Why do so many people with Poor Mental Health end up in Prison?

The complex relationship between the social issues of criminal behaviour, involvement within the criminal justice system (CJS) and poor mental health show no discrimination of class, race, gender, sexuality, location, culture or ethnicity.  In the UK alone as of March 2017, the prison population stood at 85,476 persons - 81,537 male prisoners and 3,939 female prisoners (Ministry of Defence, 2017).  What is not so clear, however, because of insufficient data, is how many of these individuals entered prison with pre-existing mental health issues (MHI) or how many have since developed MHI that need transferring out of custody for treatment (The Prison Reform Trust, 2016)?

The Prison Reform Trust - Bromley Briefings report (2016) identifies how men and women with MHI are proportionately overrepresented within the CJS: 26% of women and 16% of men say they had received treatment for a mental health problem in the year before custody; 25% of women and 15% of men in prison reported symptoms indicative of psychosis, with the rate among the general population being reported to be approximately 4%. In 2015, the rate of suicidal deaths reported within the prison population was 120 per 100,000 individuals. Within the general population, this figure dramatically drops to 10.8 per 100,000 individuals.  The report also found, 70% of prisoners that committed suicide where already know to the CJS as having MHI, however only about 50% of these individuals had been identified as having MHI upon entry into the prison system (The Prison Reform Trust, 2016).  Further evidence of individuals with MHI being proportionately overrepresented within the CJS comes from Singleton et at., (1998) cited in Open University, (2015).  This robust study into psychiatric morbidity found a staggering 90% of the prison sample displayed symptoms of mental disorder with most experiencing between 1 and 3 disorders. They were also 37 times more likely to suffer from a psychotic disorder than the general population. However, paranoid and antisocial personality disorders and neurotic symptoms such as anxiety, depression, fatigue, sleep deprivation and irritability were significantly more prevalent than psychosis within the prison sample, and than that of the general population (bib).

Reviewing this data raises many questions about the potential correlations of gender,  criminal behaviour, poor mental health and the overrepresentation of individuals with MHI within the CJS.  This paper will now focus more on the complex relationship between MHI, involvement within the CJS and the significance of environmental risk factors by exploring the concept of criminalisation, and criminal behaviour within the wider social context and how this can impact mental health and involvement within the CJS, in an attempt to understand why so many people with MHI end up in prison.  Since deinstitutionalization, which resulted in the closure of the long stay mental health institutions and the introduction of the provision of the ‘community care’ model in the second half of the 20th century, there has been an ever-increasing number of individuals with MHI living within the community.  Research suggests this had a profound impact on all stages of the CJS; from arrest to incarceration (Vogel et al., 2014). The concept of criminalisation suggests the CJS uses its powers of social control to manage the perceived ‘undesirable, deviant and/or dangerous or difficult behaviours’ of this socially excluded population.  In 1972, psychiatrist, Marc. F. Abramson further defined this concept as the “Criminalisation of mentally disordered behaviour” cited in Ringhoff et al., (2012).  The CJS ethos is that of punishment, surveillance and control: it is there to enforce the law not to provide diagnosis, care and treatment (Open University, 2015).  Ringhoff et al (2012) suggest criminalisation and incarceration have therefore become a substitute for mental health treatment because other mental health options are perceived as being not available. 

Does poor mental health, therefore, cause crime or do individuals with MHI become involved in the CJS as a result of criminality?  Do suffers, therefore, make the choice to engage in criminal thinking and behaviour rather than because of their MHI?  Gross and Morgan (2013) study into the comparisons between criminal thinking and psychiatric symptoms, was designed to clarify the similarities and differences in criminal thinking and psychiatric symptomatology between individuals with MHI who are and are not CJS involved.  They found individuals with MHI may engage in criminal thinking and behaviour because of ‘criminal risk factors’, finding no direct relationship with psychiatric symptomatology. These findings are further supported by Elbogen and Johnson (2009) and Draine et al (2002) who found respectively, that MHI did not predict violence unless it was paired with contextual factors/criminal risk factors such as past violence, unemployment, low socioeconomic status and victimization.  They found that MHI were a weak predictor of crime, suggesting limited social and family support, poverty, lack of education and unemployment served as mediating predictors within this complex relationship.  These predictors showed no discrimination to race, gender, class and ethnicity, or indeed the presence or absence of MHI cited in Gross and Morgan (2013).

Furthermore, Ringhoff et al (2012) investigations into the implications of individuals with MHI within the CJS also found nonclinical factors such as antisocial behaviour, cognition, attitudes and associations and, relationship and school/work issues and lack of leisure activities to be greater predictors of offending and reoffending.  Additionally, there is evidence to suggest the link between MHI and criminality to be significant when paired with substance misuse and with those experiencing symptoms of a psychotic episode such as hallucinations and delusions.  Moreover, individuals who become involved in the CJS were more likely to be unemployed before their arrest than those without MHI (Gross and Morgan, 2013).  Similarly, other social factors such as family dynamics and experiences past and present, living arrangements, sexual, physical and psychological abuse, and family criminality; the intergenerational transmission of criminal careers, homelessness and experiences of substance abuse can all also have a detrimental impact on an individual's sense of community and social inclusion, mental health and behaviour (Ministry of Justice, 2012).

