Mental Health and Recidivism 1

Fionna Tam
ENG 123 KE
Prof. Morris
Spring 2016
Literature Review

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Mental Health and Recidivism

Incarcerated individuals face many challenges that are often overlooked. These
individuals deal with issues both inside and outside the physical walls of prison and are in need
of mental health treatment and rehabilitation. Around 26% of the prison population is said to be
suffering from mental illness with little to no treatment (Gonzalez et al. 2330). Due to the lack of
rehabilitative services, individuals with mental illness face higher chances of recidivism (relapse
into criminal behavior) than their counterparts. This creates a situation where reintegration into
their communities becomes difficult due to their mental instability, thus placing them at a higher
disadvantage than others. Various studies show that if these individuals have their mental
conditions properly assessed and treated, they are likely to face less challenges during their
reintegration process and lower their chances of returning to prison.
Authors Gonzalez and Connell speculated on the issue of mental health and recidivism.
For their study, they evaluated mental health and treatment of US prisoners, but before executing
the study, it was known to them that correctional facilities lacked the right funding for mental
health intervention and treatment. They also found that of those diagnosed with a mental disorder

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had a 70% chance of being incarcerated again (Gonzalez et al. 2328). They speculated that
mental health treatments are not taken seriously because the prison systems place more
importance on physical health over mental health. Improper diagnosis for easier facilitation of
inmates is also another speculated factor. For their analysis, they obtained nationally represented
data from 2004 Survey of Inmates in Federal Correctional Facilities (Gonzalez et al. 2329). The
data analyzed focused on questions related to mental health and was answered by the 18,185
prisoners that participated. Gonzalez et al. found that 26% inmates had diagnoses of a mental
health condition with only 18% of that 26% were being treated pharmaceutically for their
condition (Gonzalez et al. 2330). It can be seen that a lack of continuity in treatment is partially
at fault for the increase of the prison population. Gonzalez et al. proposed that offering a variety
of counseling in conjunction with medication during and after prison term, may lower the
chances of recidivism. However, proper diagnosis is just as important as treatment.
Without proper diagnosis, inmates fail to get the treatment needed. Galanek explores this
issue in his study and also speculates that the cause could be due to clinicians constructing
psychiatric disorders among inmates in prison systems. For his study, Galanek personally
examined the mental health system at Pacific Northwest Penitentiary (Galanek, 203). He
described the process of assessment with clinicians as objectifying the inmates and prescribing
disciplinary action as a way to normalize. He found that mental illnesses diagnosed were
mainly through the norms, social, and cultural factors of the prison environment. The role of a
clinician within that prison culture differed between prisons, thus treatment and diagnosis would
differ as well (Galanek, 219). Galanek also brings up the point that prisons will always have
safety and security as the number one priority. This causes a tailoring of treatment and diagnosis
to maintain safety and security. This however, fails to correctly address and treat a potential

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mental illness. If a clinician finds that an inmate fits two diagnoses, the clinician will only choose
one and not both so that treatment will be simple and not complicate security and facility rules
(Galanek, 221-222). This allows room for error. Recidivism will not go down without a
communicative effort between programs and even prison facilities. Even with such efforts, not
all facilities are properly equipped to give proper rehabilitation.
Improper rehabilitation can be a detriment to an inmates road to recovery. An example of
improper rehabilitation would be the use of solitary confinement, as explored by authors Cloud,
Drucker, Browne, and Parsons. They examined current studies and found that solitary
confinement is currently overused in the United States. Solitary confinement as a rehabilitative
punishment increased 40% just in a decade (Cloud et al. 18). A history of solitary confinement
revealed that this punishment was originally set in place to bring forth repentance in prisoners. It
was noted that the political theorist in favor of solitary confinement observed it in action in the
first silent prison of the U.S. They came to the conclusion that instead of reforming people for
the better, it was a detriment to their mental health. Prolonged isolation drove some inmates to
insanity (Cloud et al. 19). People with mental health issues had higher chances of being put in
solitary confinement than other inmates. It was speculated that those with mental health issues
had difficulties following facility rules, thus the reason for their prison confinement (Cloud et al.
22). With a population of diagnosed and undiagnosed inmates already suffering from mental
health issues, solitary confinement would cause them more harm. Also with a lack of proper
rehabilitative help, transition from prison to an outside community will a difficult task for
mentioned inmates, thus increasing the chance of recidivism.
Recidivism is also a concern for communities, as examined by authors Hatzenbuehler,
Keyes, Hamilton, Uddin, and Galea. They researched the risk of negative mental health

