Severe Mental Illness in Federal Prison.
The mental health of prisoners is not taken as seriously as the general population. According to the National Alliance on Mental Illness, “many people with mental illness who are incarcerated are held for committing non-violent, minor offense related to symptoms of unrelated illness…” (NAMI, 2022). Individuals with a severe mental illness, who experience psychotic symptoms especially, are often viewed as dangerous or threatening. These mental illnesses can include schizophrenia, major depressive disorder, bipolar disorder, and schizoaffective disorder with different co-morbidities. Individuals who live with these mental illnesses may experience psychotic symptoms. They can be targeted due to their behaviors and even incarcerated instead of hospitalized. Unfortunately, the treatment worsens if the individual is incarcerated. According to Torrey et al., there is a “deterioration in psychiatric conditions of inmates with mental illness as they go without treatment” (Torrey et al., 2014). Imprisoning individuals with severe mental illness and not providing proper resources is typical, so special consideration should be given to those individuals.
There is also a growing number of individuals with mental illnesses in prisons. “Mass incarceration has become the default option for long-term care of serious mental illnesses in the USA, partly because it is less expensive for US states than providing a full range of community programmes, supported accommodation, and rehabilitation beds” (Allison et al., 2017). Mass incarceration without proper supports is arguably a human rights issue that impacts many incarcerated people with severe mental illnesses. A policy that impacts this issue is the First Step Act of 2018 (The FSA). The FSA, although established for different purposes, positively impacts the mental health of prisoners in the United States. This act provides services and treatments that benefit individuals who may be struggling with severe mental illness in the U.S. prison system.
The history that precedes the FSA is a meaningful one. In the 1980s, cocaine was growing tremendously. After a public overdose of a Boston Celtics draft pick, the Anti-Drug Abuse Act of 1986 was enacted, establishing mandatory sentences. The act gave harsher sentences to those with cocaine base versus powdered cocaine. Following this, the ADAA was criticized for its racial disparities. “Efforts to reduce these racial disparities resulted in the Fair Sentencing Act of 2010 (FSA). This law decreased mandatory minimum sentences associated with cocaine base while maintaining existing sentences for powder cocaine” (Walker, L. S., & Mezuk, B. 2018). Following the Fair Sentencing Act came the First Step Act. The FSA hopes to reduce and prevent harsh sentences and prison reform through various initiatives. The FSA also grants compassionate release, mandates de-escalation training for correctional officers, and allows inmates to be placed close to home. In addition, it modifies mandatory minimum sentences, reduces prison convictions to 25 years instead, and gives way to courts sentencing low-level drug offenders to less severe sentences (Grawert, 2020). While those with severe mental illness should be getting hospitalized care, it is essential to implement proactive measures for them to provide support if they are in a prison setting. Being treated humanely can positively impact these individuals, potentially lessening the worsening of their symptoms while resources are lacking. The FSA benefits prisoners with severe mental illness by decreasing their risk of worsening symptoms due to improving prison conditions and providing access to essential treatment.
Black and Latino populations are impacted by the presenting problem as they have a high level of incarceration, so much so that “the proportion of black children who will ever have a father imprisoned is high. A black child born in 1990 had a 25.1% chance of having their father sent to prison, for those fathers whose did not finish high school, the risk was roughly double that at 50.5%.” (Wildeman & Wang, 2017). It was further stated that black people were more likely to know someone incarcerated than other races. These disparities can lead to health disparities as well. According to Wildeman & Wang, black inmates in solitary confinement who were in New York City jails had higher odds of fatal self-harm. The implementation of the FSA caused criticisms stating that the FSA excluded people of color and was criticized for its potential exclusion of people of color and undocumented immigrants. It was noted that black and Latino individuals comprise a large portion of the prison population, and their mental health should not be secondary.
Alongside these racial disparities, prisoners with severe mental illness are disproportionately abused. Torrey et al. stated, “mental ill prisoners are victimized much more frequently than other prisoners” (Torrey et al., 2014). The FSA contains many programs and services that help prisoners who have a mental illness. These programs benefit prisoners with mental illness and will be highlighted later.
