The prevalence of mental illness in jails is significantly higher than in the community or in prisons. As with prisons, jails are constitutionally required to provide mental health care to incarcerated individuals. However, several factors make providing adequate mental health treatment in jails versus prisons significantly more complicated. Individuals incarcerated in jails are admitted directly from the community; tend to present as more clinically unstable, often with intoxication and withdrawal symptoms; and are three times more likely to commit suicide than are individuals in prison. This is likely due to uncertainty about their legal situation, lack of recent mental health treatment or support, and often limited jail resources. Treatment of behavioral health needs in jails constitutes a public health intervention, since most detained individuals return to their communities. In addition, mental health interventions are essential to prevent suicide, mitigate acute psychopathology and stress, and reduce recidivism. This chapter provides a review of the research on jail mental health treatment, as well as current practice standards and recommendations.
The increased rates of serious mental illness, self-injury, and suicide in jail creates a unique burden on mental health staff who work in these settings. Other environmental risk factors place additional strains on jail providers that can lead to a variety of consequences ranging from trauma spectrum symptoms to burnout. This chapter will review established occupational syndromes including vicarious trauma, secondary traumatic stress, compassion fatigue, and burnout and apply these to the experiences of the jail mental health care provider. It will also incorporate trauma spectrum disorders such as posttraumatic stress disorder. Organizational interventions to limit the impact of workplace stress and trauma and to maximize staff recruitment, development, and retention are also discussed.
The provision of mental health services in American jails requires a working understanding of the societal forces that shape the American criminal legal system and the culture and experiences of those who are incarcerated. Structural inequities that exist in American society have led to the overrepresentation of certain racial and sexual minorities in the criminal legal system, which, in turn, can impact clinical presentations and decision-making by correctional health care staff. This chapter will provide an overview of the relationship between race, sexual and gender identity, and jail incarceration in the United States. It will apply this information to the correctional clinical setting and provide guidance and tools to help mental health clinicians working in jails deliver clinical care that is culturally and structurally informed.
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