The Benefits of Shifting from a Punitive Justice System to One that is Mental Health Aware

Since the 1950’s there has been an increasingly large population of individuals suffering from psychological disorders within the United States criminal justice system. Many psychiatrists and psychologists attribute this rising population to deinstitutionalization, a period in which psychiatric hospitals drastically reduced the number of patients they would serve. As a result, a larger amount of persons suffering from psychological disorders were released into society, where their symptoms are sometimes misinterpreted and criminalized, thus involving the criminal justice system. In response to this growing population the criminal justice system has begun to implement several methods for handling individuals suffering from psychological disorders. In this paper, I will assess the benefits of the criminal justice system shifting away from a purely punitive approach towards one that is mentally health aware. In order to accomplish this I will be examining the various methods the criminal justice system has begun to apply, such as mental health courts, treatment programs within the prison system, jail diversion programs, and the array treatment referral programs for post incarceration. This analysis involves the perceived success from the vantage points of the criminal justice system, the mental health experts involved, and the individual participants, as well as statistical evidence such as recidivism rates, improvement in behavior and symptoms, and improvements in quality of life. Finally, I propose a combination of the presented programs that provide the most beneficial care and outcomes, in the hopes that federal policy will make the necessary changes to beneficially serve individuals suffering from psychological disorders. The Benefits of Shifting From a Punitive Justice System to One that is Mental Health Aware 3 Acknowledgements This thesis would not be the paper it is today without the steady guidance of Dr. Lizabeth Roemer, professor of psychology at University of Massachusetts Boston. Thank you for your unwavering reassurance and aid throughout this incredible process. The Benefits of Shifting From a Punitive Justice System to One that is Mental Health Aware 4 Introduction Extensive research suggests there is a large population of persons suffering from psychological disorders within the criminal justice system. For the purposes of this thesis the terms psychological disorder and mental illness are interchangeable; however, only psychological disorder will be used due to the stigmatizing nature of the term mental illness. The criminal justice system, for the purposes of this thesis, refers to police departments, court systems, and both the prison and jail systems. The National Commission on Correctional Health Care found that roughly 10 to 19 percent of people in city and county jails, 18 to 27 percent of people in state prisons, and 16 to 21 percent of people in federal prisons suffer from psychological disorder(s) (Lamb, Weinberger, Marsh, & Gross, 2007). Some common psychological disorders present in the criminal justice system are schizophrenia, major depression, bipolar disorder, mania, manic-depressive disorder, post-traumatic stress disorder, and co-occurring substance abuse disorders (Lamb & Weinberger, 1998; Dunnegan, 1997; Gordon, Barnes, & VanBenschoten, 2006). Due to the disproportionate amount of persons in the criminal justice system who are suffering from psychological disorders, this thesis discusses the benefits of shifting from a punitive justice system to one that is mental health aware. Many psychologists and psychiatrists have perceived the tremendous amount of individuals with psychological disorders within the criminal justice system as the result of “deinstitutionalization” (Lamb & Weinberger, 1998). Deinstitutionalization refers to the period roughly between 1955 and 2000 when psychiatric hospitals decreased the amounts of beds and patients they would provide (Prins, 2011). For example, treatment occurrence in psychiatric state hospitals dropped from 77 to 28 percent, while the number of beds in psychiatric state hospitals dropped from 339 per 100,000 to 22 per 100,000 (Prins, 2011). The tremendous decrease of The Benefits of Shifting From a Punitive Justice System to One that is Mental Health Aware 5 hospitalization of individuals suffering from severe psychological disorders led to an increase of this population within society. Due to the transinstitutionalization, or the interdependency of each system on the other, the criminal justice system and the Psychiatric Hospitalization system, many believe that decreasing one system’s involvement with the persons suffering from psychological disorders increases the other system’s involvement (Lamb & Weinberger, 1998). Following this logic, as the treatment and hospitalization opportunities decreased over time, the persons suffering from psychological disorders became increasingly criminalized as the criminal justice system’s involvement inversely increased. It also leads many to the solution of increasing treatment opportunities as a means to remove and avert the individuals with psychological disorders from becoming further involved with the criminal justice system (Prins, 2011). While this relationship may not seem so direct, many within the psychology fields believe that the period of deinstitutionalization provided the groundwork for the criminalization of individuals suffering from psychological disorders (Lamb & Weinberger, 1998; Prins, 2011). While many argue over the definition of criminalization, for the purposes of this paper it refers to the phenomenon of those suffering from psychological disorders being arrested for minor offenses, rather than being placed into treatment (Lamb & Weinberger, 1998). The decrease in long-term treatment for individuals suffering from psychological disorders led to society being exposed to the possibly deviant behavior of these individuals with psychological disorders. Deviant behavior refers to any behavior that contradicts society’s perceived acceptable behaviors, including those behaviors that are considered illegal. Society as a whole has a limited range of tolerance of such deviant behavior and it is believed that if this behavior is not remedied, by placing the individuals suffering from psychological disorders in the mental health The Benefits of Shifting From a Punitive Justice System to One that is Mental Health Aware 6 system, then society will put pressure on the criminal justice system to respond (Lamb & Weinberger, 1998). During the period of deinstitutionalization, the criminalization of persons suffering from psychological disorders increased drastically. There are others within the psychology field that argue that deinstitutionalization is not responsible for the large shift in the amount of persons suffering from psychological disorders within the criminal justice system. One main argument is that deinstitutionalization did not cause a rush of individuals suffering from psychological disorders to the streets because many were placed in general hospitals or nursing homes as a result of the introduction of programs like Medicaid (Prins, 2011). Further, studies have found that those suffering from psychological disorders who are incarcerated and those individuals suffering from psychological disorders within psychiatric hospitals have different characteristics, suggesting that the two populations are inherently different (Prins, 2011). However, the evidence for this argument is mixed, with some studies finding great difference between the two populations and others finding very little difference (Lamb & Weinberger, 1998). Finally, the last core argument against deinstitutionalization is the fact that community based treatment is effective (Prins, 2011). This is an argument that deinstitutionalization is not a real phenomenon because those who believe in deinstitutionalization argue that the individuals suffering from psychological disorders did not have as reliable or effective treatment options after the psychiatric hospitals closed (Prins, 2011). Therefore, if community-based treatment, which has remained available, is determined to be effective then the argument that there were not adequate treatment options is unsupported. While there are effective community-based treatment options available, funding for these programs is often limited and prevents service to the many individuals who need it. The argument that community-based treatment is effective matters little if the existence of community-based The Benefits of Shifting From a Punitive Justice System to One that is Mental Health Aware 7 treatment is lacking in areas of need. Regardless of which side of the argument mental health professionals fall on, it is agreed that there are an overwhelming number of individuals suffering from psychological disorders within the criminal justice system and the criminal justice system cannot provide the ideal treatment for this population (Prins, 2011). The argument itself is important in that it shapes professionals’ mindsets on solutions to the problem of individuals suffering from psychological disorders within the criminal justice system. For example, those that believe that deinstitutionalization is responsible may argue for more funding for psychiatric hospitalization and community-based treatment. They argue that decrease in this treatment caused an increase in individuals suffering from psychological disorders within the criminal justice system because they did not have proper treatment options available to them (Prins, 2011). On the other hand, those that do not believe in the reality of deinstitutionalization may deem funding for psychiatric hospitals as a waste of money (Prins, 2011). This is because they would argue that community based treatment helps most individuals suffering from psychological disorders and putting large amounts of money into psychiatric treatment would