Survey Points to Solutions for Prison Mental Health Woes
> 9/12/2007 10:33:19 AM

That mental health concerns remain a major problem for prisons goes without saying, and while some areas and individuals are taking steps to improve conditions, there largely continue to be more questions than answers. Dr. Robert Morgan of Texas Tech has made it his business to find answers for these questions, and to that end, he has published results from a recent survey in the latest issue of the journal Psychiatric Services that point to several areas of improvement. Dr. Morgan didn't waste time speculating or pontificating about trouble areas in his study, but instead went to the individuals most affected by prison mental health concerns and asked them what they thought. That's right, it was a prisoner survey.

When Morgan and his team tallied the results, what they found was that the reasons that prisoners don't use mental health facilities aren't all that different from the reasons that non-prisoners don't use the same services in the community. The inmates' barriers to use came in four general varieties:
  1. Self-preservation—Similar to real-world stigmas, prisoners were afraid that use of services would be perceived as weak or as part of collusion with staff. They were also concerned about issues of confidentiality.
  2. Procedural concerns—As can be the case in society, survey respondents reported uncertainty about how, where, or when one could access services.
  3. Self-reliance—Perhaps reflecting a stronger version of more "macho" beliefs, inmates often responded that people should "deal with their own problems," or if necessary consult only close family or friends.
  4. Concerns with staff—Respondents had worries that stemmed from prior bad experiences with mental health services, or they were concerned that the prison staff member was not a doctor.
Morgan and his associates also enumerated five areas of need that covered the primary reasons why inmates might seek care. They concluded that often prisons have people or systems in place to deal with these problems, but that the barriers to use prevent inmates from seeking or receiving the treatment they need. In their write-up, the team points to education as the key to changing inmate perceptions and behaviors. Orientation, the time when new prisoners are first introduced to the services available, is an important time for establishing a positive image. By way of suggestion, Dr. Morgan wrote in the article from Psychiatric Services:

Mental health professionals can target these specific barriers by educating inmates about how and when they should access services (procedural concerns); challenging stereotypical beliefs and educating inmates about issues of confidentiality, including limits to confidentiality (self-preservation concerns); discussing benefits of help seeking for functioning inside as well as outside the prison walls (self-reliance); and educating inmates about the qualifications and specialized skills of professional staff (professional service provider concerns).

It would appear that prisoners don't seek treatment for mental health concerns for many of the same reasons that the un-incarcerated don't seek treatment. And as Dr. Morgan points out, the benefit of that is that we can turn to tactics that have proven beneficial in community settings. To be sure, prison and community attitudes about mental health are different, but if even small gains can be made on prison populations—where as many as 50% of individuals have a mental health problem—then those tactics should be embraced. Dr. Morgan's survey also revealed that prisoners with a prior history of treatment while in the community were more likely to access treatment while in prison. This is further evidence that an understanding of the benefits will lead to greater usage, and in the end, both prison populations and free communities will benefit from improved mental health care in prisons.

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