Experiences of Formerly Incarcerated Adults with Mental Illness: Interactions with Correctional Officers and Health and Mental Health Staff

Background: Mass incarceration disproportionately affects people with mental illnesses. The experience of incarceration poses several physical and mental health risks due to the stresses and circumstances associated with imprisonment. People with mental illnesses are more likely to experience physical and sexual victimization and attempt suicide while incarcerated. They also may have difficulty following rules or act inappropriately due to their psychiatric symptoms drawing attention from correctional officers. While we know something about correctional officers’ attitudes towards those incarcerated with mental illnesses, little is known about the prison experiences of people with mental illnesses, their interactions with corrections officers, and the impact of these experiences on their overall physical and mental health. This study aimed to understand how individuals with mental illnesses experience interactions with correctional officers and treatment staff, use of physical and mental health care, and sanctions (e.g., solitary confinement).

Method: This concurrent mixed-method project utilizes structured surveys and in-depth one hour interviews as data sources. Recruitment of participants took place at three different sites in the U.S.: Missouri, New York, and Pennsylvania (N = 37). Participants were required to have been released from prison within the past three years and have a major mental illness (i.e., major depression, schizophrenia, bipolar disorder, post-traumatic stress disorder). Data were analyzed using a combination of analytics including grounded dimensional analysis, content analysis, and descriptive statistics.

Results: Ninety-two percent of participants were male and 41% identified as White. Participants reported an average of 3.6 juvenile 24.4 adult arrests. Seventy-six percent reported a substance use disorder and 73.0% reported a major medical condition. Experiences with staff and use of services varied both within and across sites. The experience of stigma was predominant causing some to conceal the need for treatment while others felt they were punished for exhibiting psychiatric symptoms. Most mental health treatment consisted of medication with few counseling or supportive services. However, consistently across sites, participants discussed the variability in correctional officer interactions with some officers showing compassion and concern while others overusing their power. Participants referenced how the strength of rapport with officers can help or hinder entrance to treatment. For the participants who spent time in solitary confinement, the reasons for segregation were mixed with some noting they were on watch for suicide, under investigation for an alleged violation, or being punished. Another consistent finding was the feeling that being in prison exacerbated their psychiatric symptoms. A few participants reported that being in prison provided an opportunity to access mental health treatment which they had difficulty accessing in the community.

Implications: Stigma towards mental illness is a common experience in prisons and efforts to educate prison staff and other inmates is needed to ensure those needing help are willing to ask for it so that all people in need have access to treatment and services. Mental health services in prison remain highly focused on behavior control and symptom abatement with little focus on counseling and supportive services for participants in this study. Results inform prison health practice and policy.