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development in non-incarcerated members of communities with high-incarceration rates. They
speculated possible causes and risks for individuals living in said communities like families of
those incarcerated, which created financial and behavioral risks (Hatzenbuehler et al. 138). For
their method, they extracted data from the Detroit Neighborhood Health study and neighborhood
prison admission rates from the Justice Atlas of Sentencing and Corrections. Their study was
done in waves and assessed mental health conditions like major depressive disorder and
generalized anxiety disorder. Hatzenbuehlers team also enlisted the help of a counselor blind to
their data. The counselor conducted interviews to compare with the authors findings and had
come to the same mental disorder assessments as the team (Hatzenbuehler et al. 140). It was
concluded that incarceration of community members also affected the mental health of those in
the community, thus putting members of those communities at risk for violent and dangerous
behaviors (Hatzenbuehler et al. 142). Violence and dangerous behavior also raises the chance of
incarceration in a community, through this a cycle between mental disorder and recidivism
continues to turn.
To break the cycle of mental disorder and recidivism, specialty programs inside and
outside the prison systems are need, as concluded by authors Kondrat, Rowe, and Sosinski. They
assessed the different programs in the United States that help inmates with severe mental health
problems. The authors introduced the issue of a growing inmate population in prisons for the past
years, as well as the issues of available mental health treatment for those inmates. They evaluated
transition planning and the Forensic Assertive Community Treatment program, also known as
FACT in the United States (Kondrat et al. 101). Transition planning is a program that arranges
community services for inmates with mental illness before release from prison. Currently it is in
use for fourteen states. This program requires prison personnel to work together with community

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mental health personnel to plan for the appropriate services the inmate will need outside of
prison. The plan is comprehensive and individualized. Transition from Prison to Community or
also known as TPC, is an example of transition planning. It was found that TPC was able to
lower the chances for recidivism (Kondrat et al. 102). The FACT program involves a team of
providers, psychiatrists, social workers, nurses and specialists to work with individuals suffering
from mental illness. There are sixteen programs in nine states currently using this program.
FACT was also seen to lower chances of recidivism (Kondrat et al. 102). With incarceration rates
still climbing, Kondrat et al. emphasized there that was still a lack of programs available to the
population of inmates. Allocating inmates with low risk to less intensive programs and higher
risk to more intensive programs was a proposed solution. More resources and development of
programs are also needed during the incarceration period to ease transition of an inmate back
into the community (Kondrat et al.105). However, more staffing and resources doesnt mean the
issue of recidivism will be solved so easily.
Instead of focusing on improving mental health programs and making them more
widespread, Greenberg and Rosenheck focus on the solution of improving employment and
education opportunities. To come to this conclusion, they studied the correlations between
mental illness (including substance abuse), history and incarceration record. The reason for their
study was that past studies found their correlations from data surveyed by the prison population
instead of national population surveys on mental illness. For their study, they used data gathered
from 2001 to 2003 from the National Comorbidity Survey Replication (Greenberg and
Rosenheck 18). Measures like gender, education, marital status, language, race, ethnicity and
other socioeconomic characteristics were also studied. They found that factors like employment
affected the odds of incarceration as well. Mood, anxiety and impulse disorders also did not

