Mental Health Resources for Formerly Incarcerated People

People with undiagnosed or untreated mental health issues often run afoul of the law, sometimes inadvertently. Instead of going into treatment, they go to prison, where they get no psychiatric care. Upon release, they repeat the cycle. More and better psychiatric care—before, during, and after prison—could save money and wasted lives.

Mental Health Resources for Formerly Incarcerated People

People with undiagnosed or untreated mental health issues often run afoul of the law, sometimes inadvertently. Instead of going into treatment, they go to prison, where they get no psychiatric care. Upon release, they repeat the cycle. More and better psychiatric care—before, during, and after prison—could save money and wasted lives.

Last Edited: 02/04/2021

Author: Stephen Bitsoli Stephen Bitsoli

There is a mental health crisis in the United States, but mental illness, in general, isn’t necessarily on the rise. It may be, but analysts and researchers disagree. Either way, the greater problem is the lack of access to and availability of mental health services, especially for vulnerable populations such as Formerly Incarcerated Peoples.

According to a 2014 survey, approximately 356,000 inmates in jails and state prisons—15%–20%—have serious mental illnesses compared to just 35,000 in state psychiatric hospitals. Most observers think the disparity has only grown since then.

Not all cases of mental illness are rated serious. The rate for any mental illness is 37% and 1.2 million inmates. The rate is even higher in local jails at more than 44%. Mental health care was not even offered to 66% of federal prison inmates. Further, there is some correlation between having less access to mental health services and higher rates of people in prison.

The National Alliance on Mental Illness (NAMI) says that 2 million individuals with mental illnesses are arrested and placed in jail every year, though not all are convicted or serve long sentences.

Many prison and jail inmates—a minority of them, but still a significant number—have a mental health problem because they had it before they were arrested. It probably wasn’t treated while they were incarcerated, so they are likely to still have it after their release.

What is Mental Illness?

Mental illness is when your thoughts, feelings, and behavior affect your ability to take care of yourself and your daily responsibilities, such as:

  • To go to school or work
  • To maintain social relationships
  • To pay bills, shop for groceries, maintain your property
  • To feed and clean yourself.

Stress, trauma, and genetic factors can cause mental health issues, concerns, and disorders. Mental illness results when these issues aren’t addressed early enough or at all.

People in state prisons are more likely to have mental health disorders than the general population and also more severe psychoses and major mood disorders. About 20% have a serious mental illness (SMI) and 30%–60% have a substance use disorder (SUD). Those rates increase when you consider all mental illnesses requiring treatment, not just SMI.

Mental illnesses common in prisons include:

  • Major depression
  • Psychotic disorders, including schizophrenia
  • Bipolar disorder
  • Substance use disorders (SUD), including addiction.

What is Addiction?

Addiction is the most severe form of SUD. It is when one uses alcohol, illicit or prescription drugs, and other substances because one has to, not because one derives pleasure or benefit from it.

Many people still believe that addiction is a sign of weak character or a lack of willpower or morality, but Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health (2016) said “addiction is a chronic neurological disorder” or disease that “needs to be treated as other chronic conditions” such as cancer, diabetes, and heart disease, with skill and compassion.

Addiction changes the wiring of the brain because these substances produce elevated levels of feel-good chemicals. The brain suffers because:

  • It stops producing these chemicals.
  • It gets used to the artificially high levels of substance abuse.
  • If the substance use stops, it feels physical and/or psychological pain known as withdrawal.
  • The dosage required to stop the pain increases over time as tolerance builds.

Eventually, it may become nearly impossible to take enough of the substance to do more than stop the pain without causing a fatal overdose.

In some extreme cases with certain substances (mainly alcohol and benzodiazepines), withdrawal can be not only painful but lethal.

Dual Diagnosis

NAMI doesn’t consider substance use disorders or addictions as mental illnesses but acknowledges that they often go together and there are causal links. This is a dual diagnosis.

Comorbidity or co-occurring disorders is a term for when someone has two conditions at the same time that are linked in some way. When those two conditions are a SUD and another mental health issue it is called a dual diagnosis. When that happens, both conditions must be treated.

Sometimes a mental illness leads to a SUD because the individual knows something is wrong and is trying to self-medicate with alcohol or drugs. In the past, substance abuse counselors didn’t check for a co-occurring mental illness and only treated the SUD. In such cases, relapse is more likely because the underlying cause of the SUD remains.

The same applies to people leaving prison or jail. To avoid a revolving-door justice system where people are released with the expectation that they will be re-incarcerated, offenders should be screened before they enter prison and receive treatment while in prison. They should be screened again as they leave prison, and have a treatment that follows them into their re-entry.

What Causes Mental Illness?

There is no single cause for mental health disorders. The most likely explanation is multiple factors, such as:

  • Genes. You may have a genetic predisposition in your family history.
  • Lifestyle. You engage in risky behaviors that result in traumatic brain injuries, long-term substance abuse, or drug overdoses. Or you have a job that causes stress and anxiety.
  • Childhood Abuse. Psychological or physical violence, possibly sexual.
  • Serious Medical Conditions. Cancer, heart disease, epilepsy, stroke, HIV.
  • Social Isolation. Lack of friendships or family relationships.

