Does Prison Cause Mental Illness?

When the words “prison” and “mental illness” appear together, we often hear them in one kind of debate. That is, Should people with mental illness go to prison when convicted of a crime, or should they be exempt? Would people with mental illness do better in a hospital setting or treatment facility?

More and more, social workers and justice activists are also looking at the reverse question. They are talking about the people who enter the criminal legal system in seemingly sound mental health but develop mental illness while there. They are asking whether prison causes mental illness, wondering what can be done about it…and asking us to care.

“When you consider the history of the U.S. criminal legal system, going back to slavery, it is unsurprising that it is a determinant of mental illness,” says Dr. Charles Lea (in photo), Assistant Professor here at the School of Social Work. “Deterrence and rehabilitation are often identified as key goals of the criminal legal system. Yet, their associated policies, programs, and practices rely on punishment to solve the social, economic, and political conditions that lead to criminal behavior.”

Given the increasingly punitive nature of our culture, asking Americans to care can be a hard sell. It seems that once we label a group of people who’ve been convicted of a crime as “offenders,” we care little that they enter the prison system whole and emerge damaged. In fact, we may think that the threat of a prison sentence makes a more effective deterrent when we increase the amount of possible harm. 

“When you have public policy based on the kind of anger and punitive sentiment that we had with mass incarceration, it’s not surprising that our facilities got meaner,” says Vincent Schiraldi, a former senior researcher at the School of Social Work who is now Maryland Secretary of Juvenile Services.

If we do care, we need to look at what practices cause these impacts. In a 2021 research roundup titled “Incarceration Can Cause Lasting Damage to Mental Health,” Katie Rose Quandt and Alexi Jones of the advocacy group Prison Policy Initiative surveyed the most common causes and triggers of mental illness in prison. They cited five main factors—removal from society, elimination of life’s purpose, overcrowding, solitary confinement, and routine exposure to violence—that can lead to a long-lasting “Post-Incarceration Syndrome” similar to PTSD. 

Disconnection from family is a typical source of psychological distress, Quandt and Jones point out. In fact, some researchers found that the farther one is held from their family, the more psychological pain results. They explain, “In 2018, when researchers at the University of Georgia analyzed the relationship between prison conditions and mental health in 214 state prisons, they found that people incarcerated more than 50 miles from home were more likely to experience depression.”

Here at the Columbia School of Social Work, members of the Center for Justice have collaborated with V-Day’s Beyond Incarceration Project and others to release a short animated film called “Doing Time: A Woman’s View,” drawn from the experiences of women separated from their children. One woman, realizing that her daughter didn’t consult her about troubling events at home, says, “I couldn’t be a mother in prison. Those were the moments I wanted to die.” 

Another woman in the film, mulling over the prospect of release, says, “Will I be able to act normal? Will I know how to make choices for myself? Will the jingling of keys trigger my PTSD? …. I sometimes wonder, would it be easier just to stay?”

The ultimate isolation, of course, is solitary confinement, which is used more extensively in the United States than other countries. In a groundbreaking research study spotlighted last year in Columbia Magazine, researchers at Columbia’s Justice Lab spoke to 100 men who were in or had been in solitary as well as  20 prison guards about the punishment and how it is administered. “You are just in a cell going crazy,” said one person interviewed. 

“My enduring impression is of an incredible, almost impossible-to-capture experience of deprivation and harm,” said Kendra Bradner, one of the scholars who conducted the interviews.

Researchers and policy experts in the social work profession fall into two camps regarding what needs to be done about prisons. Dr. Lea, one of a growing number of abolitionists, believes prisons should be eliminated in favor of “non-punitive” alternatives determined by the local community that “respond to the root causes of crime.” Others may still see potential to overhaul the current system. Either way, social workers agree that the mental harm prisons inflict is disproportionate to the goals of sentencing.

“How we treat our prisoners speaks to how we respond to human frailty and vulnerability and marginality, and that spills over into all our social policymaking,” says Jessica Simes, a leader of the solitary confinement study. “We need to find common understanding that prisons are meant to remove people’s liberty—not their health or their humanity.”

May is Mental Health Awareness Month.