Mental health care fails to address the majority of American prisoners’ needs, according to a new long-term study of medication rates and recidivism. With greater mental illness rates overall and less attention paid to prisoners’ health, researchers find the chances of second and third offenses go up, burdening the taxpaying public.

It may be easy to write off wrongdoers as undeserving of help, but mental health experts fear this outlook doesn’t consider the larger long-term drawbacks. A substandard level of care fails to rehabilitate people to the fullest extent, which on the one hand keeps financial costs higher as they stay locked up. But it also makes them a greater threat to society and to themselves once they get released, if they ever do.

The first and most crucial step in the chain of mental health care is screening. When inmates get admitted to their facility, they are to be screened for potential illness, whether it’s diabetes, high blood pressure, depression, or schizophrenia. Unfortunately, even these earliest efforts don’t adhere to a strict protocol across prisons, says Dr. Jennifer Reingle, lead investigator and professor of epidemiology and human genetics at the University of Texas at Dallas.

"A standardized mental health screening process could benefit the inmates and the prison system as a whole," Reingle said in a statement.

Reingle and her colleague Nadine Connell looked at data from a 2004 national sample of prisoners, which included 14,499 people in state prisons and 3,686 in federal prisons. For the sake of establishing continuity, subjects self-reported whether they had been taking medication upon entering the facility and whether they were still taking them. The team learned that 18 percent of each group was taking some form of medication; however, only 52 percent of federal prison inmates and 42 percent of state inmates continued on those regimens.

Mental illness no doubt contributes to elevated levels of crime in everyday life, which may partly explain why illness rates are higher among prisoners than the general public — roughly 26 percent compared to 18 percent. Among other things, prisons are tasked with getting those inflated rates back to the average. But without an organized and systematized way of fielding new inmates, assessing their level of illness, and keeping them on their medication regimen, too many prisoners fall through the cracks.

Part of the problem is awareness within prisons, and it goes back to the simple maxim that the squeakiest wheel gets the grease. In this case, the squeaking is violence stemming from schizophrenia, and the grease is treatment. People suffering from the disorder were twice as likely to stay on medication as people with quieter disorders like depression, which doesn’t cause extreme behavioral changes that provoke attention. Prisons should also be aware of certain racial disparities. Black prisoners were 36 percent more likely to stay on medication than white inmates, regardless of their diagnosis. They were also more likely to be schizophrenic. Depression was the most common illness.

Mental health issues in prison are a decidedly old and complex phenomenon. On top of few prison officials knowing what illness looks like on a day to day basis, prison culture itself devalues physical and mental weakness. This is bad news for a system that sincerely wants to help its prisoners, who choose, on their own, to conceal a preexisting condition or discontinue treatment once inside. Making matters worse, the stakes for this treatment’s failure are high.

"Individuals with untreated mental health conditions may be at higher risk for correctional rehabilitation treatment failure and future recidivism after release from prison," Reingle said. Screening failure turns into medication continuity failure, which turns into total rehabilitation failure, and the cycle continues.

One way to break the cycle is through a looser dependence on medication and an embrace of more holistic methods, Reingle says. Of those studied, 61 percent of prisoners turned to meds as their sole source of treatment. Changing the chemistry of a person’s brain may help in the short-term, but few psychologists share the view that it should stand alone. Especially in prison, where emotions are as turbulent as they are withdrawn, even something as simple as one-on-one conversation could help improve inmates’ well-being and lower their chance for recidivism over the long haul.

Source: Reingle J, Connell N. Mental Health of Prisoners: Identifying Barriers to Mental Health Treatment and Medication Continuity. American Journal of Public Health. 2014.