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The mental health crisis in the United States, likely worsened by COVID-19 and its associated impacts such as social isolation and unemployment, has reached alarming levels. According to the Kaiser Family Foundation, the proportion of American adults reporting symptoms of anxiety or depressive disorders nearly quadrupled from 11% between January and June 2019 to 41% in January 2021.
A significant issue exacerbating this crisis is the lack of access to mental health services, particularly for vulnerable populations like ex-offenders.
Individuals who have been incarcerated are known as ex-cons, ex-prisoners, the formerly incarcerated, parolees, and returning citizens. Annually, over 600,000 individuals are released from incarceration, yet more than three times that number are imprisoned. A 2020 report revealed that almost 2.3 million people are confined in the American criminal justice system annually, which includes:
Not all individuals in jails have been convicted; many remain in pretrial detention because they cannot afford bail. According to the ACLU, pretrial detention significantly increases the likelihood of conviction and longer sentences, and even a single day of detention can lead to failure to appear in court, resulting in re-arrest.
Punishment without rehabilitation often leads to recidivism, where ex-offenders reoffend and return to imprisonment. Bureau of Justice Statistics data shows that within three years of release, two-thirds of ex-offenders are re-arrested, and more than half are incarcerated again. Recidivism rates vary by state, ranging from 21.4% in Texas to 66.4% in Alaska.
The primary goals of incarceration are to separate offenders from society, deter future offenses, and rehabilitate individuals to reintegrate into society. However, rehabilitation has been historically undermined, leading to a cycle of re-offending.
Rehabilitation, or social reintegration, faces numerous obstacles due to the stigma attached to being an ex-offender. This stigma can lead to self-stigma, resulting in low self-esteem, unhealthy behaviors, and poorer mental health. Obstacles to reintegration include:
Ex-offenders typically have worse physical and mental health than the general population. Prisons often fail to provide adequate healthcare, leading to the exacerbation of health issues. The conditions in prisons, such as unhealthy food, smoking, overcrowding, poor ventilation, violence, and stress, further deteriorate inmates' health.
Incarceration can severely impact mental health. A significant portion of inmates suffer from serious mental illnesses (SMI) and SUDs. Despite the need for treatment, many do not receive adequate care. Dual diagnosis, where individuals suffer from both a mental illness and a SUD, is common but often goes untreated, increasing the likelihood of relapse and re-offending.
Mental illness has multiple causes, including genetics, lifestyle, childhood abuse, medical conditions, and social isolation. Incarceration can exacerbate existing mental health issues or lead to new ones due to the stressful and traumatic environment of prisons.
The movement towards deinstitutionalization aimed to integrate individuals with mental illnesses into society. However, without sufficient support, many ended up homeless or incarcerated. Criminalizing homelessness and inadequate mental health services contribute to the high number of mentally ill individuals in prisons.
Despite awareness of the issue, mental health care in prisons remains insufficient. Effective treatment requires a combination of therapy and medication-assisted treatment (MAT), but many inmates do not receive the care they need.
Incarceration can lead to institutionalization, where individuals become reliant on the structure of prison life, making reintegration challenging. Long-term incarceration can result in mental health issues such as PTSD, depression, and anxiety, especially for those in solitary confinement.
Providing mental health care in prisons can reduce suicide rates and help inmates become productive members of society post-release. It is more cost-effective and beneficial for public safety to offer mental health treatment before, during, and after incarceration.
Addressing the mental health needs of incarcerated individuals is crucial for reducing recidivism and helping ex-offenders reintegrate into society. Comprehensive mental health care can improve outcomes for individuals and save societal costs, highlighting the need for better access to mental health services within the criminal justice system.
Outpatient behavioral health & primary care services.