7.8 Chapter Summary
- People with mental disorders are found in all parts of the criminal justice system, including jails and prisons, where they can be housed in a variety of settings from more to less restrictive.
- Segregated or isolative housing in custody, known as solitary confinement, is both overused and particularly damaging for people with mental disorders. It is also overused with other marginalized populations in custody.
- Staffing shortages in prisons and jails contribute to inadequate support for all people in custody, and particularly for people with mental disorders who may have higher support needs. Inadequate staffing can lead to the use of approaches like solitary confinement to manage challenging situations.
- People in custody have a constitutional right to care, but that right is difficult to enforce, based on the law that has developed around these issues. Additionally, to medicate a person in custody on an involuntary basis, a facility is required to go through certain procedures. Otherwise, a person has a right to decline treatment.
- Given that jails and prisons are naturally places of transition, ensuring that people receive the care they need in custody requires systems that anticipate those transitions. One such system is the APIC framework, which suggests an approach to ensuring care that begins with assessment and planning and progresses to identifying services and coordinating those services.
- Care in custody can include treatment from numerous professionals in the field of mental health. One type of care that is very important for many—if not most—people in custody is substance use treatment, including medication-based treatment for substance use.
Key Term Definitions
- APIC framework: A set of guidelines for ensuring people in custody receive treatment that continues and is effective across transitions. The APIC framework includes four steps: assessing, planning, identifying, and coordinating treatment.
- Assessment: A follow-up evaluation triggered by a screening that flags a potential problem or issue. An assessment is more in-depth than a screening, is performed by a mental health professional, and informs the facility about the services a person will need.
- Eighth Amendment: The amendment to the U.S. Constitution that prohibits cruel and unusual punishment and regulates excessive fines and bail.
- Fifth Amendment: The amendment to the U.S. Constitution that creates numerous important rights. Among those rights is the right to receive “due process” of law, or fair treatment, when a person may be deprived of life, liberty, or property.
- Fourteenth Amendment: The amendment to the U.S. Constitution that governs the rights of citizens in the states. The due process clause of the Fourteenth Amendment is understood to guarantee fairness in proceedings in the criminal justice systems in the states, just as the Fifth Amendment due process clause requires fairness in the federal system.
- Medication-assisted treatment (MAT): The use of medication, sometimes along with other therapies, to treat substance use disorders. There are several medications that target alcohol use, as well as medications that treat opioid use disorder.
- Screening: A standardized set of questions designed to flag people who are at risk for a targeted problem, such as a mental disorder. A screening does not provide a diagnosis or guidance on the severity of any disorder; rather it informs that a person needs further assessment.
- Solitary confinement: Also called isolation or segregation, a form of incarceration where the person is isolated in a cell. Solitary confinement is generally used as a form of discipline for prison rule violations or as a method to keep the isolated person or others safe.
- Substance use treatment: Treatment that helps a person manage and recover from a substance use disorder, typically including evidence-based therapies, such as cognitive behavioral therapy and/or other therapeutic approaches, and increasingly including medication-based approaches.
- Telehealth: The provision of health care, including mental health care, via means such as phone or video appointments, as well as electronic transfer of medical data.
- Trauma-informed (training, care, or approach): A system or action that realizes the widespread impact of trauma, recognizes its signs and symptoms, and responds by integrating this information into policy and practice, while seeking to actively resist re-traumatization.
Discussion Questions
- What are the needs and problems associated with the use of very restrictive or isolative housing for people with mental disorders in custody? What changes to our system can you imagine that could reduce the use of solitary confinement for this population?
- How does the “deliberate indifference” standard impact a prisoner’s ability to bring a lawsuit or otherwise enforce their right to care in custody? How might this legal standard impact care provided in prisons generally?
- What are the barriers to providing substance use treatment in custody, and how can/should those barriers be addressed? Should the use of medication-based treatments be expanded? Why or why not?
Knowledge Check
Use these optional questions to check your knowledge after reading this chapter.
Licenses and Attributions for Chapter Summary
“Chapter Summary” by Anne Nichol is licensed under CC BY 4.0.
