Basic Mental Health Services Versus Rehabilitation

Traditionally, the goals of correctional mental health treatment have been basic, not rehabilitative. Basic mental health service goals for inmates have been primarily stabilization: to enable the patient/inmate to stay out of trouble while incarcerated, and once released, for the patient/inmate to be less likely to recidivate. Mental health rehabilitative efforts provide more than just basic mental health services. Rehabilitative efforts focus on tailor-fitting treatment to offenders so the offenders understand what precedes their thoughts and their behavioral triggers. In addition, rehabilitative efforts focus on lifestyle change and prosocial behavior.

This entry discusses the history of why mentally ill people are increasingly treated in correctional settings. This is followed by a discussion of current issues in forensic mental health and the Risk-Need-Responsivity model. Barriers to treatment are discussed, along with treatment modalities (cognitive behavioral therapy [CBT] and reasoning and rehabilitation [R & R] therapy). Finally, a culminating discussion is provided concerning basic mental health services versus rehabilitation.

History. People with mental health problems are incarcerated for a variety of reasons: (a) they are convicted of a crime; (b) the mental health system currently does not have adequate hospital beds and community mental health supports; and (c) current laws make it difficult for professionals to treat people with mental illnesses who are unwilling to be treated.

The peak year for inpatient psychiatric hospitalization in the United States was 1955 when 640,000 people were held in public and private hospitals. Since 1955, improvements in medicine, advocacy for more humane treatment, and fiscal constraints resulted in most psychiatric beds being closed. By 1980, 90% of the hospital beds in the United States had closed, and the average length of hospitalization had decreased from 6 months to less than 1 month. In 2018, the average length of stay was 10 days. As hospital beds emptied from 1955 to 1980, community mental health centers were intended to provide supports to people with mental illnesses living in the community. In other words, those people who would have received mental health treatment in hospitals in the past would now receive those services in the community. This plan, however, has not been realized. Many people with mental illnesses have fallen through cracks in the system and have ended up homeless, in nursing homes, or even incarcerated.

In 2016, sizeable portions of the U.S. jail and prison populations needed mental health treatment. Among prisoners, 37% reported to corrections officials that he or she had been told by a mental health professional that he or she had a mental illness. Among those in jails, the percentage was 44%. Research reveals that prisoners or detainees with mental illness are more likely than those without to have behavioral problems while incarcerated. If inmates with mental illness do not have their problems addressed while incarcerated, they are more likely to recidivate.