Prison psychology encompasses both clinical mental health practice within correctional settings and the study of psychological aspects of imprisonment and maladaptive behavior. As a clinical discipline, the term correctional mental health is often used to be more inclusive of its multiple professional disciplines and settings, which may include jails, state and federal prisons, juvenile or adult detention centers, and residential "halfway" houses, where inmates may live transitionally after leaving prison. Unlike its courtroom counterparts forensic psychology and psychiatry, which focus mainly on legal determinations related to criminal behavior, correctional mental health provides clinical assessment and treatment for incarcerated offenders.
The number of inmates in the United States increased more than fivefold between 1973 and the early twenty-first century, as a "law and order" political climate radically altered initial penal policy efforts at rehabilitation and reintegration of offenders into the community. At the same time public and private mental health resources failed to keep pace with the treatment needs of persons with mental illnesses, increasing the numbers of inmates with untreated mental illness in jails and prisons. Studies indicate that at least 8 to 19 percent of prisoners have significant psychiatric or functional disabilities, with another 15 to 20 percent requiring some form of psychiatric intervention during their incarceration. A recent history of a mental health problem (based on symptoms, diagnosis, or treatment by a mental health professional in the past year) was present in more than half of all prison and jail inmates in the United States. Since the 1970s numerous class-action lawsuits and the appearance of basic standards for correctional mental health care have prompted states to provide a system for identifying and monitoring persons with mental illness severe enough to interfere with their functioning, and for transferring at-risk inmates to treatment settings where specific types of services can be provided by trained mental health staff.
The number and credentials of mental health staff in correctional facilities vary greatly by state and locality. Some facilities have a mental health team consisting of a psychiatrist, psychologist, and social worker consulting together. Where special units for more severely ill inmates have been established, music, art, and occupational therapists, psychiatric nurses, and correctional officers may supplement the treatment team.
Prisons and jails vary greatly in mental health programs and services, as they vary in providing inmates access to the recreation, education, and vocational programs that relieve stress and boredom and can inspire a sense of mastery, positive self-concept, and the possibility (with adequate aftercare and community programs) of creating a prosocial future life. At a minimum, most correctional settings share an emphasis on preventing suicides through brief initial assessments and prompt crisis intervention. Primary treatment modalities may include psy-chopharmacology, group or individual psychotherapy, substance abuse treatment, and occasionally (especially for selected sex offenders) relapse prevention programs. Some facilities offer all inmates life skills training groups, including meditation and anger management, and groups such as the Houses of Healing program, which survey a range of issues commonly encountered by inmates.
Treatment needs are frequently complex. Substance abuse, homelessness, a physical or sexual abuse history, criminal recidivism, and rule violations in prison are seen more frequently in mentally ill inmates. As the inmate population has grown, so has the list of subpopulations of mentally ill inmates with special treatment needs: women, juvenile offenders, the mentally/developmentally disabled, elderly or dying inmates, sexual offenders, and those with diseases especially prevalent among inmates and the mentally ill, such as HIV and hepatitis C.
Since the 1970s the psychotherapy literature itself has changed its focus from individuals, their behavior within society, and the ways they may be rehabilitated to psychopathologies and their treatment. Critics argue that, in the pursuit of treatments for mental illness that are empirically validated or court mandated, the part of an offender that is syndromally "mad" must be distinguished from that which is morally "bad." Symptoms, diagnoses, and (especially in assessing sex offenders) actuarial data, in this view, have eclipsed the broader tasks of discovering the cause and context of offenders’ maladaptive behavior and how these fractured individuals, families, and communities may be restored.
However, several factors, including the burgeoning costs of incarceration, have prompted a renewed interest in rehabilitative possibilities. Given high rates of criminal recidivism and illness recurrence when mentally ill inmates return to communities devoid of aftercare and community resources and to avoid a new round of lawsuits, several states are enhancing aftercare programs. "Prison boom" allocations relative to communities’ education, job training, housing, community health care, and mental health budgets are under scrutiny. Research has shown that substance abuse treatment reduces serious crime ten times more than conventional enforcement and fifteen times more than mandatory minimum sentencing. Clear racial and economic disparities (approximately half of prison inmates are black, with an incarceration rate averaging five to seven times that of white prisoners) have prompted more discussion of culturally sensitive styles of therapy but have also raised the question of the social context producing the disparity. Women inmates, who typically have higher rates of mental illness than their male counterparts, are frequently separated from their children, who are often at increased risk of becoming the next generation of inmates with mental illness. Research has highlighted incarceration’s chilling effect on marital, parenting, and other relationships as well as the marginal communities from which so many young black males have been transplanted to jails and prisons.
The landmark 1971 Stanford Prison Experiment (SPE) by the psychologist Philip Zimbardo highlights the importance of institutional environments themselves in producing maladaptive behavior. Of twenty-four young men selected as "the most normal and healthiest" following a battery of screening tests, half were randomly assigned the role of prisoner, half the role of guard. After a realistic arrest and booking, each prisoner was brought to the "prison" constructed in the basement of Stanford’s Psychology Department building. Guards wore military-style uniforms and silver-reflecting sunglasses, and prisoners wore a smock with a prison ID number to enhance anonymity. Within days the "guards" were "behaving sadistically … inflicting humiliation and pain and suffering on other young men who had the inferior status of prisoner." Signs of "emotional breakdown" caused five "inmates" to be removed from the study the first week. Zimbardo had to terminate the two-week experiment after six days, not only because of the violence and degradation by the guards but because he became aware of his own transformation into a "prison superintendent" in addition to his role as principal investigator.
Hans Toch and Kenneth Adams (2002) extended Zimbardo’s "situationist" perspective within an actual prison system by documenting inmates’ maladaptive behavior demographically and cross-sectionally then following each inmate’s course over time. They found that disciplinary rates peak by the first six to nine months of incarceration, with the youngest inmates (especially when single, unemployed, and uneducated) having the most difficulty adapting. Where the SPE might predict progressively worsening behavior with more prolonged exposure to "prisonization," Toch and Adams found instead that inmates typically lead "compromise existences" in prison that allow for behavioral improvement for most inmates over time. Maturation with the passage of time, nonpuni-tive structure, and participation in even conventional activities could turn attitudes in a prosocial direction. The authors propose that the self-reform happening by chance encounters in prison might be enhanced through a problem-solving (rather than control-oriented) approach in a therapeutic community setting.
Writing in a twenty-five-year retrospective of the SPE and U.S. prison policy, Zimbardo and Craig Haney recall the era of mass incarceration that followed as "a runaway punishment train, driven by political steam and fueled by media-induced fears of crime" (Zimbardo and Haney 1998, p. 712). They conclude with a hope that the nation reconsiders its strategy of seeking and discarding "bad apples": "While a few bad apples might spoil the barrel (filled with good fruit/people), a barrel filled with vinegar will always transform sweet cucumber into sour pickles— regardless of the best intentions, resilience, and genetic nature of those cucumbers" (Zimbardo 2004, p. 47).
