Mental Health Issues in the Incarcerated Population
Introduction
On a global perspective, mental health conditions add up to an estimate of 13% of the disability- adjusted life years and close to a third of a life time spent with disability (Lovett et al., 2019). Studies indicate that the prevalence of mental health issues is increased among incarcerated population. Incarcerated people are those detained in prisons, jails, forensic in-patient units in health care facilities, and youth institutions. Several systematic reviews show that the prevalence of mental health issues is even higher in prisons, where the risk of suicide is six times higher than in other institutions (Lovett et al., 2019). According to Lovett et al. (2019) there are more than 10 million individuals confined in penal institutions globally. These individuals are at an increased risk of adverse health outcomes including suicide, self-injury, violence, victimization, and deaths.
Minimum attention has been paid to the incarcerated population even on a global level. Data from the United Nations (UN) and World Health Organization (WHO) on mental health and incarcerated populations within the past 15 years confirm that mental health issues are not well represented in the publications (Lovett et al., 2019). This evidence sharply contrasts the agreement in the international prison literature which requires provision of extensive mental health services. Further negligence of this critical area of the vulnerable population can cost the nation a lot of expenditures in terms of social welfare and a potentially productive population that can be salvaged using the rights resources in a timely manner.
Due to the paucity of studies on mental health issues among the incarcerated population, this research article aims to identify and discuss the significant mental health issues among this population, in order to inform future investigations, interventions, efforts and policies for better health outcomes. The most common mental health condition among prisoners is depression and anxiety, as approximately 11% of prisoners globally suffer from them. This discussion emphasizes on depression as a major mental health issue in the incarcerated population.
Background and significance
The global population of people in prisons is approximately 10 million. Beyen et al. (2017) assert that this population is being raised by roughly 1 million every decade. Accordingly, in the past 15 years, the U.S has experienced an increment of 16% in the incarcerated population between 2001 and 2012. The prevalence rates of mental health issues among the incarcerated population have always exceeded that of the general population. Approximately 450 million people globally suffer from mental health conditions (Beyen et al., 2017). According to Gonzalez and Connell, (2014), not less than half of the male inmates and at most three-quarters of their female counterparts reported symptoms of mental health conditions in the year 2013, while the general population was 9% fewer.
Beyen et al. (2017) contend that several epidemiological studies done among the incarcerated population reveal that there is a high prevalence of psychiatric illnesses. Compared to the general population, the prevalence of these disorders was between 5 to 10 times higher among the incarcerated population (Beyen et al., 2017). Beyen et al. (2017) further document that the prevalence of depressive an anxiety disorders was about 25%. While in some cases, prisoners are admitted to prison with these conditions, there is a high likelihood that the solitary conditions, and violations of human rights in the areas of confinement exacerbate the conditions.
In 2001, World Health Organization predicted that by 2020, depression will be second in the list of contributors to the global burden of disease. In a survey done in 24 countries to determine the rates of depression among prisoners on a global scale, the findings were that 10 and 14 % males and females respectively suffer from depression (Beyen et al., 2017). The levels of depression also differed from country to country. In a study by (Rousan et al., 2017) depression and major depressive disorders were confirmed to be the most prevalent mental health conditions, existing in 18% of all prisoners and accounting for 38% of all inmates who were mentally ill. According to Beyen et al. (2017) factors that have a significant impact on mental health, especially depression include overcrowding, increased violence, enforced solitary confinement, lack of privacy and meaningful activities, isolation from the social sphere of life, insecurity regarding future prospects, poor access to quality health services, particularly mental health, limited social support, frustration before and after serving the prison term, and older ages. The cumulative effects of these factors resulted in increased incidences of suicide, which is related to depression.
Studies document high rates of recidivism once inmates are released from prison, particularly those who were released with untreated mental health conditions. Gonzalez and Connell (2014) echo the findings of a study that established that inmates who had a professional diagnosis of any mental health disorder had a likelihood of returning to prison by 70% compared to those who were not diagnosed with any mental health condition. They further assert that the rates of recidivism for those who had been previously incarcerated was between 50-230% higher for individuals diagnosed with mental health conditions compared to those without, irrespective of the diagnosis.
Limited access to the appropriate treatment options for mental health conditions directly translate to increased cases of disciplinary issues, violation of rules and regulations, and increased cases of physical assault (Lovett et al., 2019). These cases are further compounded by the fact that they are confined in solitary environments. Even though healthcare is an essential requirement to all inmates, access to those services on a case-by-case basis is significantly impaired, even to those diagnosed with chronic illnesses such as diabetes and hypertension. According to Mental Health America (2020), there is a strong positive correlation (r= 0.69, p=000), between the rates of individuals who were incarcerated and lack of access to mental health care. The study further conforms that states with limited access to mental health care have more individuals in the criminal justice system.
The incarcerated population majorly consists of young productive people, who go on with their life in the community after serving their terms in jail. The government has set up remarkable strategies to ensure the prisoners maintain a productive mentality and are able to grow themselves even after serving their sentences in prison. This is a great move as it ensures a productive future for the country. However, it is evident that across the globe, minimum attention is paid to mental health among the incarcerated population in particular.
Unlike physical health needs, mental health needs present with less subtle signs and require keen assessment by a trained mental healthcare provider. The importance of mental health care among incarcerated populations cannot be emphasized enough, both from a legal and humanitarian approach. Even though the U.S. supreme court decisions have been geared towards advocating for the prisoners’ rights to health care, including mental health, screening and treatment for mental health conditions remains a huge challenge.
