systematically inadequate. Existing literature exposes this injustice but fails to provide a comprehensive proposal for reform. This paper attempts to fill that gap, outlining a cost- effective, evidence-based treatment proposal, directly addressing the deficits in care revealed through analysis of our current system. In addition, this paper provides historical overviews of the prison system and mental health treatment, utilizing theoretical perspectives to contextualize this proposal in the present state of affairs. Lastly, the evidence is provided to emphasize the potential economic and social benefits of improving mental health treatment in state prisons. Significant findings suggest a clear financial, legal, and moral incentive for states to address this issue, while the proposal provides a viable method of doing so. Keywords: mental health treatment, state prisons, social control, incarceration, cognitive- behavioral therapy, institutional reform Hayne 2 TABLE OF CONTENTS ACKNOWLEDGMENTS ............................................................................................................ 3 INTRODUCTION......................................................................................................................... 4 SECTION I: DEVIANCE AND SOCIAL CONTROL ............................................................. 5 SECTION II: HISTORICAL OVERVIEW ............................................................................. 15 PART I: INCARCERATION ................................................................................................... 15 PART II: MENTAL HEALTH AND TREATMENT .............................................................. 19 SECTION III: PREVALENCE OF MENTAL ILLNESS IN PRISONS .............................. 32 SECTION IV: CURRENT STATUS OF TREATMENT ....................................................... 34 INTRODUCTION ..................................................................................................................... 34 PART I: DIAGNOSTIC ASSESSMENT ................................................................................. 35 PART II: COUNSELING AND DRUG THERAPY ................................................................ 42 PART III: LEGAL FRAMEWORK AND FUNDING ............................................................. 46 SUMMARY OF KEY ISSUES ................................................................................................ 53 SECTION V: MY PROPOSAL ................................................................................................. 55 INTRODUCTION ..................................................................................................................... 55 PART I: AN IDEAL SOLUTION ............................................................................................ 56 PART II: STAFFING ................................................................................................................ 58 PART III: ASSESSING MENTAL HEALTH OF PRISONERS ............................................. 60 PART IV: EVIDENCE-BASED TREATMENT ...................................................................... 63 SECTION VI: BENEFITS OF IMPROVED TREATMENT IN STATE PRISONS........... 68 SUMMARY AND CONCLUSION ........................................................................................... 74 REFERENCES ............................................................................................................................ 78 Hayne 3 ACKNOWLEDGMENTS First, I would like to acknowledge the diligence and responsiveness of Professor Jeffrey Lewis in his guidance of my writing process. Providing consistent support of my educational goals, Professor Lewis has been invaluable in facilitating my navigation of administrative and bureaucratic obstacles. Perhaps more importantly, his accessibility and sense of humor have acted as beacons of hope throughout a challenging college process. In addition, I would like to thank Professor Marc Katz for his flexibility, kindness, and advice. Professor Katz has been a vital and grounding connection to the Scripps College campus during my pursuit of a major at Pitzer College. Beyond simply acting as an advisor, Professor Katz sparked intellectual curiosity with his wise words in the classroom and beyond. Furthermore, I would like to thank Professor Kara Placek for opening my eyes to the systemic injustices in American penal institutions and providing me with the tools necessary to meaningfully address them. Lastly, I would like to thank my family and close friends for their tireless support even through the worst bouts of writer’s block. Without them, I would surely not be where I am today. Hayne 4 INTRODUCTION Throughout American history, mental health and incarceration have shared a complex, deeply dysfunctional relationship. Today, the United States boasts the largest rate of incarceration in the world, with 655 out of every 100,000 citizens imprisoned; the two countries with the next highest rates (597 and 552, respectively) are El Salvador and Turkmenistan, nations fraught with social unrest and political dysfunction (Juhn, 2014; Freedom House, 2018; World Prison Brief, 2018). Over two million individuals are currently incarcerated in the U.S., with approximately 1.3 million being held in state prisons (Glaze, 2009; Wagner & Sawyer, 2018). More than half of these prisoners suffer from some form of psychological dysfunction, compared to around 18.5% of the general population (Glaze & James, 2006; Substance Abuse and Mental Health Services Administration, 2017). Despite a clear legal obligation to address the mental health needs of these inmates, evidence suggests a profound failure to do so (Wilper et al., 2009). This paper analyzes and critiques the deficits in our current treatment system and proposes new avenues of reform. Section I examines constructs of social control and deviance, outlining the theoretical frameworks necessary to facilitate understanding of my analysis. Section II provides historical overviews of the American prison system and mental health treatment. Section III presents statistics on the prevalence of mental illness in prison populations. Section IV analyzes the current status of prison mental healthcare, focusing on state prison systems. In this section, I will also discuss the legal path that must be taken to affect meaningful change. Section V introduces my own proposal for evidence-based systemic reform. Section VI will then place this proposal in a larger social context, outlining the potential socio-economic benefits of adopting it– benefits that span far beyond legal and ethical obligation. Hayne 5 SECTION I: DEVIANCE AND SOCIAL CONTROL To contextualize an analysis of our current prison mental health treatment systems, this section will provide an overview of historical conceptions of social control and deviance. I will begin with a general discussion of social contract theory and theoretical interpretations of social control and deviance. This will be followed by a brief theoretical discussion of psychiatry and an analysis of Foucauldian views on prisons’ role in society. Then, I will introduce several frameworks regarding the intersection of prisons and mental health treatment, finally exploring the socio-economic, political, and racial factors that influence the American prison system. The conceptual evolution of social control and deviance is closely tied to the development of mechanisms of maintaining control and power structures in society. According to Carmichael (2012), social control in the academic sense can be understood as the study of the methods through which society maintains order and cohesion. These methods may be found on an individual and institutional level, and include such components as restraint, coercion, and force (Carmichael, 2012). In this analysis, social control on an institutional level will be examined, focusing on institutions of criminal justice and psychiatry as mechanisms of social control. In particular, this section will discuss the employment of subjective analysis of behavior deemed “deviant” in imposing criminal sanctions designed to enforce social conformity. According to Carmichael (2012), “deviance” can be understood as a word used to capture a variety of behaviors that defy social
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