A Mental Illness and Psychosis or Personality Disorders - Essay Example

?Introduction There is estimated to be some type of mental disorder prevalent in 37% of male prisoners, 66% of male prisoners on remand, 57% of female prisoners and 76% of female prisoners on remand (Birmingham, 2003, p. 193). Mental issues range the gamut, from personality disorders to psychotic disorders, with anti-social personality being the most common personality disorder seen in a prison setting for both men and women (Birmingham, 2003, p. 193). By some estimation, some 47% of male inmates and 21% of female present with this disorder (Fazel&Danesh, 2002, p. 548). With men, paranoid personality disorder is the second most-common personality disorder; with women, borderline personality disorder is the second most-common personality disorder. As for psychotic disorders, schizophrenia and delusional disorder are the most common (Birmingham, 2003, p. 193). Moreover, inmates display a wide range of neurotic disorders, such as depression, insomnia, fatigue and irritability (Birmingham, 2003, p. 193). Additionally, there is substantial comorbidity in individuals with psychiatric disorders, in that many of them also suffer from substance abuse (Crawford, et al., 2003, p. S2). There are also many youthful offenders, which are defined as defenders who are between the ages of 15 and 21, with juveniles being defined as being between the ages of 15 and 17, and 30 percent of youthful males and 50 percent of youthful males on remand have a diagnosable mental disorder (Farrant, 2001, p. 1). Therefore, something must be done to address the needs of these inmates and defendants, and this requires humanitarian concerns to dominate the debate about how to treat mentally challenged defendants and inmates. Because of this, there is a great need to address the needs of these inmates when meeting their mental health challenges. Some of the ways to address these needs include diversion schemes, transfers to hospitals and treating the inmates in the prison hospital. However, as indicated below, none of these schemes are perfect, and many of them are severely flawed. Because of this the mentally ill prison population, by and large, continues to be untreated and this has severe implications for society. Discussion Unfortunately, humanitarian concerns do not dominate the penal system in England andWales, but, rather, the dominant concern is that the perceptions and attribution of risk are attenuated (Peay, 2007, p. 497). Because of the perception and risk attribution of these offenders, therapeutic considerations are considerations no longer. This in contrast to the recommendations of the Home Office Circular 66/90, which stated that mentally disordered offenders should be placed in the care of health and personal services, according to their mental illness. This recommendation would have caused the prisons to adopt a treatment-based approach, with a de-emphasis on the questions of risk and reoffending, and would have taken mental health law in the direction of medical law (Peay, 2007, p. 498). This approach was rejected by the Government, which, in its White Paper (Department of Health/Home Office 2000), put the safety of the public as the paramount concern, not treating the mentally ill offender, and called for, in essence, “a form of indefinite detention for some people with personality disorder” (Peay, 2007, p. 498). Therefore, this pushed mental health law more in the direction of penal law, and away from the direction of medical law (Peay, 2007, p. 498). There are a number of different schemes through which a mentally disordered criminal can get treatment instead of straight incarceration. One of these schemes is court diversion (Peay, 2007, p. 506). In this, the offender, the psychiatrist and the Crown Prosecution Service, are brought together to come up with a solution for what to do with the offender (Rickford&Edgar, 2005, p. 1). Diversion is especially appropriate where the offence committed is non-violent and relatively minor (Pakes&Winstone, 2009, p. 158). One of the key aims of diversion is to reduce the number of mentally ill inmates who are on remand awaiting a psychiatric report, and reduce the time that these inmates spend on remand, giving a cost and sentencing benefit while also benefiting the inmate (Pakes&Winstone, 2009, p. 161). Diversion can be administered if the prosecutor receives a mental report about the accused that states that the accused has a mental illness that would be made worse if that individual is remanded into custody or may be made worse by the stress of criminal proceedings (Prins, 2004). Studies have shown that, when the offender is admitted to the hospital, that the outcome is more favorable, both for the inmate and the community at large, because the inmate is getting the treatment that he or she needs, and reconviction rates have been shown to be half of those for offenders who are not so admitted (Peay, 2007, p. 506). This is an example of treating the inmate through the hospital, as opposed to incarceration, when the inmate is mentally ill at the time that he committed the crime. There are also schemes that resemble diversion, in that these schemes purport to keep an offender out of prison, but are not quite diversion, in that these schemes serve advisory, advocacy or service-related roles, as opposed to diversionary roles. Among these schemes are assessment schemes, in which advice is given to the court about the defendant’s mental health status, as well as recommendations about the best placement of the accused; liaison schemes, where inmates within the prison population are given mental health resources that they may need; and panel schemes, where criminal justice, health and social service agencies join forces to design a treatment plan for the accused (Pakes&Winstone, 2009, p. 159). There are also provisions for transferring inmates to the hospital after they have already been incarcerated, in cases