Case of Juan
Juan is a 47-year-old male who is serving the 12th year of a 22-year sentence for armed robbery and manslaughter. During the most recent parole board meeting with Juan, the commissioners advised him to seek mental health treatment for a long history of what Juan describes as “depression.” Juan reported that his depression has caused him to get into trouble in prison and he, therefore, needs help. The parol commission advised Juan that they will see him in 18 months to determine if he has sought appropriate care and is ready for release.
Near 23% of all prisoners and 30% of jail inmates are diagnosed with major depression (according to the reported symptoms). In order to meet the criteria for this illness, inmates are obliged to declare dejection, decreased concern in leisure time, plus 4 other symptoms of depression.
As for depression treatment in prisons, convicts and mentally ill offenders are often prescribed anti-depressants. However, there is little information applicable about dosages and prescribing patterns; that is the first indicator of how the needs of mentally ill offenders are being met in the perspective of depressive disorders.
Until the late 1980s, TCAs (tricyclic antidepressants) were prescribed in correctional settings as the most popular medicines for depression treatment. However, SSRIs (selective serotonin reuptake inhibitors) are now described as modern treatments and are introduced as a consequential percentage of basic prescriptions for depression.
We should take into consideration that according to research, patients that are taking SSRIs are more likely to stop using prescribed medicine due to severe side-effects, though TCAs cause side-effects as well. According to the research, “Hispanics exhibited significantly higher percentages of nontreatment. Among inmates with major depression and bipolar disorder, those in the 50 and over age group exhibited non-significantly elevated rates of no pharmacotherapy.” (Baillargeon, Black, Contreras, Grady & Pulvino, 2002, p. 6).
So, in conclusion, we would advise Juan to get counseling (if possible) and then take reasonable prescribed doses of anti-depressants.
It is true that a significant amount of studies is focused on the life of inmates after prison. However, only a few studies aim to observe the support and treatment of mentally ill prisoners inside the correctional settings. It has been pointed out that “criminal justice systems are primarily interested in criminal justice outcomes, such as recidivism, while mental health providers are often concerned with mental health and quality of life outcomes” (Vanderloo & Buttlers, 2012).
One challenge that justifies the lack of information regarding the treatment of mentally ill inmates is moral concerns. The studies would require dividing mentally ill patients into control groups and prescribing different medications to them. This would be one of the conditions for developing productive and proper research. Nevertheless, though there appears to be a gap in empirical explorations, researchers introduced different treatment programs across the country to get the most accurate results (Magaletta, Wheat, Patry & Bates, 2008, p. 15).
Another challenge that influences the treatment of mentally ill convicts is an insufficient quantity of community workers, which help prisoners deal with depression, suicide thoughts, and other mental problems. Though nurses and social workers are in attendance in prisons, often they do not have the necessary skills regarding a mental health or specific practice in suicide prevention among prisoners. (Daigle, Daniel, Dear, Frottier & Hayes, 2007, p. 5).
Each country has its own mental health professionals, however, the prevention of suicide in prison is quite different throughout the world.
Austria. Incoming inmates in Austria do not have a trained psychiatrist for sessions; moreover, they are examined only during the first week of imprisonment. The majority of prisoners with mental disorders are kept on the same premises as inmates without depression or other problems, which could lead to the mental instability of the last. The solution is to divide prisoners with mental issues from healthy inmates and provide them with a competent doctor, thus improving the condition of the forensic institution.
In Italy prisoners are not provided with treatment; however, they have a right to receive medical consultation during the time of their incarceration. As soon as the treating doctor makes the diagnosis, the decision rests with the judge. He has to conclude whether the clinical state of the inmate allows him to continue his sentence in prison. Moreover, nurses or consultants are present in jail, but only for a limited amount of hours per month, which depends on the number of inmates. The treatment process for mentally ill inmates in Italy lacks a central system that will allow controlling the situation and preventing suicide within the institution.
Unlike prisons in the countries mentioned above, the USA provides health care for every inmate. In other words, “prisoners have a constitutional right to receive medical and mental health care that meet minimal standards” (Daigle et al., 2007, p. 7). Nevertheless, it is wrong to turn prisons into hospitals, so the government should reconsider the program regarding recreational programs for mentally ill prisoners.
Dutch prisons have an underdeveloped program for suicide prevention among mentally ill inmates as well. Despite the fact that the Ministry of Justice established scientific research of suicidal convicts, it is not used properly in jails. Not enough attention is paid to suicide prevention either, and the awareness increases only after the series of suicides among prisoners.
Having observed the patterns of treatment for mentally ill inmates, we can conclude that the level of awareness should be increased by introducing different treatment programs, improving the knowledge level among prison workers, and establishing the course of proper pharmacotherapy.
Baillargeon, J., Black, S. A., Contreras, S., Grady, J. & Pulvino, J. (2002). Anti-depressant Prescribing Patterns Among Prison Inmates With Depressive Disorders. Web.
Daigle, M. S., Daniel, A. E., Dear, G. E., Frottier, P. & Hayes, L. M. (2007). Preventing suicide in prisons, part II: International comparisons of suicide prevention services in correctional facilities. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 28(3), 122–130.
Magaletta, P. R., Wheat, B., Patry, M. W., & Bates, J. (2008). Prison inmate characteristics and suicide attempt lethality: An exploratory study. Psychological Services, 5(4), 351–361.
Vanderloo, M. J. & Buttlers, R. P. (2012). Treating Offenders with Mental Illness: A Review of the Literature. Web.