The question remains: Does imprisonment lead to mental illness? Cause mental illness? Exacerbate mental illness? Or are metally ill people drawn to crime?

There is no clear answer as to whether incarceration can cause one to become mentally ill. Analysts disagree. Regardless, no one says incarceration is good for mental health.

The Movement Towards Deinstitutionalization

The reason that there are so many individuals with mental illnesses in prison is that there are so many individuals with mental illnesses on the street.

Dating back to the 1950s, due to well-intentioned psychiatric professionals, civil rights advocates, and some well-publicized abuses, the trend has been away from placing clients with mental health issues into specialized hospitals and towards deinstitutionalization.

The thought was that most of these individuals could remain in society with a little help, such as regular visits with a psychiatrist and medication to control their symptoms.

Without sufficient funds, however, these individuals many times fell through the cracks. Many were arrested and incarcerated without being screened for mental illnesses.

Some became homeless. Roughly 25%–33% of homeless individuals have a serious mental illness. To “solve” the homelessness problem, many communities have criminalized homelessness.

Most criminal behavior isn’t caused by mental illness, but mental illness can lead to criminal behavior. The perception is that people with mental health issues are violent and can’t be released into the community. Since adequate mental health treatment services frequently aren’t available, the state may feel that prison incarceration is the only option.

The problem is that incarceration won’t improve mental health, or stop substance use.

Mental Health Care in Prison

If mental illness doesn’t have a single cause, neither does it have a single treatment. Whether the mental health disorder is a psychosis, depression, anxiety, or SUD, the answer is probably a combination of therapy and medication-assisted treatment (MAT).

The Federal Bureau of Prisons (BOP) is and has been aware of the problem of mentally ill prisoners. In 2014, it promised better care and oversight for inmates with mental health issues, but no new resources were provided. Instead, care was reduced by more than 35%. In some areas, the number of inmates getting treatment dropped 80% or more.

By 2018, the BOP concluded that only 3% of its inmates needed regular care for mental health issues.

(State prison systems disagreed. Upwards of 20% of inmates got treatment in Texas, New York, and California.)

Part of the reason may be that the BOP considers counselors and social workers in prison as primarily “professional law enforcement officers,” not mental health care workers, and so were redirected to other jobs. There are reports that prison psychologists were sometimes stationed in gun towers and assigned to escort prisoners.

Another reason may be that many judges, politicians, and old-school physicians think that the use of drugs equals addiction. If you must take the drug every day, isn’t that an addiction?

No, not if it allows you to function in society: take care of your hygiene and home, hold down a job or go to school, drive and shop, pay your bills. Diabetics who use insulin aren’t addicts, nor are people who take blood thinners to avoid blood clots.

How Does Incarceration Affect Inmates?

Not everyone who spends time in prison is mentally ill or becomes mentally ill. If they go in with no serious mental illness, any harm caused is probably not permanent. That doesn’t mean they aren’t affected, even damaged.

Imprisonment is unnatural. To be confined for months or years is not pleasant, but one can become accustomed to it. One must, to survive.

Long-term incarceration may result in:

  • Reliance on the structure of prison.
  • An inability to trust anyone.
  • An unwillingness to show emotion.
  • Withdrawal from social interaction.
  • Accepting rules of prison life as the norm.
  • Lack of self-worth.
  • Post-traumatic stress disorder (PTSD).

That’s not necessarily a mental illness, but it can make returning to the outside world difficult.

Especially damaging is solitary confinement. Whether for punishment or protection, prolonged isolation can result in hallucinations, depression, panic attacks, suicidal ideation or acts, and other mental or physical harms.

As the experience gets worse, so does the likelihood of long-lasting harm. This is why decompression—the gradual reacclimation of prisoners to life outside—is so important. Unfortunately, direct release without much preparation is the norm.

Benefits of Mental Health Care in Prison

Returning to non-prison life requires an adjustment period, something more than showing the Formerly Incarcerated Peoples the door with a few bucks in their pockets. It’s worse for people with mental health issues.

You can’t cure mental illnesses, not even addiction, simply by locking someone up. Without comprehensive treatment, substance use may stop while imprisoned but resume with the first trigger or opportunity.

Sometimes that substance use not only doesn’t stop while in prison; sometimes that’s when it starts. Like first-time offenders who leave prison with diminished employment prospects but a lot of new criminal skills, Formerly Incarcerated Peoples can leave with a substance use disorder they didn’t have going in.

NAMI has several programs designed to keep people with mental health disorders out of jail or prison, to help them receive treatment while there, and to help their families and friends navigate the criminal justice system.

It Rehabilitates Addicts

It’s in everyone’s interest to ensure mental health treatment for individuals before, during, and after incarceration.

Individuals with mental illnesses are more likely to worsen or relapse after imprisonment, so it would be good for them to go into or continue treatment upon release.

