I really enjoy reading the blog Kellevision.com. She says it like it is and seldom misses the point of what she's writing about. She identifies a problem in programming for homelessness and proposes a set of concepts to help clarify the situation.

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Many of the "barriers" faced by the chronically homeless are not external. They are self-inflicted. Repeatedly failing to pay one's utility bills is not a barrier. It is a behavior. Repeatedly getting into relationships with drug addicts and being evicted because you have allowed your new girlfriend to turn your affordable housing into a crack house is not a barrier. It is a behavior. Choosing to pay your boyfriend's bail instead of the rent is not a barrier, it is a behavior. Consistently refusing to hold down steady employment and being evicted for not being able to pay the rent is not a barrier, it is a behavior.

[..]Lastly, how we label the problem determines how we approach solving it. True social barriers need to be addressed by social services. Better programs need to be designed to specifically address the needs of the mentally ill population. Programs designed to assist the medically disabled need to be accessed. But behaviors require a clinical intervention - therapy. Clients who demonstrate patterns of behavior which result in repeated instances of homelessness need counseling, not social services. The problem is not a social problem. It is an individual problem which requires an individual intervention.

I think it's much more complicated than that. Our world has always had an underclass, a group of individuals who have been largely invisible in the US except during the Depression. These people largely function outside the visible society and economy. They share housing with family and friends, squat in abandoned buildings, and sometimes live under bridges. They live off their housemates or family, work for temp job agencies, borrow, steal, deal drugs, and even engage in formal criminal enterprise. Given our recent policies that have reversed the tax-based redistribution of wealth since FDR, the stagnant wages, disappearing jobs, and ever increasing cost of living, that underclass has become so large it is again visible.

They are chronically under or unemployment and are not collecting Social Security, either because they don't qualify, try though they may to apply, or they haven't the where-with-all to get themselves qualified. This chronic underclass is best described as a sub-culture. They are structurally built into the economy. "Full employment" doesn't include them. Because they have given up on finding work, they no longer register with unemployment offices and so are not counted among the unemployed. Those who are chronically homeless are a sub-group of this sub-culture, and probably represents some of its most dysfunctional members.

By describing the chronically homeless, Kellevision describes most of the common attributes of this subculture.

For the majority of the [chronically] homeless population, homelessness is a lifestyle, not an event.

[..]My purpose here is not to blame the victim, but to talk openly about the severe dysfunction I see in chronically homeless families. Unless we identify the true problem, we will not be able to form a lucid solution. Homeless families typically do not function well on any level. Children are frequently truant from school and display numerous behavior and developmental problems. Dorm rules are constantly broken and there is constant turmoil between the families on the dorm. Relationships are fleeting, intense and severely dysfunctional including domestic violence, substance abuse and exploitative. Interactions with other people are inappropriate or dysfunctional. Most homeless families have burnt all their bridges with every social service agency and with their own families because of their severe dysfunction. Shelter staff often feel like we are running a middle school rather than a homeless shelter. This behavior is what needs to be addressed rather than giving them more money or building more homes.

[..]What are the elements of the homeless mindset? I'm still trying to work this out in my mind, but here are some of them which I see frequently:

• An external locus of control
• the belief that they have no control or responsibility for their choices, actions or behaviors but they are the victim of circumstances
• the belief that the causes for good or bad events in your life are totally outside your control or responsibility
• Sense of entitlement
• the belief that the worlds owes them something and they should be able to collect immediately
• the belief that they should be taken care of by others, by the government or by social service agencies
• the belief that they should be given things they have not earned (i.e. free housing, clothing, food, etc.)
• the belief that others should "help" them (i.e. by paying their unpaid bills or appealing their housing denial)
• Impulsivity
• Poor boundaries
• Emotional immaturity
• Need for instant gratification
• Dependency issues
• Predatory/antisocial behaviors
• Pathological relationships

Certainly, not every member of what I'll call the "underclass sub-culture" share all of these attributes. Each and every person has a story behind their situation. A careful account of their histories, something they usually reluctantly give, chronicles the development of these problems. It's important to discourage a prejudice developing against a whole group of people who are already stigmatized along with the "welfare mother" of the AFDC era. But we are not going to get to a more complete solution without understanding the problem. I suspect that why there is little commentary on this topic.

Kellevision hits on what I believe to be one of the most common roots of dysfunction, repeated traumas throughout their life.

A vast majority of our clients seem to have endured some sort of trauma(s) during their childhood which has(have) halted their emotional development. The result is immaturity, impulsivity, dependency, a sense of entitlement (that someone should take care of them rather than being responsible for themselves), an external locus of control (seeing problems as existing outside of themselves and therefore being outside of their control and/or responsibility), immature relationships and emotional lability. These factors result in behavior which appears erratic and irresponsible.

"Arrested development" is what Kellevision calls it. Indeed, this problem is pervasive and most often multi-generational. There are most often one or more of the following in the family history:

• lifelong repeated exposure to trauma:
  
  
  
  • child abuse and neglect
  
  
  • incest
  
  
  • domestic assault
  
  
  • gang or drug related violence
  
  
  • repeated exposure as a crime victim including assault, rape, and drive by shootings
  
  
  • inconsistent parenting ranging from abusive to no supervision
  
  
  • one or more family member who was murdered
  
  
  
  
• poor performance/attendance at school


• high school drop-out


• parenthood started by mid-teens


• by their twenties, they have several kids with mostly different partners


• sporadic work history and chronic unemployment


• efforts to qualify for Social Security


• family members relying on other families income, so no family member is able to break the pattern of poverty


• chemical abuse


• drug dealing to support a habit


• mental illness


• parents, spouses, brothers, sisters in prison


• criminal activity as income


• crime as a family enterprise

Persons who are members of the underclass see dysfunction as normal. They've never known any different. Many think this is how everyone lives. While they may dream of a good job, they appear to not have the self-discipline to keep a good job. Many of this group might be diagnosed with an anti-social personality DO. Personally, I think this diagnosis is misleading at best. A person earns this diagnosis if their history includes sufficient "anti-social" behavior. This doesn't account for family cultures that teach a confusing mix of conventional and anti-social values. Thus we have neighborhoods that have no constructive relationships with police, believe that justice is against them and label anyone reporting a crime as an informant and not to be trusted. This of course contributes to the chaos in the neighborhood.