Table 1. prevalence of mental health conditions nationwide and in New Jersey state (Rousan et al., 2017).
| Federal statistics | New Jersey State statistics | |
| Percentage of prisoners who have had a diagnosis of mental health condition. | 37% | 44% |
| Prevalence of those diagnosed with “serious psychological distress” including depression. | 40% | 61.7% |
Surveillance and reporting
Psychologists keep exploring new methods of keeping inmates in check and helping the evade behaviors that result in reicarceration following their release from prison. One of the surveillance methods is the monitoring of antisocial thinking and behavior patterns among those diagnosed with mental health disorders. This method differs from the traditional perspective where it was believed that improved mental health care alone is enough to mitigate the chances of criminal behavior patterns. Consequently, this method addresses mental health care and treatment of criminal behavior. This includes how to challenge antisocial thoughts, and enhancing healthy relationships with others.
Reporting of the mental health conditions is done via the health care facilities that are accessible to the incarcerated population. There are several bodies responsible for documenting the annual statistics regarding mental health among prisoners. For instance, the Bureau of Justice Statistics reported the highest prevalence of mental health conditions to be 60% among jail inmates and 40% among federal prisoners (Rousan et al., 2017).
Epidemiological analysis
The DSM-5 defines depression as a mental condition in which an individual manifest with persistent lack of interest in previously enjoyed activities, hopelessness and constant lethargy, resulting in low quality of daily living. Currently, over 264 million people are affected globally (WHO, 2020). It is estimated that there are 800,000 annual deaths related to suicide as a result of depression (WHO, 2020). This is observed as the second leading cause of morbidity among individuals between 15 and 29 years old (WHO, 2020). The most common reason attributed to these deaths is the lack of effective treatments, particularly in low- and middle-income countries, where lack of resources compounds the problem. The financial cost of related to major depressive disorders in the U.S. is currently estimated to be $210.5 billion annually. Major depressive disorder has a significant impact on the social aspects of life. Complications such as suicides, and serious relationship issues are related to depressive disorders.
Screening and guidelines
The most reliable and widely used diagnostic tool for depression id the DSM- 5 diagnostic manual. It contains several criteria that are used to establish a diagnosis of depression. The manual establishes that to diagnose depression, the individual must have had at least five minor symptoms within two weeks, and at least two major symptoms. The major symptoms include depressed mood and sudden loss of interest or pleasure in activities that were previously enjoyed. Some of the minor symptoms include sudden onset eating disorders, lethargy, and feelings of worthlessness.
Plan
To address depression, first, nurse practitioners should emphasize on maintaining patient contact after diagnosis through face-to-face interviews and phone calls. Keeping the patient in close contact is a way of ensuring accountability and enhancing the therapeutic relationship between the nurse and the patient (Gonzalez & Connell, 2014). Essentially, the nurse should ensure that the contact is not only regular, but also proactive with thoroughly constructed content. To assess the effectiveness of this plan, monthly survey will be conducted, and questionnaires will be provided to patients to assess how well they are benefitting from the program.
Second, nurse practitioners should conduct and interdisciplinary regular follow-up assessment of the critical aspects of treatment. This includes the symptoms of depression, compliance to the treatment regimen, and any need for adjusting treatments (Gonzalez & Connell, 2014). The collaborative care provided will contribute to the desired outcomes in the patients. To assess this plan, comprehensive reports on each patient will be generated and analyzed for the effectiveness of the processes incorporated.
Third, nurse should be actively involved in helping the patients set their therapeutic goals. By helping the identify and overcome their barriers to recovery, the nurses will be empowering the patient and enhancing their autonomy. Symptoms of depression are significantly alleviated through behavioral activation (Mental Health America, 2020). To assess this plan, the behavior of the patient after treatment will be evaluated to not any improvements.
Summary
Depression is increasingly becoming a burden to illnesses in the 21st century. Statistics indicate that the most affected group are the youth who are energetic and productive. Its increased prevalence among the incarcerated population is associated with severe financial and social implications. Its financial cost is also overwhelming as the government incurs a lot of expenditures in not only medications, but also rehabilitative services for these people. The social implications also leave individuals with hopeless and miserable personal lives and relationships. Addressing this issue with the seriousness it deserves could save the nation a lot of expenses and a productive future generation.
References
Al-Rousan, T., Rubenstein, L., Sieleni, B., Deol, H., & Wallace, R. B. (2017). Inside the nation’s largest mental health institution: a prevalence study in a state prison system. BMC Public Health, 17(1), 342.
Beyen, T. K., Dadi, A. F., Dachew, B. A., Muluneh, N. Y., & Bisetegn, T. A. (2017). More than eight in every nineteen inmates were living with depression at prisons of Northwest Amhara Regional State, Ethiopia, a cross sectional study design. BMC psychiatry, 17(1), 31.
Lovett, A., Kwon, H. R., Kidia, K., Machando, D., Crooks, M., Fricchione, G., ... & Jack, H. E. (2019). Mental health of people detained within the justice system in Africa: systematic review and meta-analysis. International journal of mental health systems, 13(1), 31.
Mental Health America. (2020). Access to Mental Health Care and Incarceration. Retrieved from https://www.mhanational.org/issues/access-mental-health-care-and-incarceration
Reingle Gonzalez, J. M., & Connell, N. M. (2014). Mental health of prisoners: Identifying barriers to mental health treatment and medication continuity. American journal of public health, 104(12), 2328-2333.
World Health Organization, (WHO). (2020). Depression. Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression
