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Hannah Smart

March 22, 2019

ENG 1201

Professor Hughes

Research Paper Rough Draft

In 2017, eleven inmates from the Nebraska state prison claimed that conditions

within the prison “endangered the health, safety, and lives of prisoners and staff on a

daily basis” (Sabata). A class action complaint, a lawsuit in which a group of people with

similar injuries caused by the same action sue the defendant as a whole, was filed

against the Nebraska Department of Correctional Services. Sabata v Nebraska

Department of Correctional Services is just one out of thousands of cases established

on the basis of denying basic human rights to those serving time in the prison system.

Therefore, prisons should reform the ways in which inmates are taken care of while

serving time because overcrowding, mistreatment or the lack thereof, and dangerous

prison environments can cause minor mental health issues and worsen already

diagnosed illnesses.

In March 2013, Zawn Villines published a blog post named, “The Effects of

Incarceration on Mental Health.” The purpose behind this post was to provide

information and evidence to support the idea that prison/jail time can have serious

effects on an inmate’s mental health. For the majority of people, the thought of serving

jail time never crosses the mind. However, incarceration rates in the United States are

steadily on the rise. In fact, according to a new study of American teens, “by age 23, at
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least a quarter of all youth in the U.S. — and perhaps as many as 41% — are arrested

at least once for something more serious than a traffic violation” (Maia). In addition, the

United States Department of Justice reports that 6.6% of people serve time in prison at

some point in their lives. More than half of the reported 6.6% are diagnosed with a

mental health disorder (Villines). As the number of Americans who run into serious

trouble with the law increases, the more susceptible they become to developing minor

mental issues or worsening already diagnosed illnesses due to their time incarcerated.

Even though the statistics that were aforementioned were associated only with

the United States, inmates are struggling with mental illness all around the world. Dr.

KKW Chow and seven other department heads of forensic psychiatry at multiple

Chinese hospitals and universities investigated the “Prevalence and Screening of

Mental Illness among Remand Prisoners in Hong Kong.” The goal of the this study was

to determine the prevalence of psychiatric disorders among remand prisoners. A

remand prisoner refers to a person that will be detained in prison until a later date when

a trial will take place. In order to study the prevalence of mental health issues among

remand prisoners, Dr. KKW Chow and seven other doctors in forensic psychiatry

recruited 150 total male remand prisoners from the Lai Chi Kok Reception Centre and

95 total female remand prisoners from Tai Lam Centre for Women. Next, each recruit

was given a CMHS questionnaire and interviewed by a specialist psychiatrist. The

CMHS is an 8-12 yes/no questionnaire given to inmates to evaluate their mental health.

There is a separate questionnaire for females and males. The results of this

investigation concluded that just over half of the tested inmates have struggled with a
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lifetime of mental illness while just under 40% have a current psychiatric disorder. The

study conducted by Dr. KKW Chow and the seven other department heads supported

the idea that mental illness is a serious issue within the justice system- not only in the

United States but also in other major countries around the world.

The first contention that urges for prison reform is overcrowding. As briefly

mentioned above, the class action complaint in the case of Sabata v Nebraska

Department of Correctional Services was filed due to poor prison conditions. One of

these conditions is alleged chronic overcrowding. According to David Fathi, a journalist

from ​The Guardian​, ​the Nebraska prison system as a whole is “at close to 160% of its

capacity, with four prisons at close to 200% of capacity and one at a staggering 302%”

(Fathi). The issue of extreme overcrowding has caused the death of one prisoner.

Obvious health issues were visible but ignored for weeks due to lack of adequate

medical and health care given to inmates. The prisoner died of a heart attack. Another

prisoner lost his sight due to lack of medical attention to diabetes. “Prisoners with

mental illness are warehoused in solitary confinement, exacerbating their suffering and

increasing their risk of self-mutilation and suicide” (Fathi). Solitary confinement is the

isolation of a prisoner from the rest of the inmate population in a separate cell. Due to

the increase of this isolation, it is no wonder that the suicide rates within the prison

system have increased as well.