In my experience people who get diagnosed anti-social are the ones the clinician don't trust or believe. The whole underclass culture tries to keep their business to themselves. Lying to protect one's family's reputation is encouraged. I suspect while there may be a few classic psychopaths out there, most of those folks who populate our jails are drug abusing, impulsive, underclass members with shut down emotional systems due to repeated chaos and trauma. These folks won't tell you the truth unless they are desperate and already feel they are the lowest of the low. Their judgment is so impaired that they see fear as a weakness they must squelch out. Danger in their world is everywhere and it must be faced, not avoided.

I have worked with some persons of the underclass who have a clinical presentation of PTSD after many years of participation in gang violence. They know what conventional values are, but they also know what is the law of streets. They are scared and tired of living a nightmare, and want a stable peaceful life but are tortured about what they've seen and what they've done to others over the years. Just seeing a gun sets off flashbacks. They describe their younger years as being "shut off" emotionally, and "not caring" about anyone or anything but money. But now in my office, they are presenting a mostly full range of emotion and a guilty conscience that suggests conventional values. Has their impulsive, "immature brain", associated with anti-social acts, matured into a more conventional pattern? Or is it more accurate to describe them as a product of an anti-social sub-culture? I suspect the latter is more accurate.

Returning to the homeless and Kellevision, she notes the major problem with relationships is homeless people's "picker is broken".

For every person in a homeless shelter with dependency issues we seem to have an predator waiting for them. Half the population seems to be working or receiving some form of assistance and the other half seem to be trying to hook up with them to take advantage of that income....

It is important to realize that single parents contribute to the problem of picking the wrong partner with their own pathology. The single mothers in the family dorm are not simply victims of the men they pick out. There seems to be a predominant attitude of these women that the man should "take care of them". They believe it is just a matter of picking out the right one. The first problem is that their "picker" is broken. They do not pick out a good one. They usually pick out one of the predators roaming the alley behind the shelter. The second problem is that you cannot sit at home expecting to be taken care of in our modern economy. That might have worked in the 1950's, even in the 1970's, but June Cleaver is no more. The modern American household takes two paychecks. Two full-time paychecks. The third problem presents it self when the man expects to be supported by the woman. Even if the woman is working full-time and picks out a man who wants to live off of her, women traditionally earn much lower wages than men. So the family's financial stability is even more shaky.

This predatory - dependent dyad seems to play out in most of their relationships and I wonder if it is not the source of their alienation from their families of origin. A person who constantly expects to be taken care of can be quite tiring. By contrast, a person who is constantly preying on others also becomes quite tiring.

Having grown up in a chaotic home and living a chaotic lifestyle, repeated trauma has numbed their emotions to the point that they are unable to make proper judgments about who is worthy of trust. The predator-prey dyad began in their family of origin where parents exploited the children when they were young, and when the children grow up, they exploit their vulnerable elderly parents. Recently, in my therapy group, one male member admonished a older woman for setting limits with her adult children because they were tacitly supporting her grandchildren for default on a loan she'd co-signed. He felt family was entitled to lean on, effectively use, each other.

Mental illness is often cited as a factor in homelessness. A significant number of homeless clients suffer from debilitating mental illnesses and many researchers sight the high numbers of mental illness in the population. However, each researcher seems to define it in their own way. Some include only the big three Axis I diagnoses (Schizophrenia, Bipolar I and Major Depression). Others include substance abuse (since it is an Axis I diagnosis in the DSM IV) which dramatically inflates the numbers of the "mentally ill". Others include Axis II personality disorders, but only some of them, usually Antisocial Personality Disorder. Still others include Post Traumatic Stress Disorder. In my experience, mental illness is a factor in about 10-20% of our homelessness clients and it is a serious problem. However, it does not explain the other 80%. These 80% use an unusually high percentage of services and monies devoted to the homeless and they are repeat customers.

Here I have to disagree with Kellevision. Everyone I've counseled with substance abuse were running from their feelings about themselves and/or their past. I have found Bipolar DO in significant numbers behind petty criminal activity, gambling addiction, alcoholism, sexual addiction, exotic dancing and prostitution. I participated in a local county survey that identified their most expensive clients. The general profile was bipolar chemically abusive who revolved in and out of the hospital, placements and jail. Personality disorders are mental illness. While many may think the rest of the world is the problem and are not willing to take responsibility, many others are desperate for relief from a horribly chaotic and often traumatic life.

There is a very high incidence of traumatic histories in the homeless community, even before they became homeless, usually during childhood. I believe that a majority of the substance abuse problem in this population is an effort to treat trauma symptoms. However, this can be said of other populations as well, including the substance abuse community. Most trauma survivors manage to maintain housing despite their trauma symptoms. Though trauma symptoms may play a factor in homelessness, I do not believe they are the sole cause.

Sole cause, no, it's the multi-generational underclass sub-culture with it's accompanied fractured families, drug abuse, trauma, predator/prey cycle, and chaotic lifestyles. Trauma comes in forms that are not readily identified. Chaotic events in close proximity in time give the victim the impression they have no control of their fate and so they scramble for every edge in the moment, and anxiously await for the next disaster to strike. Those in the underclass go way out of their way to withhold their histories of trauma and chaos, insisting that they can handle their own problems, and it's none of anyone's business. Or is this simply the accepted cultural method to deal with the shame of their past?

Most homeless clients do not have family support systems. If they did, the family would take them in and they would not be homeless. Many homeless clients come from families who are themselves very nomadic and teetering on homelessness. Some come from families rife with substance abuse, sexual abuse or domestic violence. Others have been rejected by their families for various reasons. These reasons often involve their dependent and/or dysfunctional behaviors.

Underclass families exploit each other until the resources are gone, or the member with resources cut off the leech. Once the underclass has used up their family resources, they become at risk for homelessness. Many have family who died young living violent or drug infested lifestyles, or who are in prison. By this time, they've burned out most of their friends as well. All they can do and meet new vulnerable people and continue a new predictor/prey dynamic.

