Preston Anna G, Rosenberg Alana, Schlesinger Penelope, Blankenship Kim M
Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, 06520, USA.
Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT, USA.
Health Justice. 2022 Jul 25;10(1):23. doi: 10.1186/s40352-022-00183-9.
Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the carceral state create ideological and functional barriers to effective mental healthcare.
Data for the parent study of this analysis was collected via in-depth, one-on-one interviews of about one hour's length, conducted at six-month intervals over the course of 2 years. These interviews were analyzed using an iterative process of open-coding, thematic code development, and code application to participant interviews.
The results showed a common perception of mental healthcare received within the carceral state as serving goals of the prison system, including control and punishment, rather than therapeutic goals of healing and empowerment. This often had negative implications for the quality of the treatment received, including patterns of diagnostic ambiguity, treatment that was ill-fitting to participants' needs, and treatment that was undermined by the new trauma created by the prison environment. The results also highlighted racial disparities prevalent within the carceral system. Despite the barriers created by the subjection of therapeutic practices to carceral goals, participants demonstrated resourcefulness and creativity in engaging with these treatment modalities to reap benefits where possible.
Overall, these results highlight the inappropriateness of combining therapeutic and carceral spaces, the need for greater public attention to how carceral mechanisms disadvantage vulnerable populations, and the need for a cultural reconceptualization of mental illness such that it is met not with criminal punishment but appropriate care.
尽管监禁环境可能对心理健康造成限制，但心理保健日益成为一种监禁行为。在过去几十年中，监狱已成为数千名被监禁者事实上的心理保健提供者。此外，对受监管人员强制进行心理保健等做法进一步扩大了整个刑事法律系统中接受心理保健的人群范围。本研究考察了九名在监禁状态下接受心理保健的人员的观点，这些人员无论是在监狱服刑、假释还是缓刑，特别关注监禁状态的属性如何对有效的心理保健造成意识形态和功能障碍。
本分析的母研究数据通过深入的一对一访谈收集，访谈时长约一小时，在两年时间内每隔六个月进行一次。这些访谈采用开放式编码、主题代码开发和代码应用于参与者访谈的迭代过程进行分析。
结果显示，人们普遍认为在监禁状态下接受的心理保健是为了实现监狱系统的目标，包括控制和惩罚，而不是治疗和赋权的治疗目标。这通常对所接受治疗的质量产生负面影响，包括诊断模糊的模式、不符合参与者需求的治疗以及因监狱环境造成的新创伤而受到破坏的治疗。结果还突出了监禁系统中普遍存在的种族差异。尽管治疗实践受制于监禁目标造成了障碍，但参与者在参与这些治疗方式以尽可能获得益处方面表现出了机智和创造力。
总体而言，这些结果凸显了将治疗空间和监禁空间结合的不当之处，需要公众更多地关注监禁机制如何使弱势群体处于不利地位，以及需要对精神疾病进行文化重新概念化，使其不会受到刑事惩罚，而是得到适当的护理。
