Barriers to Treatment. Treatment Modalities

The correctional system can use risk analysis to determine who should be treated. Oftentimes, though, those with the greatest need of treatment are unwilling to participate. Younger inmates are less likely than others to want to receive treatment. Other treatment barriers exist that must be dealt with in order for treatment to start and be efficacious. Inmates may not want to participate for several reasons:

1. The inmate may believe that entering treatment in a correctional setting will make him or her appear weak. Prison inmates live in a world that is full of very real physical and psychological dangers. Any inmate showing weakness risks inviting abuse from other inmates.

2. Some inmates, as well as people living in the community, may not understand how to access treatment. Inmates may not know with whom to talk, what forms to fill out, or other details about how to get into treatment.

3. Inmates may believe that they must be self- reliant. Such inmates may believe that seeking treatment cannot help them—that the best course of action is relying solely on themselves.

4. Inmates may also have concerns about mental health-care providers and the providers’ ability to treat them adequately.

Corrections officials may have the perfect treatment to provide to the highest risk offenders to reduce recidivism the greatest amount. But, if the inmate in need of treatment is unwilling to participate with mental health-care providers, then treatment will not occur, and the mental health rehabilitative efforts will not be optimal. Correctional officials, then, must actively attempt to reduce barriers to treatment in a correctional setting. To do this, inmates need to be provided general education about rehabilitative treatment along with procedural instructions on how to access treatment; stigma must be reduced for correctional mental health treatment; and confidentiality must be provided.

Treatment Modalities. One of the most successful ways to treat inmates with mental illness in a correctional setting is to use CBT in general and R & R specifically.

Research shows that CBT works with a wide variety of offenders. The R & R approach attempts to address inmates’ problematic thinking styles and poor reasoning skills. For instance, a man who has been assaulted may come to believe that his only course of action is to find the person who assaulted him and to kill his attacker. CBT would help the man learn that killing someone who hit him is too much and that there are other options to deal with this issue such as contacting the police. R & R provides patients with 8-9 months of treatment with a couple of hours of group treatment (6-12 participants) each week. The R & R treatment program uses a variety of techniques to help patients change their rigid way of thinking and subsequently develop a new set of skills to solve problems. The goal is to solve problems in a way that is prosocial and not criminal.

Discussion. Basic mental health services in correctional settings focus primarily on stabilization: helping the inmate to behave while he or she is incarcerated and to not recidivate after he or she is released. Rehabilitative efforts seek to improve the lifestyle of inmates while teaching them about what triggers them to react in a way that is antisocial and possibly even criminal. Corrections officials try to do the most good for the most people by first assessing an inmate’s risk factors through evidence-based, actuarial analysis. Correctional mental health treatment should focus on those with the highest risk of recidivism, but the specific treatment should be tailored to the inmate by responding to his or her specific needs. For mental health rehabilitative efforts to work, barriers to treatment must be addressed. Rehabilitative efforts are considered superior to basic corrections mental health services because rehabilitative efforts are more likely than basic mental health services to reduce recidivism in a manner that is not more expensive.

Daniel W. Phillips, Ariel Carter, and Jill Cutler
Further Readings: Bronson, J., Sultan, B., & Wurzburg, S. (2017, August 17). National findings of mental illness and drug use by prisoners and jail inmates. Retrieved from https:// csgjusticecenter.org/wp-content/uploads/2017/08/BJS- Webinar.pdf For

Morgan, R. D., Kroner, D. G., Mills, J. F., & Batastini, A. B. (2013). Treating criminal offenders. In I. B. Weiner & R. K. Otto (Eds.), Handbook of forensic psychology (4th ed., pp. 795-838). Hoboken, NJ: Wiley.