So what solutions are there for healing the cultural divide? The problem is mostly economic. The underclass lacks a realistic chance for escaping their plight. Oh, sure a few make it, usually through advanced education. But many will hit a ceiling in achievement when they rely too heavily on "temporary feel good" behavior that provides relief from stress, but self-destructively complicates their lives and increases the chances they will fall out of their newly found middle-class status.

The middle-class in America is shrinking, many of the hard working blue collar workers are falling into the underclass from where with a floundering economy, escape will be difficult. Jobs programs, affordable housing, and counseling are sorely needed but remains largely unfunded. What infrastructure is present is actually shrinking with government tax dollars.

Too often the only role models for success are the gang members, drug dealers or pimps who drive fancy cars and flash wads of money. Too many get lost in this dream turn nightmare. But my experiences working with recovering gang members is that many are retrievable when they get desperate enough to escape with the right kind of treatment and patience with their guarded presentations. I work in a Partial Hospital Program (PHP) at an inner city public hospital that is designed to intervene with persons with personality disorders. It's largely based on the Crisis Intervention model that relies on the desperation of the client to inspire commitment, insight and behavior change in therapy. The PHP format is ideal for persons who are suffering from acute exacerbation of substance abuse, PTSD or personality disorder. I call it "mental health boot camp". We have a satisfaction rate of over 90%.

Kellevision lists a number of problems within the system.

In my humble opinion, our current social services system and is a major factor contributing to the homeless mindset. This is a complicated element to explain. But I think it is important to make an attempt.

I see two major problems with the social services system: 1) the system itself - how benefits are applied and eligibility determined and 2) the people working within the system - the mindset of caseworkers and social workers working with the homeless population.

• The social services system seems to be designed to punish attempts by the poor to achieve independence. Assistance programs penalize people for working "too much" by cutting off benefits when assets accrue. These systems often reinforce irresponsibility and impulsivity while punishing people who try to work and plan ahead.
• Many social services programs seem to "teach" clients to wait until the last minute then create a dramatic "emergency" in order to get help. This fosters the emotionally immature and histrionic displays in emergency rooms.
• Our current welfare system does not allow exchanging work for benefits. Benefits are given away free.
• Caseworkers and social workers have a bad habit of doing things for clients, rather than expecting the client to do it or teaching them how.
• So what have clients learned so far?
  • Don't work too much.
  • Don't plan ahead.
  • Expect someone else to provide you with what you need.
  • Don't take responsibility. Someone else will fix it for you.

The welfare system is complex, cumbersome, and difficult to change into a working entity. The major problem is that it is designed not to serve the poor, but to mollify the political needs of the tax payer. That makes it inherently punitive. As we know from behavioral science, punishment doesn't change behavior. I believe it in fact feeds the cycle similar to the one Kellevision describes above. As long as we put political considerations ahead of evidence-based methods, we'll have a broken system.

Kellevision proposes ideas that I think have significant merit.

I think counseling should be provided liberally. Teach people how to fish. Teach them how their maladaptive behaviors impair their ability to function. Stop rewarding bad behavior. Stop giving away money. Stop cleaning up their messes for them. Stop giving away free stuff.

Once homeless clients are assigned jobs, they would be provided with counseling to address the behavior problems that interfered with their ability to maintain employment. If they failed to come to work due to a poor work ethic, substance abuse problems, domestic violence or other relationship issues, etc. instead of getting fired - again - and having another black mark on their work history, they would be required to participate in counseling or group work to address it.

We spend billions on imprisoning the largest proportion of our population than any other nation. Too many of those imprisoned are petty drug offenders. In prison, they some learn how to be more effective criminals and then are turned loose to re-offend. Too many are very young.

Petty drug offenders often need CD treatment, not prison. Many are simply supporting the habit that keeps them from a more productive life. However, petty criminals can become hardened career criminals just from the experience of prison.

These are facts that have been known for many years. The only thing that keeps us from acting on this knowledge is an uneducated electorate. At the recent APA convention, another expert repeats the message.

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"The current design of prison systems don't work," said criminal justice expert Joel Dvoskin, PhD, of the University of Arizona. "Overly punitive approaches used on violent, angry criminals only provide a breeding ground for more anger and more violence."

Presenting at the American Psychological Association's 117th Annual Convention, Dvoskin discussed his upcoming book, "Applying Social Science to Reduce Violent Offending," which examines why prisons are failing and what needs to change.

"Prison environments are replete with aggressive behaviors, and people learn from watching others acting aggressively to get what they want," Dvoskin said in an interview.

Applying behavior modification and social learning principles can work in corrections, he said. "For example, systematic reinforcement of pro-social behaviors is a powerful and effective way to change behavior, but it has never been used as a cornerstone of corrections," he said.

Also, punishment can be effective in changing behavior, but it only works in the short term and immediately after the unwanted behavior happens, he said. While there is a place for punishment, it should be used in psychologically informed and effective ways. However, punishment should not be one-size-fits-all, Dvoskin said.

"We need to know what may be behind the criminal behavior to know what the best treatment is," he said. "A person who commits crimes when drunk but not when sober is likely suffering from an alcohol problem. Treating the alcohol problem may diminish the criminal behavior."

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With 75% of all prisoners in state and federal prisons showing significant symptoms of mental illness, it's not surprising that youths are not immune. The sad part is that the younger the prisoner, the more damaging will be the experience of prison, the more likely they will re-offend on release, and the more likely they'll be back in prison.

At least some states are beginning to emphasize rehabilitation rather than the self-defeating plan to punish the guilty.

Psychiatric News

Prisons must be prepared to provide culturally competent psychiatric care to juvenile offenders sentenced to adult prisons. Mental disorder prevalence rates are high among these young people.

Nearly 70 percent of adolescents from a Chicago detention center charged with a crime and transferred to adult criminal courts have at least one psychiatric disorder.

Furthermore, teenagers from the detention center sentenced to prison had more than twice the odds of having a psychiatric disorder as those not sentenced to a prison term, according to a study published in the September Psychiatric Services.

