People with mental health problems have long been present in both prisons and other places of confinement. Seddon notes that throughout the eighteenth century âit was increasingly becoming the case that the ânatural repository for the lunatic who had committed a felony [âŠ] was the local gaol or house of correctionâ (Walker and McCabe 1973, p. 1)â (Seddon 2007, p. 20, citation in original). Today, prison populations worldwide experience substantially higher levels of mental distress than the general population. In a systematic review of 81 studies from 24 countries, Fazel and Seewald (2012) found a prevalence of psychosis of 3.6% in male prisoners and 3.9% in females, with corresponding figures for major depression of 10.2 and 14.1%. In England and Wales , 90% of the prison population is said to experience one or more psychiatric disorders, 1 four times the corresponding rate in the wider community (Brooker et al. 2008). Women and young people in prison are particularly vulnerable to mental health problems (NHS Commissioning Board 2013; Fazel et al. 2008). In the US , the level of mental health problems in prisons is so high that carceral institutions have been seen as âde factoâ psychiatric hospitals (Daniel 2007). This can be at least partially attributed to the low tolerance shown towards disorderly public behaviour in the 1990s, which, as Young (2004) suggests, is likely to have been motivated by a desire to control people with mental health problems wandering the streets without proper facilities or treatment. Although in recent times various attempts have been made to divert or transfer those with mental health problems away from the prison system, such attempts have had a limited impact in practice. For Seddon (2007), this is because the very presence of those with mental health problems within prison is an intrinsic element of the whole confinement project . Institutional confinement is used as a method of punishment to exclude the âdeviantâ, the dangerous and the vulnerable and â[F]rom this perspective, the confinement of some of the mentally disordered within prisons is unsurprisingâ (Seddon 2007, p. 157).
Those with mental health issues are often criminalised, but imprisonment itself can create or exacerbate mental health problems. Prisons are hostile environments where people experience fear, intimidation, psychological and physical harm due to, amongst other issues, separation from family and friends, living at close quarters with other prisoners and a lack of constructive activity. The likelihood of self-inflicted death is 8.6 times greater in prison than in the community (Ministry of Justice 2017). This has been explicitly linked to the consequences of imprisonment including boredom, isolation, stressful events within prison such as intimidation and victimisation, and the increasing use of New Psychoactive Substances (NPS ) (Dear 2008; National Audit Office [NAO] 2017).
The literature on mental health in prisons has grown exponentially in the last 20 years, and is currently somewhat dominated by mental health professionals, particularly from the âpsyâ sciences (Mills and Kendall 2016), perhaps reflecting a substantial increase in the number of mental health staff working in prisons. More critical approaches such as those from sociology, criminology and gender studies have been neglected and little attention has therefore been paid to the constraints and impositions of the prison environment and the exercise of penal power on mental health and mental health treatment (Mills and Kendall 2016). This book seeks to overcome this deficit by presenting a variety of critical perspectives on mental health in prison from academics, practitioners and those who have been involved with the criminal justice system . It examines how the environment, regime, architecture and culture of a place designed for punishment can affect mental health and determine the type, delivery and effectiveness of mental health services. A range of different jurisdictions is discussed in order to demonstrate how mental health in prisons is affected by wider socio-economic and cultural factors, and how in recent years neo-liberalism has abandoned, criminalised and contained large numbers of the worldâs most marginalised and vulnerable populations . These jurisdictions include Australia, New Zealand and Canada, where due to the ongoing effects of colonialism , indigenous groups are substantially over-represented in the prison population, in addition to England and Wales, Ireland , and the United States . All are neo-liberal societies which have seen increasing structural inequalities . This book is therefore missing other, especially non-Western perspectives in low-income and middle-income countries, which, we would argue, should be the subject of further research and discussion. Overall, this collection challenges the dominant narratives of individualism and pathology and many contributors focus instead on the relationship between structural inequalities , suffering, survival and punishment .
In doing so, this book uses a broader conceptualisation of mental health than other literature in this area. Psychiatric studies such as those cited at the beginning of this book reveal high levels of diagnosed mental illness in prison populations; however, it should be remembered that these levels will be shaped by the instruments used to diagnose and measure them, which in turn are underpinned by a bio-medical framework (Busfield 2011). Many prisoners experience mental health difficulties which do not come to the attention of treatment services or fulfil the criteria for mental illness set by diagnostic manuals. The World Health Organization (WHO ) (2014) defines mental disorders as comprising âa broad range of problems [âŠ] generally characterised by some combination of abnormal thoughts, emotions, behaviour and relationships with othersâ. However, it is difficult to judge what might be considered âabnormalâ thoughts and behaviour in the abnormal environment of a prison, where mental and emotional distress may be considered intelligible responses to experiences of imprisonment, social exclusion and the histories of trauma , loss and abuse , which are considerably more likely to be present amongst incarcerated populations (Durcan 2006).
The terms âmental illnessâ, âmental disorderâ and âmental healthâ are associated with narrow medicalised perspectives, limited in their ability to consider the causes of mental distress (Johnstone and Boyle 2018). Like Morrow and Malcoe (2017), we therefore also use terms such as âmental distressâ, âemotional distressâ and âpsychological well-beingâ, although the individual contributors to this volume may use the language of âmental healthâ and âmental illnessâ according to the aims of their work and their professional background.
Themes of This Book: Critical Approaches to Treatment in Confinement
This book aims primarily to (re)introduce a range of critical perspectives to scholarly work on mental health and penal institutions. Although each of the chapter authors brings their own unique critical approach to this topic, reflecting their varying focuses, academic and professional backgrounds and personal experiences, broadly, this volume is based upon four key themes which run throughout the chapters. Firstly, this collection acknowledges that prison is an unsuitable environment for those with mental health problems (Mills and Kendall 2016; Seddon 2007), 2 particularly as imprisonment, the prison environment, architecture and regime may create and/or exacerbate mental distress. Despite widespread recognition of this, the use of imprisonment for those with mental health issues persists. Although in England and Wales the 2010 Bradley report recommended the extension of police and court diversion services to direct those with serious mental disorder away from the criminal justice system , such schemes remain patchy, and only a small percentage of prisoners with mental health problems are transferred from prisons to outside psychiatric facilities. In the absence of alternative provision, many with mental health problems end up in prison as the âdefaultâ institution (see McCausland et al., this volume) or a place of last resort, particularly if there is seemingly nowhere else for them to go.
In recent times, prison mental health has become a topic of heightened public interest due to the increasing incidence of suicide and self-harm in prisons...