Disorders and Treatment
- Mental Illness
- Bipolar Disorder
- Mood Disorders
- Borderline Personality
- Mental Health Diagnosis
- Mental Health Treatments
- Alternative Meds
- Case Studies
This two-part article was written exclusively for PsyWeb.com by Kathy Heyde, RN.
This article is entirely my opinion, which has formed after working for many years for the State dealing with the many issues that arise from mixing people with a mental illness or a developmental disability or both (dual diagnosis) in the same prison, along with other inmates, and the ramifications caused by that decision.
I have some very strong feelings about how or why many of the people with mental illnesses or developmental disabilities or both ended up being incarcerated in the first place. I also feel that individuals with a mental IQ that places them at 70 or below, or who have been diagnosed upon entry with a true mental illness, have no business being in our prison system.
Are you familiar with the term “deinstitutionalization”? Back in the '60s, the U.S. government decided that the mentally ill and mentally disabled of America would fair better if they were set up in the community with a community-based mental health care system in place to handle their needs. Over several years, they went about closing most of the state facilities throughout the United States and placed the residents into the community.
The community-based mental health system that was supposed to assist them with their needs fell apart due to inadequate funding, coordination, and lack of communication. The lack of commitment and resources just were not there. Many of these people were left in inappropriate housing, while some were set-up in their own apartments. Many had elderly parents who were unable to assist in caring for them; they could not control them nor could they afford to hire the help needed to train and assist them.
What a sad day as the caregivers working in the institutions that were closing saw what was happening to the people they had worked with, cared for and trained. Many had formed strong bonds after caring for them for several years. The lucky residents went home to be cared for and supervised by staff from these institutions.
These staff members were used to their behaviors; they dealt with these issues for years and had developed a system that worked for them. They thrived, worked on farms or in workshops, and attended special events, and their days were full of activities. They had picnics, proms, boating, fishing, work, relaxation – their lives were kept as “normal” as possible.
I dare say everyone had fun. Life was grand! We had behaviors and episodes happen while in the community that were uncomfortable, but we had the training and education to deal with them and still allow them to flourish. The clients had their families that could participate anytime they wanted, and many of them did. If something happened, staff were there to handle the situation and go on with the activity and no one would suffer. Many of these individuals had what was later called a “dual diagnosis” – these people were unpredictable, some dangerous, and many had IQ's in the 70s or below, placing them in the category of “definite feeble-mindedness.”
The second policy shift causing an increase of “dual diagnosed individuals” to be placed in the prison system was the tougher sentencing laws implemented in the 1980s and '90s. There is a population out there that, at times, is not as desirable as one would like, and it is this population that ends up in prison where they may or may not get treated.
In the meantime, they ended up as victims of the times. As I watched this population, I saw how they were put to work by the other inmates to do their illegal bidding. They were the ones who the other inmates took medications from. For those who received “desirable” medications, which they needed for their medical conditions, these medications were taken from them right after an officer had given them.
They would be threatened or beat up if they refused, so many of them learned just to give them up – or hide them under their tongues and give them to their abusers once they got out of the officer's sight. If they got caught “cheeking” their medications, they were the ones who ended up in segregation for a period of time.
Photo courtesy of Prison Photography
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