The findings point to a crisis in the juvenile-justice system, in which a substantial number of adolescents are remanded to adult courts for trial, according to Jason Washburn, Ph.D., lead author of the study and a research assistant professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine.

"Psychiatric treatment needs to be an integral part of any rehabilitation program for these," Washburn told Psychiatric News.

Deinstitutionalization of the mentally ill was considered the most humane solution to the long-term hospitalization and poor conditions of state hospitals. However, the money did not follow the released into the community. As a result, the mentally ill make up most people who are homeless and in prison. Given the high cost of housing the mentally ill and chemically dependent in prison, and the likelihood the problem will be make worse before release, we need real reform for community treatment.

Hennepin County in Minnesota has begun to take on the problem. Britain has come under withering criticism about their juvenile system.

California has reform in mind, but will also realize cost savings. The public supports reform for juvenile offenders, I have to wonder if public attitudes are moving for adult rehabilitation as well.

Alfred Blumstein, the winner of the Stockholm Prize in Criminology published a paper titled "An O.R. Missionary's Visits to the Criminal Justice System". It appears in the February issue of Operations Research, the flagship journal of the Institute for Operations Research and the Management Sciences (INFORMS®).

He challenges the very political and ideological foundations of our correctional system. I've previously written about the self-defeating nature of our corrections policies. Rehabilitation has been little more than a symbolic effort rather than the central tenant of corrections. The mentally ill, released from institutions 30 years ago, are now populating the streets and our prisons.

EurekAlert

"By bringing their analytical skills and system perspectives and without being constrained by the traditional presumptions that permeate all fields—perhaps to an extreme in criminal justice because of the strong ideological perspectives that pervade it—operations researchers bring new insights, new questions, and new challenges," writes Professor Blumstein of the Heinz School at Carnegie Mellon University.

Professor Blumstein, a pioneer in operations research, has been named a recipient of the prestigious 2007 Stockholm Prize in Criminology for his research into how criminals' activities vary over the course of their criminal careers. Operations research, says the professor, has changed the way that government and experts view the spike in murder and drug-related crimes in the nineties, the jump in imprisonment rate that began with the introduction of mandatory minimum sentencing, and the extent that removing criminals from the streets really helps prevent crime.

Prof. Blumstein startlingly observes that crime-fighting efforts aimed at deterring drug use in the 1980s and 1990s actually spurred a rise in murder and drug-related crime. He determined that during the crack cocaine epidemic, imprisoning less violent drug dealers in their twenties led to the recruitment of younger teenage boys, who are more prone to resolve arguments with violence. These teens began obtaining handguns for self-defense and that stimulated others to get their own guns for their own defense and to achieve status among their peers. As a result, he observes, crime rates for this age category soared. Murder and drug arrests dropped in the mid-1990s, but no thanks to law enforcement, he maintains. Instead, the crime rate fell precipitously when people in drug-ridden areas realized how badly crack cocaine was damaging their parents and older siblings and turned away from the drug. A reduced need for teenage drug sellers coincided with a robust economy, so these young people could leave the underground economy for regular jobs.

[...]Prof. Blumstein's paper also looks at a jump in imprisonment since the 1970s from 110 per 100,00 to 500 per 100,000 that has made the United States the world leader in incarceration, now ahead of even Russia.

The change, his research shows, is a result of the political system pushing aside the criminal justice system in addressing crime in America.

He writes, "the results of those analyses make it clear that more crime has not been a major driver and that arrests per crime has been astonishingly flat over the period."

He adds, "The 30-second sound bite that featured a cell door slamming provided much more powerful rhetorical appeal than mulling over the trade-offs among incarceration, community treatment, rehabilitation, and the other complexities in decision on appropriate sentences." MORE

Just like the alcohol prohibition in the 1930's helped create a major organized crime wave, the prohibition against drugs of all kinds have made billion dollar drug empires of the likes of Pablo Escobar, widely considered to be one of the most brutally ruthless, ambitious and powerful drug dealers in history.

We have based much of social policy on something called "common sense", what a researcher calls face validity. Common convention suggests punishing those who violate the law deter further crime. Besides, its the "right" think to do. Doing anything like help or training "rewards" the wrong doer. We see just how self-defeating common sense can be.

There is news today of a new study about mental health problems in prison and jails. The information shows a much bigger problem than previously reported.

MSNBC.com

More than half of America's prison and jail inmates have symptoms of a mental health problem, the Justice Department estimated Wednesday. But fewer than one-third of those with problems are getting treatment behind bars. The study by the department's Bureau of Justice Statistics also found the incidence of symptoms much higher among women than men.

Compared to inmates without symptoms, these mentally troubled prisoners were more likely to have been jailed before, to get into a fight behind bars, to have been physically or sexually abused in the past and to have drug problems, the bureau said. But troubled inmates were no more likely to have used a weapon during their offense (37 percent for troubled and nontroubled state prisoners) and only slightly more likely to have committed a violent offense (49 percent of state prisoners with symptoms but 46 percent among inmates without problems).

The results are "both a scandal and national tragedy," said Michael J. Fitzpatrick, executive director of the National Alliance on Mental Illness, a national grass-roots organization dedicated to improving the lives of the mentally ill. "The study reveals that the problem is two to three times greater than anyone imagined." Fitzpatrick said the results indicate "that the mental health system is failing -- long before people enter the criminal justice system and after they leave it." He said more resources devoted to mental health treatment on the outside would avoid "enormous costs shifted onto our police, courts, jails and prisons at all levels."

[...]Fred Osher, health service policy director in the criminal justice program of the Council of State Governments, noted that previous studies that focused on those diagnosed as mentally ill found fewer troubled inmates -- closer to 20 percent.

The mental health system has been called in "crisis". The use of that term is misleading. The problem has been with us forever, we are just starting to figure out why so many people are in jail and prison. Services for mental health have always been under funded. Previous studies and a Frontline public television report prompted a previous post on this topic.

Mental health problems and criminality have common roots. I've written about this topic before.