where the inmate becomes mentally ill after being imprisoned (Peay, 2007, p. 510). However, this is not always desirable, because the inmates often get transferred towards the end of their sentences, and, because a hospital stay is indeterminate for the most serious offences, the inmate may spend many years in the hospital; thus, these transfers are often motivated more by the need to protect the public then by concern for the inmate’s well-being (Peay, 2007, p. 510). Moreover, the provisions for transferring inmates to psychiatric facilities faces problems for a variety of reasons, including budget shortfalls; the inability to transfer inmates expeditiously; and the inability to identify the inmates who need treatment the most, due to the fact that many mentally prisoners are put into general population (Reed, 2003, p. 287). The inability to identify inmates who need psychiatric services is compounded by insensitive and untrained prison officials, such as the guard who neglected to get an inmate who was hallucinating, having delusions, and not leaving his cell or bathing for several weeks, with the guard stating that the inmate was just acting up because of desire to stay in his single cell (Reed, 2003, p. 287). Another problem is that there is a general lack of secure psychiatric beds. Consequently, transfers may be delayed for months, even years (Reed, 2003, p. 288). Also, there are very few inmates who get transferred - the number of inmates who are transferred is only about 700 per year (Rickford& Edgar, 2005, p. 4). Treatment in prison is another option. These initiatives are focused upon “cognitive behaviouralprogrammes for sex offenders, offence-focused problem solving…,substance-abuse treatment programmes, controlling and managing anger (CALM), and cognitive self-change programmes for violent offenders” (Peay, 2007, p. 515). However, these programmes can be affected negatively by prison overcrowding and short sentences for individual inmates. Moreover, for prisoners with psychotic disorders, prison remains an inappropriate location, because these prisoners need medication, and the care that they receive in prison is below the standard of care that they would receive in a psychiatric hospital. These prisoners especially have special needs that cannot be met in prison, and there is often a mismatch between the needs of the inmate to have the care necessary to control his or her psychosis and the treatment the health and criminal justice personnel can deliver (Peay, 2007, p. 516). Moreover, the treatment that inmates receive in prison is often grossly inadequate. For instance, a patient who was nursed in a health care centre was without bedding or furniture, due to the fact that the centre ran out of supplies (Reed, 2003, p. 287). Nevertheless, there is a policy in place that prisoners are to receive the same standard of care as if he or she was not incarcerated, and this standard was implemented with the National Health Service took over the care of inmates in 2003 (Wilson, 2004, p. 5). However, according to Wilson (2004), prison hospital beds occupy a kind of netherworld – not quite prison community, but also not quite up to the standards set for hospitals (Wilson, 2004, p. 5). Because of this, they do not have the equivalency of a hospital. One way to fix this, according to Wilson (2004), would be to bring prison hospitals under the aegis of the Mental Health Act 1983. This would not only eliminate the wait time for NHS hospital beds, but this would also allow for compulsory treatment if this is necessary, and this treatment would be more in line with what the inmate would receive in a hospital bed (Wilson, 2004, p. 6). The issue of compulsory treatment is important, because, as it stands, an inmate may not be compelled to undergo treatment while in a prison health care wing, because these wings have been specifically excluded from National Health Service 1977, which authorizes such compulsory treatment (Wilson, 2004, p. 5). This has obvious implications, as mentally ill prisoners are not likely to recognize that they need treatment, especially if the person is delusional, and, if the individual has to consent to treatment, this might never happen, which would result in the inmate getting worse and worse. While the above describe in detail how mentally ill prisoners and defendants should be treated, there are also some guidelines established with regards to the accused and prisoners with other mental impairments such as learning disabilities. Put forth by the Prison Reform Trust (PRT), these guidelines provide support for adults with disabilities, such as learning disabilities, by helping these adults understand the proceedings and providing advocacy to ensure that they receive diversion when they do not have the capacity to understand or participate in the criminal proceedings. The PRT recognizes that many of adults who have learning disabilities have the ability to participate in court proceedings if they have assistance, and this is where the PRT steps in. For the issue of vulnerable defendants, in this case defined as defendants with a learning disability, the PRT has outlined seven recommendations. They are 1) the policy framework regarding vulnerable defendants should be reviewed, so that the principles about when a defendant’s trial should not continue due to lack of capacity shall become clearer; the fitness to plead criteria should be reviewed; vulnerable defendants should receive the statutory support as vulnerable witnesses; and ensuring that guidelines regarding mentally disordered defendants takes into account those with learning disabilities along with those with a mental illness; 2) every court should have adequate liaison and diversion schemes, that have, at a minimum, access to learning disability specialists, for screening, facilitated access to appropriate services, advisement to courts about measures to support the learning disabled adult, and contribution to court disposals; 