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affect incarceration rates. Factors they found to be associated with history of incarceration
include single, male, of the poorer socioeconomic class, little education, homelessness, trauma as
an adult, all mental health diagnosis (excluding agoraphobia) and substance abuse. Substance
abuse was found to have greater odd with incarceration chance and term than psychiatric
diagnosis. Interestingly, they found that with a lifetime diagnosis of a mood disorder showed
lower odds of long-term incarceration (Greenberg and Rosenheck 26). They also found that
anxiety, mood and impulse disorders did not have a strong connection to incarceration odds
(Greenberg and Rosenheck 29). Greenberg and Rosenheck proposed that instead of focusing on
mental health, resources should be directed towards more educational opportunities and combat
of homelessness to reduce recidivism in both individuals of mental issues and non-sufferers
(Greenberg and Rosenheck 29-30).
Providing various support services to newly released inmates is important to set them on
the proper path of rejoining their communities. The process of rehabilitation is longer than most
people expect, and studies show there is a need to help these individuals while incarcerated as
well as after their release. It can be concluded that the prison system is currently a dangerous
environment for an individuals mental health and can impact the mental health of the
communities outside of prison system as well. Action needs to be taken as the ever rising rate of
the prison population wont change until individuals in the criminal justice system are treated
with the same care and compassion as everyone else. It should be noted that Gonzalez et al.
study was based off data from 2004, which is outdated but is the most updated data considering
funding restrictions in correctional facilities (Gonzalez et al. 2333). Galaneks study and
observations were isolated to only that of the environment of Pacific Northwest Penitentiary, thus
environments in other prison systems may differ (Galanek, 203). Cloud et al. examined other

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studies and derived his conclusions from them. No studies were done on their part so
speculations and data are confined to the sources used (Cloud et al. 26). Hatzenbuehler et al.
used data primarily from the area of Detroit, which could result in differing data if compared to
another area in the U.S. (Hatzenbuehler et al. 138). Kondrat et al. also derived data from other
studies, so speculations and data are confined to the sources used (Kondrat et al. 108). Greenberg
et al. used data from a 2001 to 2003 survey, which is past a decade old. Their limitations also
included data that required respondents memory and survey exclusion to prisons and health
facilities (Greenberg et al. 31). Overall more variety in the data is used amongst these studies are
needed to solidify their arguments on the issues of mental health and recidivism.

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Works Cited

Cloud, David H., et al. "Public Health And Solitary Confinement In The United States."
American Journal Of Public Health 105.1 (2015): 18-26. Academic Search Premier. Web.
14 Jan. 2016.
Galanek, Joseph. "The Cultural Construction Of Mental Illness In Prison: A Perfect Storm Of
Pathology." Culture, Medicine & Psychiatry 37.1 (2013): 195-225. Academic Search
Premier. Web. 14 Jan. 2016.
Greenberg, Greg A., and Robert A. Rosenheck. "Psychiatric Correlates Of Past Incarceration In
The National Co-Morbidity Study Replication." Criminal Behaviour & Mental Health
24.1 (2014): 18-35. Academic Search Premier. Web. 14 Jan. 2016.
Hatzenbuehler, Mark L., et al. "The Collateral Damage Of Mass Incarceration: Risk Of
Psychiatric Morbidity Among Nonincarcerated Residents Of High-Incarceration
Neighborhoods." American Journal Of Public Health 105.1 (2015): 138-143. Academic
Search Premier. Web. 12 Jan. 2016.
Kondrat, David C., William S. Rowe, and Melanie Sosinski. "An Exploration Of Specialty
Programs For Inmates With Severe Mental Illness: The United States And The United
Kingdom." Best Practice In Mental Health 8.2 (2012): 99-108. Academic Search
Premier. Web. 13 Jan. 2016.

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Reingle Gonzalez, Jennifer M., and Nadine M. Connell. "Mental Health Of Prisoners:
Identifying Barriers To Mental Health Treatment And Medication Continuity." American
Journal Of Public Health 104.12 (2014): 2328-2333. Academic Search Premier. Web. 12
Jan. 2016.