The US has one of the highest rates of incarceration of any country in the world. At year end 2002, 1,440,655 prisoners were under the jurisdiction of State or Federal correctional authorities. Four years later, that number is estimated at 1.8 million. In 2001, about 592,000 State prison inmates were released to the community after serving time in prison. (DOJ). Of the more than half a million offenders released every year, nearly 70% of them return to prison within three years.

In reaction to the problem of the "career criminal", the states and federal legislators passed tough new mandatory sentencing laws. The prison population as a result has grown precipitously. Now virtually every prison in the US is overcrowded. There is evidence that overcrowding "creates competition for limited resources, aggression, higher rates of illness, increased likelihood of recidivism and higher suicide rates." In addition, the cost of incarcerating an ever increasing population is skyrocketing, for the most part made up of non-violent offenders.

[...]We live our lives based on experiences we've had over our lifetime and the skills we learn and abilities with which we are born. People who behave in anti-social ways have learned that this behavior has advantages over socially acceptable behavior. Many of the studies reviewed in Hare's book reflect a poor relationship between parent and child, an absent or ineffective father figure, and abusive, inconsistent and/or neglectful child rearing. Children who grow up anti-social witness a disproportionate level of violence and perhaps most importantly, a level of chaos and absence of a perception of fairness and justice in their lives. They learn that their behavior in the long run doesn't change anything, delay of gratification just produces more pain. So short-term gain is chosen as the primary motivator. And the child's own self-interest is considered above all other considerations.

The study, by the Bureau of Judicial Statistics, a division of the Department of Justice, is done periodically. Previous reports found focused on only previously diagnosed inmates finding only 20%, similar to the current study based on recent history. The new study suggests that inmates are overwhelmingly under diagnosed. That's not particularly surprising since much so called "criminal behavior" is also associated with mental illness. An untrained eye in law enforcement is not likely to see what are often subtle differences that could only be verified by a formal diagnostic assessment by a mental health professional experienced in forensic mental health. Here are some key excerpts from the study:

At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 70,200 in Federal prisons, and 479,900 in local jails. These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates. The findings in this report were based on data from personal interviews with State and Federal prisoners in 2004 and local jail inmates in 2002. Mental health problems were defined by two measures: a recent history or symptoms of a mental health problem. They must have occurred in the 12 months prior to the interview. A recent history of mental health problems included a clinical diagnosis or treatment by a mental health professional. Symptoms of a mental disorder were based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV).

• More than two-fifths of State prisoners (43%) and more than half of jail inmates (54%) reported symptoms that met the criteria for mania.


• About 23% of State prisoners and 30% of jail inmates reported symptoms of major depression.


• An estimated 15% of State prisoners and 24% of jail inmates reported symptoms that met the criteria for a psychotic disorder.


• Female inmates had higher rates of mental health problems than male inmates (State prisons: 73% of females and 55% of males; local jails: 75% of females and 63% of males).


• About 74% of State prisoners and 76% of local jail inmates who had a mental health problem met criteria for substance dependence or abuse.


• Nearly 63% of State prisoners who had a mental health problem had used drugs in the month before their arrest, compared to 49% of those without a mental health problem.


• State prisoners who had a mental health problem were twice as likely as those without to have been homeless in the year before their arrest (13% compared to 6%).


• Jail inmates who had a mental health problem (24%) were three times as likely as jail inmates without (8%) to report being physically or sexually abused in the past.


• Over 1 in 3 State prisoners and 1 in 6 jail inmates who had a mental health problem had received treatment since admission. State prisoners (18%), Federal prisoners (10%), and jail inmates (14%) most commonly reported that they had used prescribed medication for a mental problem in the year before arrest or since admission.


• To meet the criteria for major depression, inmates had to report a depressed mood and decreased interest or pleasure in activities, along with 3 additional symptoms of depression. In order to meet the criteria for mania, inmates had to report 3 symptoms during the 12-month period. For a psychotic disorder, 1 symptom of delusions or hallucinations met the criteria.


• About half reported a family member incarcerated, 15% higher rate than none MI.


• Past physical or sexual abuse more prevalent among inmates who had mental health problems State prisoners who had a mental health problem (27%) were over two times more likely than those without (10%) to report being physically or sexually abused in the past. Jail inmates who had a mental health problem were three times more likely than jail inmates without to have been physically or sexually abused in the past (24% compared to 8%).


• Among State prisoners who had a mental health problem, nearly half (49%) had a violent offense as their most serious offense, followed by property (20%) and drug offenses (19%) (table 8). Among all types of offenses, robbery was the most common offense (14%), followed by drug trafficking (13%) and homicide (12%). An estimated 46% of State prisoners without a mental health problem were held for a violent offense, including 13% for homicide and 11% for robbery. About 24% of State prisoners without a mental problem were held for drug offenses, particularly drug trafficking (17%).


• Almost an equal percentage of jail inmates who had a mental health problem were held for violent (26%) and property (27%) offenses. About 12% were held for aggravated assault. Jail inmates who had a mental health problem were two times more likely than jail inmates without a mental problem to be held for burglary (8% compared to 4%). Use of a weapon did not vary by mental health status.


• The proportion of State prisoners who had used prescribed medication for a mental health problem since admission to prison rose to 15% in 2004, up from 12% in 1997 (table 15). There was little change in the percentage of inmates who reported an overnight stay in a hospital since admission (around 3%), or in the percentage who had received professional mental health therapy (around 12%).

Three-quarters of female inmates in State prisons who had a mental health problem met criteria for substance dependence or abuse. Female State prisoners who had a mental health problem were more likely than those without to --

• meet criteria for substance dependence or abuse (74% compared to 54%),


• have a current or past violent offense (40% compared to 32%),


• have used cocaine or crack in the month before arrest (34% compared to 24%),


• have been homeless in the year before arrest (17% compared to 9%).


• report 3 or more prior sentences to probation or incarceration (36% compared to 29%),


• report past physical or sexual abuse (68% compared to 44%),


• report parental abuse of alcohol or drugs (47% compared to 29%),


• report a physical or verbal assault charge since admission (17% compared to 6%).