It would be better if they could get mental health treatment while imprisoned, so they could smoothly segue into aftercare. It would be best if they could get treatment before they ended up in the justice system in the first place.

The next best solution is for Formerly Incarcerated Peoples to find help upon their release.

Providing access to mental health services in prison reduces the likelihood that inmates will attempt suicide. It also makes it more likely that they will become healthy, productive members of society when they leave prison.

Formerly Incarcerated Peoples were more likely to have better mental health after incarceration if treatment begins during (or before) incarceration and there is assistance in continuing treatment on the outside.

It Saves Money

If that doesn’t motivate authorities, it also saves money.

When budget cuts are deemed necessary, prison treatment is seen as a safe cut, because authorities feel most people won’t be upset if criminals lose some amenities. This is short-sighted because prisoners who don’t get mental health treatment in prison or jail are more likely to require:

  • Longer incarceration.
  • More staff.
  • Isolation from the general population.
  • Expensive psychiatric medications.
  • Contesting lawsuits for neglect or wrongful death.

All of these consequences cost money.

A 2010 National Center on Addiction and Substance Abuse report estimated that each inmate who remains sober, employed and crime-free would save $91,000 per year.

In 2011, the National Institute on Drug Abuse estimated that the cost to society of drug-related crime was $113 billion.

The cost of treating drug abuse was $14.6 billion..

It Saves Lives

An SMI or SUD, alone or as a dual diagnosis, can both result in death, either accidentally (a motor vehicle mishap, an accidental overdose, an alcohol-drug interaction) or deliberate, i.e. suicide.

Not all suicides are due to mental illness. An increasing number seem to be “deaths of despair”: individuals whose life plans have gone so far off the rails (unemployment, money problems, isolation due to a drug habit, divorce, or COVID-19 social distancing) that they see no way out.

In 2015, a Swedish study found that newly released prisoners committed suicide 18 times more often than the general population, especially in the early months. Risk factors included having attempted suicide at least once and past psychiatric disorders, especially SUD.

The researchers suggested authorities should help Formerly Incarcerated Peoples transition to life outside prison and provide clinical monitoring to reduce the risk of relapse in the early months.

Mental Health Treatment for Formerly Incarcerated Peoples

If Formerly Incarcerated Peoples didn’t get help for their mental health disorders or SUD in prison, decompression is going to be much harder and relapse more likely. That doesn’t mean they should give up.

Fortunately, the Patient Protection and Affordable Care Act (ACA or “Obamacare”) requires that “All Marketplace plans cover mental health and substance abuse services as essential health benefits,” as well as pre-existing conditions. If you had SMI or SUD before prison, you are still entitled to coverage as an Formerly Incarcerated People.

Specifically, all marketplace plans must cover:

  • Behavioral therapies or other counseling methods. These are “talk therapies” designed to teach healthy ways to respond to life’s problems.
  • Inpatient services. Sometimes clients need immersive treatment to control or prevent triggers that led to their mental illnesses.
  • Medication-assisted treatment (MAT). Sometimes the right drug, in the proper doses, can control the symptoms of mental health disorders, including some SUDs.

Since it may be difficult to get mental health treatment without a place to live, housing may also be available, including public housing, transitional housing, and supportive housing.

If you can’t find these services on your own or need other services to decompress after incarceration, organizations are willing to help.

Sources

  • treatmentadvocacycenter.org – How Many Individuals with Serious Mental Illness are in Jails and Prisons?
  • nicic.gov – The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey
  • prisonpolicy.org – Mental Health: Policies and practices surrounding mental health
  • mhanational.org – Access To Mental Health Care And Incarceration
  • healthaffairs.org – Mental Illness In America’s Jails And Prisons: Toward A Public Safety/Public Health Model
  • bjs.gov – Mental Health Problems Of Prison And Jail Inmates
  • bjs.gov – Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002
  • addiction.surgeongeneral.gov – Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health
  • nami.org – Substance Use Disorders
  • pubmed.ncbi.nlm.nih.gov – Need for the assessment of dual diagnosis in prisons
  • medlineplus.gov – Mental Disorders
  • npr.org – How The Loss Of U.S. Psychiatric Hospitals Led To A Mental Health Crisis
  • health.harvard.edu – The homeless mentally ill
  • nlchp.org – Criminalization of Homelessness in the United States of America
  • who.int – Mental Health and Prisons
  • themarshallproject.org – Treatment Denied: The Mental Health Crisis in Federal Prisons
  • themarshallproject.org – Federal Watchdog Finds Mentally Ill Are Stuck in Solitary
  • aspe.hhs.gov – The Psychological Impact of Incarceration: Implications for Post-Prison Adjustment
  • nami.org – The Stepping Up Initiative
  • thenationshealth.org – Online only: Report finds most U.S. inmates suffer from substance use or addiction
  • drugabuse.gov – Is providing drug abuse treatment to offenders worth the financial investment?
  • ncbi.nlm.nih.gov – Suicide after release from prison – a population-based cohort study from Sweden
  • healthcare.gov – Mental health & substance abuse coverage
  • nami.org – Securing Stable Housing

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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