With the overpopulation in prisons, there becomes a shortage of prison staff,

corrections officers, and medical personnel to treat and control the inmates serving

time. This shortage of needed prison staff is causing mental health issues/worsening of
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already diagnosed illnesses, unnecessary injury, and ultimately death in severe cases;

all of which could be easily preventable.

Josh Rushings, a journalist for Al Jazeera English, covered the idea of

overcrowding and the effects of the issue on inmates in a Youtube video. To open the

documentary, Rushings talks about how the majority of state run asylums closed down

in the 1970’s leaving hundreds of mentally ill patients on the streets. Most of the time,

this led to troubles with the law that eventually caused hospitals and asylums to be

replaced by jails and prisons. Those struggling with mental illness were now inmates

instead of patients.

As a part of a Capstone Project, graduate student, Kathleen Joyce dives into the

issues surrounding mental illness in a Kansas jail. As Joyce explores the Shawnee

County Jail, comparisons are made between the legal standards of a detention center

and of the standards that were realistically carried out in the jail. Poor environmental

conditions were described as the jail was overcrowded leaving many inmates without

proper treatment and/or lack thereof (Joyce). As more research was done and the case

study continued, Joyce found that after Topeka State Hospital closed, hundreds of

people who dealt with mental illnesses were left with nowhere to turn. The community of

Topeka began to run out of resources for the mentally ill and started to handle the

population with more aggression by shifting the destination of the mentally ill from a

treatment center to a detention center.

After reading through the research and examples just mentioned, trends can start

to be put together. Overcrowding is a result of the closing of treatment centers where

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the mentally ill found refuge and help. Jails and prisons do not produce the

environments or have the resources to maintain and help those with mental health

problems. Therefore, a possible solution to this contention is to reopen treatment

centers, asylums, and hospitals or put government funds towards the prison system so

that more training of prison/jail staff can be done as well as expanding mental health

facilities within detention centers.

The second contention that urges for prison reform is mistreatment of inmates.

As referred to previously, prisons and jails are no place to treat and maintain those who

struggle with mental illnesses. Consequence to this, mental health patients do not

receive the necessary and needed treatments as they would in an asylum or hopital.

Detention centers are required, by law, to provide basic health care for inmates but the

quality of this care can vary greatly. “Often, prison-based mental health care focuses on

stabilizing, rather than treating, inmates. A person experiencing hallucinations or

psychosis might get medication to control the most severe symptoms, but people with

anxiety issues, depression, post traumatic stress disorder, and other mental health

conditions that don’t cause radical changes in behavior may go untreated” (Villines).

Mental health issues that were previously treated by medication and therapy may

worsen during incarceration due to the rarity of therapy or comprehensive treatment

provided.

Under the eighth amendment, cruel and unusual punishments shall not be

inflicted on an inmate while serving time in a prison/jail setting. The Constitution does

not explain in detail the meaning of cruel and unusual punishment nor gives examples
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of what constitutes as cruel and unusual. Therefore, it is left up to the Supreme Court to

decide and grant punishment based off of t​he case.

“The Eighth Amendment’s prohibition of cruel and unusual punishment also

protects your right to safe and humane conditions in prison. You can challenge prison

conditions that are unsafe or that deprive you of a “basic human need,” such as shelter,

food, exercise, clothing, sanitation, and hygiene” (Your). In the case of Estelle v

Gamble, “the Supreme Court established that the Eighth Amendment may be violated

due to factors related to a prisoner's confinement. A prison guard's deliberate

indifference to a prisoner's serious illness or injury would constitute cruel and unusual

punishment which would violate the Eighth Amendment” (Busby). Deliberate

indifference is the conscious or reckless disregard of the consequences of one's

actions. Most of the time these serious illnesses deal with mental health. Situations as

mentioned in Estelle v Gamble, are happening more and more often.

