In the United States (US), prison populations house a much higher percentage of mentally-ill people in comparison to the general population. For example, 92% of inmates experience a mental illness to some degree (Hean et al 1), whereas, according to the National Institute for Mental Health (NIMH), in 2017, only 20% of the American population had a mental-illness. On the other hand, according to the International Journal of Research and Student Engagement (IJRSE), In Scandinavia, it is unlikely that mentally-ill offenders would be placed in a prison at all (IJRSE). Scandinavian countries have a different philosophy: “all healthcare, including mental health, is viewed as a right for all individuals, including prisoners” (Ward). Therefore, offenders with diagnosed mental-illnesses are often placed in treatment facilities rather than in the prison system. If correctional facilities fail to address mental-illness, mentally-ill criminals may continue to pose a threat to society upon release. A 2017 study conducted by the American National Association for Mental Illness (NAMI) demonstrated that US offenders with diagnoses have a 15% higher chance of reoffending than those with no mental-illness. This suggests it is common in America for mentally-ill inmates to repeat their previous patterns after incarceration. According to the American Psychological Association (APA), there are two ways of approaching mental-health in penal systems: to rehabilitate or to punish. Inmates in Scandinavia are more often rehabilitated, whereas inmates in the US are subject to punishment. Regardless of the approach to incarceration, the psychological health of the inmate ought to be a top priority, and treatment must be accessible. Scandinavia’s prison system seems to have a more positive effect on mentally-ill inmates than the US system. In the US, the condition of mentally-ill inmates worsens in the prison system, and in Scandinavia, where the focus is on rehabilitation, the condition of mentally-ill inmates improves.
American Penal Systems and Their Impact on Mental Health
Over-representation of Mentally Ill and Lack of Resources in American Prisons
The US’s approach to imprisonment results in the over-representation of the mentally-ill in an ill-equipped prison system. If an inmate struggles with a mental-illness, little consideration is given to caring for the inmate (APA). This is due to “strict sentencing guidelines, budget shortfalls and a punitive philosophy” (APA). In America, the focus is on punishing the mentally-ill for their crimes rather than treating their health issues. NAMI reinforces this picture. Across the US, 7.1% of Americans have a major depressive disorder and 4.4% have bipolar disorder (Gordon et al 1). In comparison, the APA discovered that within the American prison population, “24% of prisoners have been previously diagnosed with major depressive disorders and 17% with bipolar disorder” (Stringer). Moreover, these statistics show a significant over-representation of the mentally-ill in prison. The United Nations World Health Organization (UNWHO) stated that in some countries “People with … a mental disorder, [who] have committed minor offenses are often sent to prison rather than treated for their disorder. These disorders, therefore, continue to go… undiagnosed and untreated” (UNWHO). America appears to be a country that inadequately treats mentally-ill offenders. For example, Ana Swanson, a reporter with The Washington Post, stated in 2012 there were an estimated 350,000 inmates with severe mental-illness being held in US prisons (Swanson). Proper psychiatric facilities in the US housed around 35,000 mentally-ill from the general population (Swanson). Thus, only 10% of the mentally-ill were placed in properly equipped facilities to treat their conditions, whereas the majority were sentenced to prison. The evidence suggests that the US prison system is failing its mentally-ill patients through over-representation of the mentally-ill in prisons and the lack of well-equipped treatment facilities for mental-illness.
Usage of Segregation to Deal With Mental Illness in American Prisons
In the United States, a common form of punishment in prisons, which has a negative effect on mentally-ill inmates, is segregation. A study completed in 2004 by Professor Kyleigh Clark from the University of Massachusetts discovered the odds of those with mental-illness being put in segregation are 36% higher than those without (Ware). It is an easier way to deal with inmates having psychotic episodes (Ware). Even for those without any mental-illness, segregation can cause “depression, anxiety, paranoia, … insomnia, and anorexia” (APA). Although it is detrimental for any inmate, segregation is a convenient way to deal with mental-illness in American prisons. Matthew Teague, a reporter with The Guardian, elaborates on this issue. He discovered that in Florida, one in five mentally-ill inmates are segregated. Howard Simon, head of the American Civil Liberties Union in Florida, told Teague “[When] people with mental health problems… are put in solitary, not only are we not addressing the problem, we’re making it worse” (Teague). If mentally-ill inmates are continuously placed in solitary confinement, their illness may worsen, causing a continuous loop that puts the inmate’s health at risk. According to an article from Jeffrey Metzner in the Journal of the American Academy of Psychiatry and Law, “All too frequently, mentally-ill prisoners decompensate in isolation, requiring crisis care or psychiatric hospitalization. Many simply will not get better as long as they are isolated” (Metzner). Segregation has a negative effect on mentally-ill inmates that significantly exacerbates previous mental illnesses.
Scandinavian Penal Systems and Its Impact on Mental Health
In Scandinavian countries, the penal system’s primary focus is rehabilitation (APA). Although humane prisons can be viewed as a luxury, the philosophy is inmates must be ready to be a part of society when they are released. Since the mid-1900s, Sweden has adopted a system that benefits mentally-ill offenders. If they are determined to have been mentally stable, they are held accountable. But if it is discovered the person is suffering psychologically, they go through a unique process: a forensic psychiatric examination and treatment, which results in crime prevention (Lidberg et al).
Off the coast of Norway, Bastøy Island is an example of a humane prison. Each day, prisoners will tend to animals and grow their food, among several other activities. This gives inmates a chance to practice how to behave in society upon release, forming good behavioural habits. Furthermore, in Norway, mental-health is just as important as physical health, and the country has a strong approach to delivering mental-health care. In 2013, journalist Erwin James from The Washington Post visited Bastøy Island prison. Prisoner Hessle, who was serving 11 years for murder, explained how his crimes were driven by severe drug addiction. “Now I have no desire for drugs. When I get out I want to live and have a family. Here I am learning [how] to do that” (James). James’s interview sheds light on the positive effects that a humane prison brings.
The success of the approach is supported by extremely low reoffending rates, resting at 20% in Bastøy island, according to Christina Sterbenz from Business Insider. In contrast, according to Encartele, an organization that advocates for prisoners, the US recidivism rate is 70%. The Scandinavian system addresses the true issue: the illness rather than the crime. A study conducted by the World Economic Forum discovered that these low reoffending rates from Scandinavian countries stem from shorter prison sentences, lack of overcrowding, job training, drug addiction programs and post-release support (Bhuller). This creates a better environment for the mentally-ill, leading them through an enhanced rehabilitative prison sentence (Bhuller). In summary, the Scandinavian countries have successfully implemented a penal system—although more luxurious than typical prisons in America— that have a positive effect on mentally-ill inmates.
Scandinavia and the US administer prisons with different approaches, using very distinct priorities and values. However, despite differing styles, there must be proper resources to treat mentally-ill criminals regardless of location. In Norway, 25% had some form of psychiatric intervention during their time in prison (Kjelsberg). However, because of the support they receive, “their prison stays are likely to be shorter, and they’re less likely to return after serving their time” (Bouffard). Scandinavian prisons give inmates space to rehabilitate and support, as they approach their release date (Larson). These conditions are ideal for a mentally-ill inmate and will teach them how to function in society, which is evident with the substantial difference in recidivism rates. Whether prisons give inmates individual responsibilities or not, their mental health must be taken seriously. If it is desired that the inmates learn from their actions, they must be able to learn how to prevent the incident from happening again, and how to truly manage their mental-illness.
*Congrats if you made it all the way through my lengthy research paper! I spent many months on this research for my AP Seminar class, which should explain how academic it is compared to my usual writing.