What do we know about the mental health of inmates? What are the implications of what we know? Nathaniel J. Pallone characterizes opinion on these questions as falling into two broad camps: the "tender-hearted," those who see an overlap between mental illness and criminal behaviour, and are treatment-oriented; and the "tough-minded," those who have little confidence in psychiatric categories, do not really accept arguments about diminished responsibility, and who feel the emphasis should be on punishment. Which is closer to the truth?
When this book was first published, the incidence of mental disorder among prisoners was nearly four times greater than among comparable groups in the general population in part because prisoners are disproportionately drawn from demographic groups with a high incidence of mental disorder—non-white and from lower socioeconomic strata. But other data is equally dismaying: mental retardation is 50 percent higher; alcohol and drug abuse is between five and eight times greater; and neurogenic disorders may be 1,700 times greater. In all categories of mental illness, the incidence among prisoners is far higher than among the general population.
Pallone asserts that evidence suggests that the design and implementation of mental health care needs serious revaluation, particularly in view of Supreme Court decisions mandating mental health care despite obstacles with implementation. Palone saw mental health care as the primary issue for those who manage prisons. Sadly, this remains as true as when this book was first published.
1 Without Comprehensive Data, Bias Flowers Easily
Cherished Beliefs at Diametric Poles
Toward Sophisticated Guesswork
The Burden of Inconvenient Knowledge
2 Epidemiological Studies of Mental Health and Illness
Methods of Assessing Mental Disorder
Studies of Mental Illness in the General Population
Demographic Characteristics of Correctional Populations
Relative Incidence of Mental Disorder by Race
Relative Incidence of Mental Disorder by Gender
The Issue of Socioeconomic Class
Psychometric Studies among Prisoners
Mental Retardation among Prisoners
The Limits of Generalizability
3 Alcohol and Substance Abuse Disorders
Substance Abuse as Criminal and as Criminogenic
Incidence of Alcohol and Substance Abuse
Base Rates in the General Population
4 Neurogenic Mental Disorders
Organic Disorders and Violent Behavior
Cause, Effect, or Concomitant?
The Question of Culpability Revisited
Correctional Management of Neurogenic Violence
5 Reprise: Estimates of Mental Health Staffing Needs
Probable Incidence of Mental Disorder among Prisoners
The Right to "Treatment" and to "Care"
Judicially-Imposed Mental Health Staffing Standards
6 After-Words: Parables of Convenient Ignorance and
A Demurrer about Causality
Mental Health Care vs. Correctional Rehabilitation
A Parable about Elephants and Giraffes
7 General Summary