The rate of mental health issues among inmates varies by type of correctional facility.

The National Institute on Mental Health keeps information on the prevalence of mental health in the prison system.

(According to the Department of Justice, 56.2 percent of State prison inmates, 44.8 percent of Federal prison inmates, and 64.2 percent of Local jail inmates suffer from a mental health issue.)

Between 1980 and 1995, the total number of individuals incarcerated in American jails and prisons increased from 501,886 to 1,587,791, an increase of 216 percent. During this time, the general population increased by only 16 percent.

 

A 1973 study in Santa Clara County indicated the jail population had risen 300 percent in the four years after the closing of Agnews State Psychiatric Hospital, located in the same county.

According to E. Fuller Torrey there is a direct relationship between the type of mental illness and type of crime committed. Individuals with paranoid schizophrenia are likely to commit assault against those they believe may be after them.  Schizophrenia may also lead to public harassment, trespassing, and petty theft. A secondary illness of many mental disorders, such as manic depressive disorder and severe depression, is drug and alcohol abuse, which can lead to a whole new slew of issues.

There is also a trend of “mercy bookings” for which police officers will arrest individuals for their own protection. They may be so delusional that they are malnourished and obviously wounded, or in the case of many women, they may be the victims of assault.

Within San Quentin State Prison, there exists a basic mental health care system. In 2010, Marin Medical Society interviewed the chief psychologist and chief of mental health for San Quentin State Prison, Eric Monthei, PsyD.

Similarities to treatment in the outside world: HIPAA, due process, community standards, best practice, treatment modalities, emergency and on-call services, crisis intervention, routine follow-up, hospital admission processes, discharge, qualifications of the staff providing services, and spectrum of psychiatric illness.

Differences from treatment in the outside world: the institutional setting, balancing prison rules and regulations with best practice, the integration of law enforcement into treatment, and finally Death Row inmates offer a completely new set of challenges.

California is one of three states that have ruled it unconstitutional to segregate mentally ill prisoners from the rest of the prison population.

When asked how effective the treatments in San Quentin are, Monthei responded:

Consistent with the newly restructured MHSDS at San Quentin, we have implemented a Recidivism Reduction Team (RRT) specializing in evidence-based treatment and inmate/patient reintegration into society. By design, this team serves as an internal outcome measure to determine what treatment is most efficient and effective. Keeping with the unique structure at San Quentin, we anticipate that our RRT will prove to be the next step in our evolvement into efficient and effective evidenced-based treatment with outcome measures.

This quote shows that the prison setting is not ideal for treatment of serious mental illnesses. Even so, Patrick O’Reilly, PhD, wrote an article on group therapy practices at San Quentin. He describes two types of mental illness patients in San Quentin. Correctional Clinical Case Management (CCCMS) clients are diagnosed with mental illness but the symptoms are not severe. Enhanced Outpatient (EOP) clients are inmates who suffer from severe mental illness and therefore receive a more rigorous therapy routine.  In group therapy, the inmates are places in individual cages. O’Reilly claims that therapy has positive effects on the inmates and that inmates are for the most part respectful of the process.

Monthei also states that the majority of inmates will reintegrate into society once they are released. The fact is, the California Department of Corrections reports that California’s recidivism rate is among the highest in the country at 67.5 percent. The Bureau of Justice reports that this number is much higher among the prison system’s mentally ill population. A quarter of both State prisoners and jail inmates with a mental illness had served three or more prior incarcerations compared to a fifth of those inmates without a mental illness.