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49 Fed. Probation 27 (1985)
Addressing Inmate Mental Health Problems

handle is hein.journals/fedpro49 and id is 297 raw text is: Addressing Inmate Mental Health Problems A New Direction for Prison Therapeutic Services BY KENNETH ADAMS, Ph.D. School of Criminal Justice, State University of New York at Albany OF ALL THE MAJOR components of the criminal justice system the correctional stage traditionally has had the most explicitly avowed therapeutic purpose. Within the context of prisons, an assortment of therapeutic activities were usually available to inmates. Individual therapy, group therapy, counsel- ing, medication, self-help, and behavior modification are among programs that have been offered. These programs involved a variety of professionals (e.g., psychiatrists, psychologists, social workers), working in a variety of set- tings (e.g., one-to-one, small groups, residential com- munities), using a variety of theoretical perspectives (e.g., psychiatric, psychodynamic, behavioral). Over the past decade, however, critics have seriously challenged the fun- damental. rationales for the therapeutic activities of prisons. Some critics argue that the justifications for pro- viding these services have been greatly oversold because in their opinion when it comes to rehabilitating offenders nothing works.' Others argue that even if we could rehabilitate offenders society should allocate more resources to other functions of the criminal justice system such as deterring potential offenders.2 In the process of reevaluating the therapeutic activities of correctional institutions, distinctions have been made among services in terms of the goals they are attempting to achieve and the client populations they are attempting to reach. An important distinction is that between therapeutic services attempting to achieve specific peno- logical goals-the treatment of offenders so that they might become law abiding citizens-and therapeutic serv- ices intended to achieve more general health care goals- the treatment of emotionally disordered individuals so that they might function more effectively in social set- tings. For convenience, we can refer to the former as cor- rectional rehabilitation services and the latter as mental health care services. Having recognized this distinction, it is clear that most of the concern has been with correc- tional rehabilitation services and that, by comparison, there has been only limited interest in prison mental health I Douglas Lipton. Robert Martinson. and Judith Wilks, The Effectiveness of Correctional Treatment (New York: Praeger, 1975); Robe Martinson, What Works? Questions and Answers about Prison Reform, The Public Interest. 35, 1974, pp. 22-S4. 2 Ernest van den Haag. Could Successful Rehabilitation Reduce the Crime Rate?, Jour- nal of Criminal Law and Criminology, 73. 1982, pp. 1022-1035. 3 Ernest van den Haag. Punishing Criminals: Concerning a Very Old and Painful Ques- tion (New York: Basic Books. 1975), pp. 117-123. services. This article explores the distinction between cor- rectional rehabilitation services and mental health serv- ices and discusses the developments which are leading to greater recognition of the need for prison mental health services. Distinguishing Among Therapeutic Services One reason why the distinction between mental health services and correctional rehabilitation services has not been emphasized is that the distinction can be as simple as it is complex. Simply stated, correctional rehabilita- tion services are therapeutic interventions intended to ad- dress the causes of criminality in an attempt to reduce criminal propensities, while mental health services are therapeutic interventions intended to address the causes of mental illness in an attempt to alleviate emotional ad- justment problems. The distinction is complex because types of behaviors, causes of behaviors, and treatment interventions available to change behaviors cannot always be so neatly compartmentalized. The complexity of the relationship between correc- tional rehabilitation and mental health services stems from the fact that the conceptual and operational development of two services has historically been linked together. In the early nineteenth century, as scientific ap- proaches to the study of crime were starting to appear, psychiatric theories vigorously stressed the notion that mental illness is the major cause of crime. These theories outlined a medical model of crime causation which viewed crime as a disease of the mind that needed to be cured. From about the middle of the 19th century to about the middle of the 20th century, psychiatric theories of criminality were widely accepted. Once the proposition that mental illness is the cause of crime was accepted, it followed logically that in order for thera- peutic services to be rehabilitative in the penological sense, they must be designed to address mental health problems. From this point of view, there was little to be gained from distinguishing between correctional rehabilitation services and mental health services. Criminologists have currently forsaken the view that mental illness is a major cause of criminal behavior. This is partly the case because the argument as it is usually stated is circular.3 Criminal behavior is used as evidence of mental illness and then mental illness is invoked to ex-

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