3) making improvements in screening and assessing the needs of the learning disabled adult, which would include screening a party when anybody raises a concern about the individual, referral for timely mental health assessments and the reporting of screening results to the court; 4) increasing training for judges and magistrates, with the aim of these judges and magistrates being able to recognize the range of impairments a defendant can display and how to enhance the judicial proceedings for these individuals; 5) ensuring that all court proceedings comport with the Disability Discrimination Act, so that courts are fully accessible to these individuals; 6) extending health care and other benefits for defendants on bail and 7) community sentencing orders should be more flexible in sentencing vulnerable defendants (Jacobson & Talbot, 2009, p. 4). The PRT has also recommended specific guidelines for youthful offenders with a mental illness. These are 1) early interventions that will prevent youthful offenders with mental illness from entering prison, which would include the appropriate referrals to the appropriate agencies that can help these youths with their mental illness before the youths turn to criminal behavior; 2) better assessment of mental health problems, which means that the professionals who come in contact with these youths, such as teachers and counselors, need to be better trained in spotting mental issues; 3) greater geographical spread of diversion schemes; this is important because some geographical points do not have adequate diversion schemes, and these diversion schemes need to be available to all youths, no matter where the youth lives; 4) an extension of restorative justice measures, which confront the youth with the crime that they committed and force the youth to take responsibility for their actions; 5) a reduction in the use of remand; 6) upgrading the youth’s environment in which they are placed to meet the youth’s social, physical and psychological requirements, which would include access to the youth’s family and a high quality of care; 7) improvements in prison regimes, which would include additional training for prison staff in meeting the special needs of the youths in their care; and 8) ending prison sentences for youths under the age of 17 (Farrant, 2001, pp. 15-18). Conclusion There is no doubt that many of our prison population suffers from some type of mental impairment, be it a mental illness such as psychosis or personality disorders, or another mental impairment, such as a learning disability. There is also not a doubt that society cannot just ignore this fact, and expect the mentally ill inmate to exist in prison without treatment and further expect that inmate to come out of his prison sentence with any kind of an ability to live in the outside world. It is bad enough that the individual has a mental illness to begin with, let alone adding the stress of living in prison without treatment to the mix. Therefore, the needs of these inmates cannot go unanswered. That said, there is a dearth of satisfactory solutions to address this problem. Diversion is one way to address the problem. Another way to address the problem is by transferring the inmate to a hospital. A third way of addressing the problem is by giving the inmate treatment while in prison. None of these schemes are perfect, however, and most suffer from a lack of funding and a lack of caring. Too often, people dismiss the concerns of these inmates, such as the guard who ignored the hallucinating inmate by stating that the inmate was simply acting out. This is a perfect example of a prison employee who is both ignorant and untrained. Transfers to hospitals take months, even years, due to inadequate funding, lack of training in spotting inmates who need hospital services, and lack of hospital beds for these inmates. In-prison care suffers considerably because of a lack of resources and the fact that psychiatrists cannot force care onto individuals who may be so mentally ill that they do not realize that they need care. This ties the hands of the treating psychiatrist who no doubt sees that the inmates who need care the most will also be the ones who will completely go without care because they did not consent. The upshot is that our inmate population continues to suffer, which isn’t right. These inmates are, after all, human beings, just like anybody else, and, as such, they are worthy of dignity and care just like anybody else. This is especially true when it comes to youthful offenders, the majority of which present with a mental illness of some sort. These youthful offenders, above all, must receive the proper amount of care, for, if they receive the care that they need, they have a chance of living a normal adult life. However, if they are put into prison without addressing their needs, they are liable to become ever more hardened and their mental illness will only get worse. Because of all of these reasons, there is a great need to address, once and for all, the mental health needs of all of our inmates. Sources Used Birmingham, L. 2003. “The Mental Health of Prisoners,” Advances in Psychiatric Treatment, vol. 9, pp. 191-201. Crawford, V., Crome, I. & Clancy, C. 2003. “Co-existing Problems of Mental Health and Substance Misuse,” Drugs: Education, Prevention and Policy, vol. 10, pp. S1-S74. Farrant, F. 2001. “Troubled Inside: Responding to the Mental Health Needs of Children and Young People In Prison,” Prison Reform Trust UK. Fazel, S. &Danesh, J. 2002.“Serious Mental Disorders in 23,000 Prisoners,” The Lancet, vol. 359, pp. 545-550. Jacobson, J. & Talbot, J. 2009. “Vulnerable Defendants in the Criminal Courts: A Review of Provision for Children and Adults,” Prison Reform Trust UK. Mental Health Act 1983. Pakes, F. &Winstone, J. 2009. “Effective Practice in Mental Health Diversion and Liaison,” The Howard Journal, vol. 48, no. 2, pp. 158-171. 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