One cause of this deliberate indifference towards inmate illness could be from

lack of medical personnel from understaffing. In the case of Sabata v Nebraska

Department of Correctional Services, the eleven prisoners who filed the class action

complaint claimed that Nebraska prisons were chronically overcrowded and

understaffed. In situations like these, it is very easy for corrections officers, prison staff,

and medical personnel to turn their backs on inmates with serious mental illnesses. If

there is not enough prison staff to take care of the inmate population, it is very easy for

prisoners to be treated wrongly or even forgotten about. The government issued a rule

under the eighth amendment that states that “prison officials may not act with deliberate
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indifference to a serious medical need” (Your). The eighth amendment may protect

prisoners right to medical care but it does not protect them against medical malpractice.

Also, the medical care that is guaranteed may not be the same level of medical care

one might choose outside of prison. With that being said, it still does not allow the prison

system to disregard medical care for inmates.

In the case of Brown v Plata, “the Court held that prison overcrowding in

California was unconstitutional because the living conditions resulted in medical care

violations. The Court reasoned that prisoners would suffer and could die if they did not

receive adequate medical care” (Busby). As mentioned previously, overcrowding is a

major concern for prison reform. It also fits in with the idea of deliberate indifference.

Such an issue also violates the eighth amendment.

The third contention that urges for prison reform is dangerous jailhouse or prison

environments. As the number of people who find themselves in trouble with law

increases, the more people end up in jails and prisons for long periods of time. “Prison

environments are known to be hostile, toxic, and at times provide for harsh living

conditions. Factors that contribute to the noxious state of prison living are the

prevalence of violence and the risk for victimization faced by inmates” (Stoliker).

Victimization is the action of singling someone out for cruel or unjust treatment. Gangs

or groups of inmates who “stick together” tend to single out newly incarcerated

prisoners and victimize them to gain control or establish a reputation.

According to Bryce Evan Stoliker and Joseph Varanese, doctors from the

department of sociology at Western University, “it is reported that the highest rates of
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victimization are among older inmates relating to psychological and property

victimization” (Stoliker). The targeting of older inmates is due to diminished health, lack

of confrontational character, and diminished social status. These traits attract the

younger population of prisoners who look to exploit and dominate the jailhouse in order

to control limited resources.

A short time ago, a study was done that analyzed a sample of 208 male

prisoners recently released from prison. The study was done to establish the correlation

between those who were victimized in prison and their mental health after being

released. The results found that “victimization in prison led to post-traumatic stress

disorder (PTSD) and symptoms of depression” (Stoliker). A wide range of ages was

used in the study but the average age was 32 years old. If the study included more

geriatric inmates, “one could reasonably expect that older inmates would display even

higher rates of mental health issues as a result of victimization/traumatic experience”

(Stoliker). As detailed above, older inmates are at a higher risk of victimization,

therefore, they may experience more trauma while serving time.

Violence and riots also add to the dangers of everyday living in incarceration.

The Department of Justice found that 70,000 prisoners are sexually abused every year,

and assaults, fights, and other acts of violence are common in a prison setting. This

violence is on the rise due to the increase of inmates in one particular prison causing

major overcrowding. This violence does not just create difficult and dangerous living

conditions for inmates but also creates a dangerous work environment for corrections

officers. Prison guards “work in a high-stress environment that can increase their
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likelihood of becoming violent. With little hope for reporting abuse by guards, some

inmates may endure verbal abuse, threats of physical violence, and even severe

attacks. Female inmates are at an increased risk of being sexually assaulted by jail and

prison guards. This ongoing climate of trauma can create anxiety, depression, phobias,

and post traumatic stress disorder in prisoners who previously had no serious mental

health issues” (Villines). An example of this brutality is the Nebraska prisons

aforementioned. According to ​The Guardian,​ “in the last two years alone, riots have left

four prisoners dead and multiple staff members injured” (Fathi).

