Are Jails the New Mental Hospitals? What Carcerally-Involved Individuals Have to Say about It

Background and Purpose: After the unnatural deaths of three prisoners with serious mental disorder diagnosis (SMD) in 1991, the Supreme Court in Coleman v. Wilson found the State of California in violation of the 8th Amendment; the State’s inability to provide adequate mental health services to inmates constituted cruel and unusual punishment. The Coleman case sparked a decade long legal battle, ultimately resulting in national recognition that prison overcrowding threatens health and civil rights (Simon, 2013). Efforts to reduce prison populations across the country are now underway. Unfortunately, not all released prisoners successfully re-enter society; in the case of California, local jails now see a one inmate increase for every four prisoners released under reform efforts (Lofstrom & Raphael, 2013).  Growing jail populations now raise concern regarding the ability of counties to provide adequate mental health services for jail inmates. Given their service needs and vulnerability (Haney, 2006), concern is especially high for individuals with SMD; we cannot risk another Coleman.   

Individuals with SMD are overrepresented in jails (Steadman et al., 2009), yet little is known regarding the nature of jail psychiatric services (JPS) from the first hand experiences of these individuals. In an attempt to create a baseline understanding of JPS from the perspective of these individuals, this study utilizes interviews on JPS in a California county jail that has not yet faced overcrowding, asking (1) How do carcerally-involved individuals with SMD make meaning of JPS? And, (2) how do these conceptualizations inform our understanding of the strengths and limitations of JPS “as usual”?

 

Methods: This study employs a phenomenological approach (Benner, 1994).  Data include 19 semi-structured interviews with individuals with SMD with recent and repeated incarcerations in a county jail (a purposive, homogenous sample; Palinkas et al., 2013).  Data from four interviews with clinicians are used to triangulate reports (n=23). Researchers first inductively coded essential descriptions of JPS, staying as close as possible to descriptions provided by participants. Researchers then deductively coded perceived strengths and limitations of JPS.  Dedoose, qualitative data analysis software, facilitated interview coding of transcripts and Miles and Huberman’s Qualitative Data Analysis (1994) informed analytic procedures.

 

Results: Interviewees primarily conceptualized JPS as a manager of medications, and, secondarily as a brokerage service (similar to clinical case management). Interviewees largely saw the strengths of JPS in the provision of social support, access to information, and protection from correctional officers. Limitations of jail psychiatric services included inadequate access to psychiatric medication, and incompatibility with psychotherapeutic work.  Ultimately, JPS workers were most often viewed as helpful and benevolent, but the therapeutic alliance was undermined by jail conditions and dominance of the Sheriff’s correctional staff.

 

Implications: Findings provide a unique glimpse into the significance of JPS for individuals with SMD, one with practical application to forensic social workers and correctional administrators.  While findings undermine the popular notion that jails are or can be “the new mental hospitals” (PBS, 2005), results also provide fundamental information regarding what constitutes adequate JPS services and, ultimately, how we can prevent civil rights abuses.