Although the FSA was beneficial, there were a few issues with its implementation. According to Grawert and Lau of the Brennan Center for Justice, the FSA initially stalled while in the Senate as it became a political issue. Some politicians considered the FSA a grave mistake. Per Durbin et al., in the Federal Sentencing Reporter, it was expressed in letter form “the bill’s recidivism reduction plan would require BOP to create a new risk assessment system to determine time credits…research shows that risk assessments often do not accurately predict risk and can produce results that are biased against people of color-particularly African Americans” (Durbin et al., 2018). This letter argued that many people of color and undocumented immigrants would be excluded from earning time credits and be disproportionally affected. The letter further explained that the FSA’s requirements for prisoners to earn time credits only after the warden proves they are safe would not improve recidivism rates as expectations are too high. According to Durbin et al., “recidivism reduction must be aimed at high-risk persons in order to be most effective” (Durbin et al., 2018). This letter thoroughly explains the dangers of this bill, excluding people of color and undocumented immigrants.
A significant strength of this policy are the many programs offered. The programs include vocational training, therapy, and educational classes. According to the BOP, The BRAVE program is a treatment program for young males serving their first federal sentence. This treatment program allows participants to work in groups and engage in self-improvement groups where they work on social and interpersonal skill building. The FSA shows that the mental health of prisoners is being valued. One of the programs offered is the Cognitive Processing Therapy program. This is an evidence-based intervention for prisoners that addresses dysfunctional thinking and trauma. The FSA also has a Dialectical behavior Therapy treatment program for individuals who present with passive and active suicidal ideations. This group works on mindfulness, emotional regulation, and distress tolerance. Participation in these programs highly benefits prisoners with severe mental illness because it allows them to gain credits (USA BOP, 2020). Another major strength of the FSA is allowing prisoners for time credits if they participate in recidivism and valuable activities. Prisoners are also able to gain time credits, allowing for some prisoners to be able to leave prison earlier. The FSA strives for a better prison system and offers opportunities for people serving time. This benefits prisoners with severe mental illnesses in prisons as they can have their needs met while serving time (Grawert & Lau, 2019). Providing these services will ensure that the experience of those with a mental illness is not an unbearable one.
Despite the FSA being very beneficial, it is not immune to errors and issues. There are some significant weaknesses of the policy. One major weakness of the policy was the rollout process. As stated above, there were some concerns about the FSA not being fair toward marginalized populations. Another weakness of the FSA is its inability to address specific fundamental problems. One of those problems is the transition of prisoners from being institutionalized to living in the community. While the FSA has strengths in addressing the need for shortening harsh sentences for nonviolent drug offenders, addressing poor prison conditions, and granting compassionate releases, it has not provided as much support when prisoners are transitioning out. Per Forrester et al., “the stigma attached to ex-offenders results in a reluctance from mainstream mental health services in the community to accept people for treatment and care upon their release from prison. Significant challenges exist in achieving stability and rehabilitation for this population….” (Forrester et al., 2018). Transitioning out of incarceration is an area that should be further developed within the FSA. The transition period is an area where many prisoners commonly struggle. The FSA has benefited ex-offenders by releasing them after the successful completion of time credits or participation in the BOP programs. It is true that “more than 3,000 federal inmates have been released from prison under the First Step Act since it was signed by President Donald Trump in 2018” (Jenkins, 2021). Although the evidenced-based recidivism reduction programs within the FSA are designed to ensure inmates have skills upon release, more extensive support is required for those with a severe mental illness, as participation in any mental health program is hard enough even when not incarcerated.
Lamb & Weinberger write, “it is critical to recognize that the treatment of offenders with SMI is very different from that practiced in a traditional community clinic” (Lamb & Weinberger, 2017). All formerly incarcerated persons benefit from further support upon release, whether mentally ill or not. In that case, providing extensive mental health assistance through FSA for those with severe mental illness is essential. According to Wallace and Wang, combining helpful mental health services in prison and post-prison mental health support leads to decreased recidivism (Wallace & Wang, 2020).