In an attempt to understand the complex relationship between poor MH and involvement with the CJS statistical data was evidenced highlighting the overrepresentation of individuals with MHI within the CJS. The impact of deinstitutionalization on the CJS, the concept of criminalisation and the significance of environmental risk factors on criminal behaviour and MHI within the wider social context were also investigated. As of March 2017, there were 85,476 individuals in UK prisons. However, what’s not clear is how many of these individuals entered prison with pre-existing MHI or how many have since developed MHI?  The Bromley Briefing Report’s (2016) starting findings evidenced that individuals with MHI are being proportionately overrepresented within the CJS, with 42% of prisoners reporting they received treatment for a MHI in the year before custody and 40% reported symptoms indicative of psychosis. Each of these figures is proportionately higher than that of the general population.  This report also concerningly found of those that committed suicide within the CJS, only about 50% of them had been identified as having MHI upon entry into prison.  Other prison sample studies also found this population were 37 times more likely to suffer from a psychotic disorder and significantly more likely to suffer from neurotic symptoms than that of the general population.

Since deinstitutionalization, there appears to have been an increasing strain of the CJS on individuals with MHI and an increasing strain of individuals with MHI on the CJS.  Some research suggests this is because of a failing and inability of communities to effectively handle the provision of community care for those with MHI and, that a lack of sufficient comprehensive MH training hinders, for example, police officers’ ability to recognise when an individual is presenting with poor MH symptoms. Comprehensive training could then potentially assist referrals to appropriate services and reduce arrest, especially, for minor offences. Others pertain deinstitutionalization has assisted in the criminalisation and social control and exclusion of those with MHI, as incarceration becomes a substitute for appropriate MHI treatment. In 1972, psychiatrist Marc. F. Abramson further suggested there was now a criminalisation of mentally disordered behaviour.

The complex relationship between MHI and crime becomes further intertwined with the exploration into research designed to investigate the predictors of criminal behaviour and MHI, and the impact of environmental risk factors on poor mental health and criminal behaviour.  Each of the studies investigated suggested MHI to be a weak predictor of crime unless paired with contextual/criminal and poor MH risk factors such as past violence, unemployment, low socioeconomic status, victimization, limited social and family support, poverty, lack of education, and that factors such as antisocial behaviour, cognition, attitudes and associations and, relationship and school/work issues and lack of leisure activities were greater predictors of offending and reoffending.  Conversely, there was a significant link between MHI and criminality when paired with substance misuse and/or experiences of hallucinations and delusions. With no direct link (other than the aforementioned) between the dynamic and complex relationship of criminality and MHI, it is thought that an increased awareness and tolerance of MHI, along with sufficient MH training within the CJS, and greater access to comprehensive services for ongoing treatment and support with gaining employment, housing and family issues, education and substance misuse may result in a decrease in the overrepresentation of individuals with MHI within the CJS? 

Author:  Anita Steer Couns, Dip. Registered (MBACP) 

 

 

References

Gross, N. R., and Morgan, R. D. (2013) ‘Understanding Persons With Mental Illness Who Are Not Criminal Justice Involved: A Comparison of Criminal Thinking and Psychiatric Symptoms’, Law and Human Behaviour, vol. 37, no. 3, pp. 175-186.

 

Ringhoff, D., Rapp, L., and Robst, J. (2012) ‘The criminalization Hypothesis: Practice and Policy Implications for Persons with Serious Mental Illness in the Criminal Justice System’, Best Practices in Mental Health, vol. 8, no. 2, pp. 1-19.

 

The Ministry of Defence, (2017) Official Statistics - Prison population figures 2017: Population bulletin: weekly 10 March 2017 [online]. Available at

https://www.gov.uk/government/statistics/prison-population-figures-2017 (Accessed 15 March 2017).

 

The Ministry of Justice, (2012) Troubled families: prisoners’ childhood and family backgrounds.  Results from the Surveying Prisoner Crime Reduction (SPCR) longitudinal cohort study of prisoners [online]. Available at

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/278837/prisoners-childhood-family-backgrounds.pdf (Accessed 16 March 2017).

 

The Open University (2015) Mental Health and Community: Workbook 3, Milton Keynes, The Open University.

 

The Prison Reform Trust, (2016)  Bromley Briefing Report [online]. Available at

http://www.prisonreformtrust.org.uk/Portals/0/Documents/Bromley%20Briefings/Autumn%202016%20Factfile.pdf (Accessed 15 March 2017).

 

Vogel, M., Stephens, K. D., and Siebels, D. (2014) ‘Mental Illness and the Criminal Justice System’, Sociology Compass, vol. 8, no. 6, pp. 627-639.