Mental Health in prison?

The degree of civilization in a society can be judged by entering its prisons –Dostoyevsky got that right. But in the years since he wrote it, have we learned anything? Have we learned enough? Prisons may have changed over the years to include more individual rights, more facilities and even more education… But for the most part they still seem to function as warehouses: storage bins, where the troublesome -and the troubled– are secreted away so they are off the streets and out of the consciences of the rest of us. Out of sight, out of mind…

But as to who should be in prison, there seems to be some confusion. Some have argued that it should be a form of societal vengeance for any who have violated public normative behaviour -a way of avoiding the egalitarian justice suggested in the ancient babylonian Code of Hammurabi: the ‘eye for an eye’ principle. Some would argue that incarceration of one sort or another should be reserved for those who have both broken the law and are a danger to the public. Still others feel that for more obviously egregious transgressions -whether or not violent: white collar crimes, for example- justice is better served behind bars than with fines or mandated public service. Prison, in other words, is a punishment.

And yet, what if the crime was unintended, or indeed unappreciated? What if there was no criminal intent, no perception of wrongdoing? What if a minor misdemeanor and its subsequent detection led to behaviour that further incriminated, further entangled, and antagonized the system and its enforcers? The case of Ashley Smith and the investigation into her suicide in a prison cell while guards allegedly watched from outside the cell is merely the most recent and publically exposed example in Canada:

Self-injury is increasing in prisons: -especially amongst women inmates. That, surely, is a sign that all is not well in our prison system… A sign that we ignore at our moral peril.

I suppose that this disturbing news could be treated with a simple shrug of the shoulders and an indifferent sigh. As Oscar Wilde said, “One of the many lessons that one learns in prison is, that things are what they are and will be what they will be.” Looking at it this way, however, we learn nothing. We improve nothing. These incidents are telling us something.

That prisons are for criminals would seem self evident; that they should not include those with treatable mental pathology is less so. At first glance, the two may seem inseparable -or at least similar: surely violent criminals, chronic offenders, or even overly greedy white collar convicts have some form of mental illness -something the rest of us don’t have: something alien, unfathomable, pathological

Perhaps they do; perhaps all crime is attributable to some form of mental aberration. But in many ways, that dilutes the need to notice and treat those who have more recognizeable syndromes -syndromes more amenable to therapy. More rescuable. And it implies that such mental states are manageable within the prison system and don’t need separate facilities for successful resolution. The problem is that the primary contact with these troubled individuals is usually not by people trained for mental illness, but by those trained for suppression. Violence begets violence in response; it rarely engenders compassion, or a reasoned, helpful approach that might more successfully mitigate the behaviour. Mental illness unappreciated, is mental illness denied. Revoked. Abrogated.

No, prison is not a place for mental instability, or obvious, diagnosed mental pathology:

I mean, this should be obvious, but is frequently deceptively so. Things are seldom black and white; mental illness is one of the ‘The Great Masqueraders’ as they used to call difficult to diagnose conditions in medical school. Indeed it’s often far from obvious, and may even languish in the background, overshadowed by the actions that occasioned the arrest. We tend to focus on actions, not motives -if that’s what one would call the underlying incentive, the mental aberration that engendered the violation in the first place… We tend to see the criminality of the result, not the intent (once again to ascribe, say, an hallucination or paranoia to something as logical and thoughtful as intent is problematic at the very least).

It is clearly not an easy problem to solve, nor, given the many other issues plaguing prisons -funding priorities, training of staff, and overcrowding, to name a few- is it likely to gain the level of government support it so obviously deserves. And yet it is a priority. The very problem speaks to who we are; who we want to be. Those unfortunate enough to suffer mental illness in the system can never be properly served within the confines of an institution designed to serve other needs -warehouse needs, dare I say.

As Dostoyevsky implies, a society is judged by how it treats the most vulnerable of its members: the old, the poor, the mental disadvantaged… Remember that hymn: God sees the little sparrow fall? Justice is served, not by vengeance, but more by understanding, remediating… Caring.

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