Mental Illness and Prisoners: Concerns for Communities and Healthcare Providers

Samantha Hoke, MSN, PMHNP-BC, RN


Online J Issues Nurs. 2015;20(1) 

In This Article

Abstract and Introduction


The United States prison system is the largest in the world. Mental illness is disproportionately represented within this system where half of all incarcerated individuals have a mental illness, compared to 11% of the population. Four of 10 inmates released from prison recidivate and are re-incarcerated within three years. A social hypothesis suggests recidivism is the result of compounding social factors. Mentally ill individuals often find themselves in less than ideal circumstances of compounding social factors such as illicit substances and unemployment. Prison life may provide improved social situations and a rehabilitating environment, yet corrections often fall short of meeting acceptable standards of healthcare. This article provides a brief overview of healthcare in the corrections environment and discusses factors that affect mental healthcare in prisons, such as characteristics of the prison population and social policy. The article also addresses factors impacting mentally ill persons who are incarcerated, including access and barriers to mental health treatment and efforts to reduce recidivism.


Inmate X is a 49-year-old Caucasian male who was first seen for mental health concerns at age 26 while incarcerated; he was diagnosed with schizoaffective disorder and antisocial personality disorder. Inmate X was born to working class parents and grew up with two younger brothers, a twin sister and an older sister. He was never married, but has a 15-year-old daughter.

Records indicate there is no family history of drug/alcohol abuse or mental illness. However, inmate X has an extensive substance abuse history beginning at the age of 11; he has admitted to abusing alcohol, marijuana, cocaine and hallucinogens. Inmate X graduated high school, worked several jobs, and also served briefly in the United States Navy until his less than honorable discharge. Inmate X's original offense was rape and burglary, but he sustained many additional probation violation charges for drug use, violation of restraining orders, and shoplifting. While incarcerated, inmate X picked up an additional charge for mailing threatening letters to the United States President. All of his time on these sentences has been served.

Since his incarceration, inmate X has been stabilized on Olanzapine, Fluphenazine Deconate, Cogentin and Clonazepam. Inmate X was transferred to an open mental health unit and has been a stellar resident indicated by job performance, medication compliance, group attendance and cooperation with other peers. Upon inmate X's risk panel assessment he was deemed to no longer be a risk to society and was released from prison. A short 5 months after release, inmate X reoffended while under the influence and was brought back into custody on violation of parole. Shortly thereafter, inmate X has again been stabilized on medications and according to his reviewing treatment team, inmate X appears to be upholding qualities deeming him appropriate for society.

This case study presents one story that illustrates the fate of thousands of inmates. Prison inmates represent a very vulnerable population exposed to many stressors. These stressors can lead to outcomes such as substance use, suicide, and recidivism. This article will explore the issue of recidivism in corrections; discussion will include characteristics of corrections, reasons for recidivism, and the limitations presented to corrections in the treatment of mental health. The article will also describe current efforts to reduce recidivism and offer alternative, literature based strategies to reduce recidivism that are compliant with jail/prison protocols in the United States.