The study report also included baseline information about mental health problems in adults for comparison purposes. Here is a summary:

As I said, the problem is not new, the recognition of the problem is an encouraging sign. The news reports quote the need for better mental health services to prevent crimes. That would certainly help. But the problem is bigger than that. From another previous post on the topic:

The US has one of the highest rates of incarceration of any country in the world. At year end 2002, 1,440,655 prisoners were under the jurisdiction of State or Federal correctional authorities. Four years later, that number is estimated at 1.8 million. In 2001, about 592,000 State prison inmates were released to the community after serving time in prison. (DOJ). Of the more than half a million offenders released every year, nearly 70% of them return to prison within three years.

In reaction to the problem of the "career criminal", the states and federal legislators passed tough new mandatory sentencing laws. The prison population as a result has grown precipitously. Now virtually every prison in the US is overcrowded. There is evidence that overcrowding "creates competition for limited resources, aggression, higher rates of illness, increased likelihood of recidivism and higher suicide rates." In addition, the cost of incarcerating an ever increasing population is skyrocketing, for the most part made up of non-violent offenders.

[...]Children who grow up anti-social witness a disproportionate level of violence and perhaps most importantly, a level of chaos and absence of a perception of fairness and justice in their lives. They learn that their behavior in the long run doesn't change anything, delay of gratification just produces more pain. So short-term gain is chosen as the primary motivator. And the child's own self-interest is considered above all other considerations.

Much the same could be said about people who grow up with mental health problems. The rates of child abuse and neglect due to chemical abuse by parents, and a chaotic lifestyle leads to the next generation at risk. From a previous post:

The correctional system we have is a complete failure. The only thing that works is locking people up for life. Truly, we as a society can't afford to lock up more than 2% of our total population at any one time. We need another solution. Career criminals are seldom caught. When they are, it's after more than a dozen offenses. Punishment will never be assured because we can't afford to lock them all up. We need a solution to the problem, not an over-sized band-aid.

The problem of crime [mental illness] and drug abuse originates in childhood. Years of research has shown that parents with chaotic lifestyles produce children with chaotic futures. Until we improve our parenting skills across the board, we will have to live with incredible crime and incarceration rates. We need to be teaching parents-to-be the skills beginning in junior high rather than assuming that parents pass on this skill to their children. Teaching parents-to-be how to nurture a quality attachment their children is critical. But it is also necessary to train parents-to-be emotion management skills and how to systematically teach those skills to their children. Competent parenting requires knowledge about emotion management and how to solve behavioral problems. My local school includes "Character Education" in it's curriculum. Creative approaches can be acceptable to both sides of the political spectrum. Improving parenting skills is critical to retrieving what has become a chronic underclass living a chaotic drug infested lifestyle.

Prior to about 1960, mental ill individuals were warehoused in state funded hospitals which provided structure and asylum for people who created at least a nuisance for the community and a hardship for families and others feared. Periodic expose's about the deplorable conditions in these settings and the development of modern psychotropic medications lead to realistic alternatives in the community. Deinstitutionalization like all great policy ideas, began as a noble mission, and gradually was distorted into a means to save tax dollars.

The Joint Commission on Mental Illness and Health in 1955 made several recommendations published in 1961. Several key laws followed. In 1963, Aid to the Disabled and the Community Mental Health Act provided community based treatment and support pensions for disabled created the means to pay for community based living for those who couldn't work and had no history of work to make them eligible for Social Security. Then California reformed commitment laws in 1968, beginning a trend towards indefinite confinement, especially when states discovered that they could save millions of dollars moving thousands of persons with mental illness to the community. Two thirds of those released returned home to their families. A third ended up in "board and care homes" provided by local entrepreneurs.

Many people with mental illness are too ill or under socialized to survive with disability payments and board and care. Episodes of illness create gaps in treatment when it's needed most. Without the ability to work, see little value in their lives, and often victims of discrimination and crime, many persons with mental illness drift.

Drifter is a word that strikes a chord in all those who have contact with the chronically mentally ill--mental health professionals, families, and the patients themselves. It is especially important to examine the phenomenon of drifting in the homeless mentally ill. The tendency is probably more pronounced in the young (aged 18 to 35), though it is by no means uncommon in the older age groups. Some drifters wander from community to community seeking a geographic solution to their problems; hoping to leave their problems behind, they find they have simply brought them to a new location. Others, who drift in the same community from one living situation to another, can best be described as drifting through life: they lead lives without goals, direction, or ties other than perhaps an intermittent hostile-dependent relationship with relatives or other caretakers.

Why do the chronically mentally ill drift? Apart from their desire to outrun their problems, their symptoms and their failures, many have great difficulty achieving closeness and intimacy. A fantasy of finding closeness elsewhere encourages them to move on. Yet all too often, if they do stumble into an intimate relationship or find themselves in a residence where there is caring and closeness and sharing, the increased anxiety they experience creates a need to run.

They drift also in search of autonomy, as a way of denying their dependency, and out of a desire for an isolated life-style. Lack of money often makes them unwelcome, and they may be evicted by family and friends. And they drift because of a reluctance to become involved in a mental health treatment program or a supportive out-of-home environment, such as a halfway house or board-and-care home, that would give them a mental patient identity and make them part of a mental health system: they do not want to see themselves as ill.

Those who move out of board-and-care homes tend to be young; they may be trying to escape the pull of dependency and may not be ready to come to terms with living in a sheltered, segregated, low-pressure environment (Lamb 1980a). If they still have goals, they may find life there extremely depressing. Or they may want more freedom to drink or to use street drugs. Those who move on are more apt to have been hospitalized during the preceding year. Some may regard leaving their comparatively static milieu as a necessary part of the process of realizing their goals--but a process that exacts its price in terms of homelessness, crises, decompensation, and hospitalizations. Once out on their own, they will more than likely stop taking their medications and after a while lose touch with Social Security and no longer be able to receive their SSI checks. They may now be too disorganized to extricate themselves from living on the streets--except by exhibiting blatantly bizarre or disruptive behavior that leads to their being taken to a hospital or to jail.

Somewhat less than 55,000 Americans now periodically receive treatment in psychiatric hospitals, this number has been dropping for many years, despite the fact that in urban areas, finding a hospital bed for an acute mentally ill person is often impossible. So not surprisingly, chronically deprived act out their anger and end up in prison. Almost 500,000 mentally ill men and women are serving time in U.S. jails and prisons. Prisons have become the New Asylums in America.

