Stigma Against MH Treatment Takes Unique Form in Prison

Psychiatrists and others working with inmates in correctional settings can anticipate inmates' concerns about mental health treatment and help them to be more receptive to treatment by addressing those concerns.

This is the suggestion from one clinician based on a study in the September Psychiatric Services.

“Educating inmates about how we can help them through treatment and demystifying some aspects of mental health treatment may help them to be less skeptical about treatment,” first author Robert Morgan, Ph.D., told Psychiatric News. Morgan is an associate professor of psychology at Texas Tech University in Lubbock.

He pointed out that untreated mental health problems are common among people in the correctional system, and as many as 45 percent of those with serious mental health problems do not receive services while in prison or jail.

To investigate some of the barriers that hinder inmates' willingness to receive mental health treatment while behind bars, Morgan surveyed 418 male inmates from the Kansas Department of Corrections who volunteered to be part of the study. A total of 147 of the inmates were being housed in a reception and diagnostic unit, 148 were in a maximum-security correctional facility, and 123 were in a minimum-security correctional facility.

Each completed a survey that included questions about past mental health treatment in and out of the correctional setting and whether the treatment was voluntary or mandated.

Morgan found that inmates who had had mental health treatment in the community—whether in a group setting or on an individual basis—were more likely to participate voluntarily in mental health services to manage problems related to feelings of stress, anxiety, or depression (p<.01) and interpersonal problems (p<.05) than were inmates who had not had treatment in the community.

In addition, inmates who reported being ordered to undergo mental health treatment previously expressed more concerns related to self-preservation (p<.05) than those who had not been mandated to treatment in the past. Inmates categorized as having self-preservation concerns endorsed survey items indicating that they believe that if they receive services, they will be seen as “weak” or as a “snitch” by other inmates. They may also be afraid that the information they reveal in therapy could be used against them, for instance.

Morgan, who has conducted previous research on the effectiveness of mental health treatment for inmates, found that therapy was as effective for those who were mandated to treatment by correctional personnel as for those who sought treatment voluntarily.

“It didn't matter whether treatment was mandated or voluntary,” he noted. “It was equally effective.”

Morgan offered some interventional strategies for clinicians working with inmates who may feel as if participating in mental health treatment makes them seem weak or like “snitches.”

“We need to help inmates view treatment a bit more realistically,” he noted. “We can explain that it doesn't make them weak, and their personal information won't be used against them.”

Many inmates attend an orientation session at their correctional facility, during which they are informed about prison routine and how to receive health services, including mental health services. Morgan said this would be the ideal time to learn about how mental health treatment works in the correctional setting and to correct any misperceptions in inmates' minds.

“For many of these inmates, mental health treatment is crucial to their success once they've been released,” he said.

An abstract of “Needs for and Barriers to Correctional Mental Health Services: Inmate Perceptions” is posted at<psychservices.psychiatryonline.org/cgi/content/abstract/58/9/1181>.▪