While researching this mental health policy, I found that it takes a lot for an approach to be implemented. The FSA’s implementation was rocky even though it vowed to solve several human rights issues in U.S. prisons. The FSA did an excellent job at addressing the harsh sentences in prisons, and thousands of prisoners with health issues were compassionately released due to the FSA. There have been benefits to prisoners with severe mental illnesses, such as the FSA’s compassionate releases, and less harsh sentences benefit individuals with mental illness. However, I found that the FSA still lacks adequate help for those prisoners who will be released. I found that many policies in the U.S. fall short in critical areas. In the future, I predict that political differences and marginalization will be significant issues when advocating for and reviewing policies. For example, through my research of the ADAA Act of 1986, I found that many laws appear well-meaning but are, instead, very damaging.
The First Step Act of 2018 has successfully reduced long federal sentences and improved the way of living in prisons. It has provided relief from penalties, expanded compassionate release, placed many current and future inmates close to home, and provided programs meant to decrease recidivism. Implementing the FSA was told with some criticisms and hiccups in the Senate, but it has managed to release 3,000 prisoners. However, more work is needed to accommodate prisoners with severe mental illness.
References
Allison, S., Bastiampillai, T., & Fuller, D. A. (2017). Mass incarceration and severe mental
illness in the USA. The Lancet, 390(10089), 25. https://doi.org/10.1016/s0140-6736(17)31479-4
(BOP) U.S Department of Justice Federal Bureau of Prisons. (2020, October). The First Step Act Approved Programs Guide. BOP: Federal Bureau of Prisons Web Site. https://www.bop.gov/inmates/fsa/docs/fsa_program_guide_202010.pdf
Durbin, R. J., Booker, C. A., Harris, K. D., Lee, S. J., & Lewis, J. (2018). Dear colleague letter expressing concerns with First Step Act. Federal Sentencing Reporter, 31(2), 150-152. https://doi.org/10.1525/fsr.2018.31.2.150
Forrester, A., Till, A., Simpson, A., & Shaw, J. (2018). Mental illness and the provision of mental health services in prisons. British Medical Bulletin, 127(1), 101-109. https://doi.org/10.1093/bmb/ldy027
Grawert, A. (2020, June 23). What is the First Step Act — And what’s happening with it? Brennan Center for Justice. https://www.brennancenter.org/our-work/research-reports/what-first-step-act-and-whats-happening-it
Grawert, A., & Lau, T. (2019). How the First Step Act became law — and what happens next. Brennan Center for Justice. https://www.brennancenter.org/our-work/analysis-opinion/how-first-step-act-became-law-and-what-happens-next
Jenkins, G. (2021, July 25). The First Step Act released them from prison. Then the government tried to lock them back up. The Washington Post. https://www.washingtonpost.com/nation/2021/07/25/first-step-act/
Lamb, H. R., & Weinberger, L. E. (2017). Understanding and treating offenders with serious mental illness in public sector mental health.
Torrey, E.F., Zdanowicz, M.T., Kennard, A.D., Lamb, H.R., Eslinger, D.F., Biasotti, M.I., Fuller, D.A. (2014). The treatment of persons with mental illness in prisons and jails: A state survey. Arlington, VA: Treatment Advocacy Center.
Wallace, D., & Wang, X. (2020). Does in-prison physical and mental health impact recidivism? CrimRxiv. https://doi.org/10.21428/cb6ab371.20f1582f
Walker, L. S., & Mezuk, B. (2018). Mandatory minimum sentencing policies and cocaine use in the U.S., 1985–2013. BMC International Health and Human Rights, 18(1). https://doi.org/10.1186/s12914-018-0182-2
Wildeman, C., & Wang, E. A. (2017). Mass incarceration, public health, and widening inequality in the USA. The Lancet, 389(10077), 1464-1474. https://doi.org/10.1016/s0140-6736(17)30259-3