Frontline on PBS website has a 60 minute specially available in streaming video about the problem. Here is an excerpt from the introduction.

In "The New Asylums," FRONTLINE goes deep inside Ohio's state prison system to explore the complex and growing issue of mentally ill prisoners. With unprecedented access to prison therapy sessions, mental health treatment meetings, crisis wards, and prison disciplinary tribunals, the film provides a poignant and disturbing portrait of the new reality for the mentally ill. "It was surprising to see how much treatment was going on inside Ohio's prisons," say FRONTLINE producers Miri Navasky and Karen O'Connor. "And while the prison system is doing a commendable job, you are still left with the feeling that prison is not the answer to this very large social problem."

As the rising number of mentally ill inmates shows no sign of abating, those working inside the nation's prisons are struggling with a system designed for security, not treatment. Corrections officers now have the responsibility of not only securing inmates, but also working with mental health staff to identify and manage disturbed prisoners.

"Providing effective psychiatric care in a maximum security prison is extraordinarily difficult," says prison psychiatrist Gary Beven. "If you have untreated manic depression or bipolar disorder, untreated schizophrenia, somebody might be hallucinating and extremely paranoid. If you don't identify the fact that [a] person has schizophrenia, if you don't provide them with the proper medication, if you don't place them in an environment that allows them to function at an adequate level, then it's just a matter of time, perhaps, [that] something aggressive might occur."

And because these inmates have difficulty following prison rules, a disproportionate number are placed in solitary confinement. "People who are just so unsocialized and so psychologically fragile to begin with are deprived of any kind of social support, any kind of psychological stimulus. And they just fall apart," says Fred Cohen, a prison litigation specialist. Inmate Carl McEachron, sent to prison for stealing a bicycle in 1988, has spent much of his time in prison in isolation, unable to cope with the strict prison environment and racking up an extensive list of violations. His mental illness was left undiagnosed and untreated until recently. "He was the type of individual who was very difficult to work with," says Beven. "[He's] been very aggressive towards staff, including, I believe, by spitting on staff members and throwing body waste. And so there wasn't a lot of empathy for him. ... The tendency would be for somebody like that to just [say], 'Let's lock him away … let's just not have anything to do with him.'"

"Being placed in a solitary situation is like being placed in a prison's prison," McEachron tells FRONTLINE. "And that's worse than simply being taken from society and placed in prison."

Eventually, a majority of mentally ill inmates are released back into the community, generally with a limited amount of medication, little preparation, and sometimes no family or support structure. "We release people with two weeks' worth of medication. Yet it appears that it's taking three months for people to actually get an appointment in the community to continue their services … and if they don't have the energy and/or the insight to do that, they're going to fall through the cracks and end up back in some kind of criminal activity," warns Debbie Nixon-Hughes, chief of the mental health bureau of the Ohio Department of Corrections.

More information on Deinstitutionalization and other government policies effecting mental health.

The US has one of the highest rates of incarceration of any country in the world. At year end 2002, 1,440,655 prisoners were under the jurisdiction of State or Federal correctional authorities. Four years later, that number is estimated at 1.8 million. In 2001, about 592,000 State prison inmates were released to the community after serving time in prison. (DOJ). Of the more than half a million offenders released every year, nearly 70% of them return to prison within three years.

In reaction to the problem of the "career criminal", the states and federal legislators passed tough new mandatory sentencing laws. The prison population as a result has grown precipitously. Now virtually every prison in the US is overcrowded. There is evidence that overcrowding "creates competition for limited resources, aggression, higher rates of illness, increased likelihood of recidivism and higher suicide rates." In addition, the cost of incarcerating an ever increasing population is skyrocketing, for the most part made up of non-violent offenders.

A study by an advocacy group called Families Against Mandatory Minimums (FAMM) finds that rigid mandatory sentencing laws are largely to blame for the growth in incarceration of non-violent offenders, who make up over half of all prisoners. According to a FAMM news release, one in four prisoners are serving time for a property offense, one in five for a drug offense, and one in 12 for driving under the influence (DUI).

[...]The report also outlines comprehensive suggestions for sentencing reform and immediate steps to reduce overcrowding and save money. [...] "After 25 years, the verdict is clear: Arizona's mandatory sentencing laws do not enhance public safety and the certainly do not deliver justice," says Judge Rudy Gerber, who helped author the 1978 criminal code that established mandatory sentencing. "In my 22 years on the bench, I was forced to sentence far too many people to prison when treatment, community service and restitution to victims would have been more appropriate."

FAMM is a non-profit organization dedicated giving back to the judge the option of setting sentences. It's website makes a strong argument:

The American justice system traditionally permits judges to weigh all the facts of a case when determining an offender's sentence. But in the 1970s and 1980s, the U.S. Congress and many state legislatures passed laws that force judges to give fixed prison terms to those convicted of specific crimes, most often drug offenses. Lawmakers believed these harsh, inflexible sentencing laws would catch those at the top of the drug trade and deter others from entering it. Instead, this heavy-handed response to the nation's drug problem filled prisons with low-level offenders, resulting in over-capacity prison populations and higher costs for taxpayers. Mandatory sentencing laws disproportionately affect people of color and, because of their severity, destroy families. Two decades after the enactment of mandatory sentences, these laws have failed to deter people from using or selling drugs: drugs are cheaper, purer and more easily obtainable than ever before.

Some have argued that the increase in prison populations led to a drop in crime rate during the Clinton years. Other studies demonstrate:

"that crime rates have risen again after 2000 while the incapacitation and sentence/crime imprisonment/population both remained high."

There is other correlative evidence that suggests other factors were involved including:

(1) a strong economy and low unemployment; (2) a decline in the nature of drug markets, especially a change in the crack-cocaine market; (3) a reduction in the number of young males in the population as the 1960s birth cohort matured; (4) increased law enforcement budgets under the Clinton presidency; (5) increased adoption of community policing strategies.

Newsweek, in it's 4/24/06 issue, describes a new movement to adopt a primary role of rehabilitation for offenders incarcerated for methamphetamine offenses.