Even though there are multiple contentions that urge prison reform, there are

things currently being done to try to help the issue at hand. As mentioned previously,

Josh Rushings documented in a Youtube video the idea of overcrowding in prisons due

to asylums and hospitals closing in the later 1970’s. The closing of these mental health

treatment centers left hundreds of mentally ill patients without a place to go. The

majority of them become homeless and are left on the streets where they run into

trouble with the law. Houston, Texas has one of the largest homeless populations in the

United States with the majority of them reporting to be mentally ill (English). Law

enforcement in Houston has began to rethink their approach in how they deal with the

mentally ill. The Houston police department created CIT teams which stands for Crisis

Intervention Teams. The goal of these groups is to partner police officers with mental

health clinicians. These teams talk with the homeless and help them through their

issues by taking them to treatment centers instead of into jails. The Houston Police

Department hopes to inspire other departments around the United States to create
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teams like CIT to reach out to the homeless and mentally ill before they run into trouble

with the law and wind up in prison or jail.

In conclusion, prison reform has become a necessity. Changes in the amount of

prisoners held in one prison, treatment of inmates, and the prison environment must be

made in order to begin decreasing the amount of people who suffer from mental illness

caused by being incarcerated. As seen throughout the research and evidence collected,

all issues within the prison system are related to each other. Overcrowding,

mistreatment, and dangerous environments all feed off of each other creating an

unnecessary, overly brutal place for inmates to serve time, especially those dealing with

mental health problems.

(Jenkins)
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Works Cited

Busby, John C. “Cruel and Unusual Punishment.” ​Legal Information Institute,​ Legal Information

Institute, 17 Oct. 2018, www.law.cornell.edu/wex/cruel_and_unusual_punishment.

English, Al Jazeera. “󾓦 Mental Illness in America's Prisons | Fault Lines.” YouTube​, YouTube,

7 Dec. 2009, www.youtube.com/watch?v=bPUsdxMBEOQ.

Fathi, David. “This Prison Causes Heart Attacks, Blindness and Mental Illness | David

Fathi.” ​The Guardian,​ Guardian News and Media, 16 Aug. 2017,

www.theguardian.com/commentisfree/2017/aug/16/nebraska-prisons-cause-hear

t-attacks-mental-illness.

Jenkins, Rosemary. “Mental Health Self-Determination: Not Incarceration.” ​LA

Progressive,​ LA Progressive, 7 May 2016,

www.laprogressive.com/mental-health/.

JOYCE, KATHLEEN, et al. “Mental Illness, Jail Inmates, and a Capstone Project: A Case Study

in Kansas.” ​American Jails,​ vol. 32, no. 5, Nov. 2018, p. 21. ​EBSCOhost,​

sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?direct=true&d

b=f5h&AN=132895176&site=eds-live.
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Maia Szalavitz. “Study: 1 in 3 Americans Arrested By Age 23.” ​Time,​ Time, 19 Dec.

2011,

healthland.time.com/2011/12/19/study-1-in-3-american-youth-are-arrested-by-ag

e-23/.

Sabata v. Nebraska Department of Correctional Services | Civil Rights Litigation

Clearinghouse,​ www.clearinghouse.net/detail.php?id=16113.

Stoliker, Bryce Evan, and Joseph Varanese. “Spending the Golden Years Behind Bars:

Predictors of Mental Health Issues Among Geriatric Prisoners.” ​Victims & Offenders​,

vol. 12, no. 5, Sept. 2017, pp. 718–740. ​EBSCOhost​,

doi:10.1080/15564886.2016.1170086.

Villines, Zawn. “The Effects of Incarceration on Mental Health.” ​GoodTherapy.org - Find

the Right Therapist,​ GoodTherapy.org Therapy Blog, 17 July 2018,

www.goodtherapy.org/blog/prison-incarceration-effects-mental-health-0315137.

“Your Right to Be Free from Cruel and Unusual Punishment.” ​Jailhouse Lawyer's Handbook,​

jailhouselaw.org/your-right-to-be-free-from-cruel-and-unusual-punishment/.