As the methamphetamine epidemic continues to ravage the country, some states are responding with a new innovation: "meth prisons" dedicated exclusively to inmates addicted to the drug. The Montana Department of Corrections just approved construction of two of them—an 80-inmate unit for men and a 40-inmate unit for women. Illinois, which already has a two-year-old drug prison that handles a variety of addictions, plans to open two meth-specific facilities by July 2007; each one will house 200 male inmates.

[...]The meth prisons are aimed not just at drug dealers and manufacturers, but also at those who commit crimes, like robberies, to feed their addictions. While the Illinois program will be voluntary for offenders, the law in Montana will authorize judges to order prisoners to serve time in a meth facility. Treatment will include group counseling, individual therapy and seminars on work, family and life skills. In Montana, family visits won't be permitted until inmates are deemed ready. Upon their release, case managers will monitor parolees to ensure that they continue to attend treatment programs.

Similar approaches appear to be working elsewhere. In Indiana, where corrections officials have set up meth units within four regular prisons in the past year, 66 members of the first graduating class were released about six months ago; so far, none have committed another offense. In Illinois, recidivism among inmates released from the drug prison is 50 percent less than among a comparable group in the regular prisons.

Bible Believers Fellowship, Inc.

The group's study involved 190 prisoners who between 1975 and 1979 had taken part in Christian discipleship training, and a similar number who had not, matched by age, race, gender and other factors. Both groups had been released from prison eight to 14 years prior to the study. It found that the religion-trained ones had an 11 percentage point lower recidivism rate than the control group. Forty percent of the religion-schooled group committed new offenses, while 51 percent of the others did so. The religiously trained group also had a longer crime-free period following release, and when they did commit new crimes, the crimes were less severe compared to past offenses. The control group had increased crime-severity. The recidivism rate for women who took religious training was even lower, only 19 percent, compared to 47 percent among the control group of women. Among men only, the differential was only seven points.

The classic book on the criminal character predicted the effectiveness of faith-based approaches to criminal rehabilitation. In the book Psychopathy by Robert D. Hare, PhD notes that religious conversion and marrying a good woman is the most effective way to teach the offender self-control. It's not a large leap of faith to see how emotional maturity is directly related to the kind of "conversion" that changes a criminal character. Clearly much of the literature reports the ineffectiveness of rehabilitation in changing career criminals. The evidence suggests that the people who are currently over-filling our prisons are not the violent anti-social career offenders who were subjects of the studies. My own clinical experience says that many of the minor offenders do respond to treatment and skills training.

We live our lives based on experiences we've had over our lifetime and the skills we learn and abilities with which we are born. People who behave in anti-social ways have learned that this behavior has advantages over socially acceptable behavior. Many of the studies reviewed in Hare's book reflect a poor relationship between parent and child, an absent or ineffective father figure, and abusive, inconsistent and/or neglectful child rearing. Children who grow up anti-social witness a disproportionate level of violence and perhaps most importantly, a level of chaos and absence of a perception of fairness and justice in their lives. They learn that their behavior in the long run doesn't change anything, delay of gratification just produces more pain. So short-term gain is chosen as the primary motivator. And the child's own self-interest is considered above all other considerations.

The American Psychological Association (APA) concludes that corporal punishment in raising children cannot be condemned or recommended based on the available literature. However, since it is statistically associated with physical abuse by parents so prone, the APA recommends that abusive parents be counseled to avoid corporal punishment.

"The act of corporal punishment itself is different across parents - parents vary in how frequently they use it, how forcefully they administer it, how emotionally aroused they are when they do it, and whether they combine it with other techniques. Each of these qualities of corporal punishment can determine which child-mediated processes are activated, and, in turn, which outcomes may be realized," Gershoff concludes.

The meta-analysis also demonstrates that the frequency and severity of the corporal punishment matters. The more often or more harshly a child was hit, the more likely they are to be aggressive or to have mental health problems.

While the nature of the analyses prohibits causally linking corporal punishment with the child behaviors, Gershoff also summarizes a large body of literature on parenting that suggests why corporal punishment may actually cause negative outcomes for children. For one, corporal punishment on its own does not teach children right from wrong. Secondly, although it makes children afraid to disobey when parents are present, when parents are not present to administer the punishment those same children will misbehave.

The quality of the relationship between parent and child has a direct impact on the effectiveness of punishment. Criminals have few relationships they value. They see society as a arbitrary punisher, rationalize that everyone is on the take, they are the unlucky one who were caught. Therefore punishment is in the context of resentment. More punishment just provokes more resentment and an escalation of anti-social behavior. Ask experienced prison guards if the violence has escalated over the years.

Hare's book noted that the method that had any hope of changing the behavior of a criminal character, was a religious conversion, falling in love with a "good" woman, or living in a situation where all the rewards of life are totally controlled by well intentioned others. Only when socially acceptable behavior is largely rewarded, and anti-social behavior is mostly punished will behavior change. Once that control is gone, the criminal character will return to anti-social behavior.

The correctional system we have is a complete failure. The only thing that works is locking people up for life. Truly, we as a society can't afford to lock up more than 2% of our total population at any one time. We need another solution. Career criminals are seldom caught. When they are, it's after more than a dozen offenses. Punishment will never be assured because we can't afford to lock them all up. We need a solution to the problem, not an over-sized band-aid.

The problem of crime and drug abuse originates in childhood. Years of research has shown that parents with chaotic lifestyles produce children with chaotic futures. Until we improve our parenting skills across the board, we will have to live with incredible crime and incarceration rates. We need to be teaching parents-to-be the skills beginning in junior high rather than assuming that parents pass on this skill to their children. Teaching parents-to-be how to nurture a quality attachment their children is critical. But it is also necessary to train parents-to-be emotion management skills and how to systematically teach those skills to their children. Competent parenting requires knowledge about emotion management and how to solve behavioral problems. My local school includes "Character Education" in it's curriculum. Creative approaches can be acceptable to both sides of the political spectrum. Improving parenting skills is critical to retrieving what has become a chronic underclass living a chaotic drug infested lifestyle.