When the punishment deemed suitable for a particular crime is decided upon by judge and jury, the convicted face the start of a long and painful journey of institutionalized obedience to authority, their focus being the end of the sentence. This end is awaited anxiously as being the ‘end of the line’, a perception that is wholly naïve.
According to statistics in both the United Kingdom and the United States of America (Jones, JK 34, pg 234 A Journal of Law 1988), more prisoners than ever before leave confinement to return to family life. However, they leave ill prepared for family life outside the gates of confinement, with many suffering from serious mental health problems and finding themselves unable to integrate successfully back into society. Increasingly large numbers of released prisoners are shown to suffer from anxiety, depression, personality disorders and psychotic episodes, often committing new crimes and being imprisoned again within a three year period.
This cycle of incarceration and reentry into society carries the potential for profound adverse consequences for prisoners, their families and communities. Opportunities therefore exist for intervention by health professionals to enhance public safety, family stability and the mental health and well being of the communities at the center of this cycle.
Former prisoners struggle with a host of issues that complicate the reintegration process. Compared to the general population, released inmates experience higher rates of substance abuse, mental illness, infectious disease, unemployment and homelessness. Their needs are particularly acute, and the associated health services needed are not only challenging, but often not readily available to those with the highest need. Lack of employment, housing and heath insurance means that the mental and physical health and stability of many are left unrecognized and untreated. These issues not only present serious barriers to successful reentry into society, they also may present risks for the communities and families to which they return.
The immediate obstacle to independent living is the classification of an ex-offender as a ‘public risk’, a label which makes job accessibility extremely difficult. Housing and social interaction are immediately affected by the inability to earn decent income leaving many little choice but to live in low income/high crime areas where the risk of poor health is greatest. Many also turn to drugs and alcohol, engaging in high risk activities and being susceptible to infection and illness.
Released individuals not only have to face the enormous practical obstacles of work and housing, they are also ill prepared for family life. Families too are ill prepared for the return of a loved one who usually a radically different person from the one they knew well. Inmates may receive visits, letters and phone calls, however rarely are feelings discussed and anger regarding the crime or the incarceration, feelings of abandonment, confusion, isolation and frustration are the real and present emotions left to be dealt with upon release. Inmates may feel unable to cope with the emotions and feelings that come with relationships with those outside, notwithstanding the immense emotional task of dealing with new and forced relationships with fellow inmates and authority figures. Many released inmates are shown known to therefore isolate themselves, feeling unable to cope with the strangeness of free social interaction. This group show high incidences of paranoia, agarophobia, bipolar disorder, many exhibiting suicidal or homicidal ideation.
Institution based programs for inmates and their families must facilitate effective learning for identification of the personal signs of stress and how to cope with decision making and realistic goal setting. Psychological assessment could take account of individual personalities and coping skills , as well as episodes of solitary confinement and the degree of involvement in social and educational activities a within the institution. Individual based therapy should take note of social sensory deprivation syndrome which may result from radical and prolonged restriction to social interaction and which may lead to self imposed social isolation upon release or to substance abuse as a means of social escapism.
Institutionalized personality traits may arise from living in an oppressive environment which demands compliance to authority figures and passive acceptance of severely restricted acts of daily living, repression of personal lifestyle preferences and individual decision making. Structured stages of de-programming and confidence re-acquisition for social skills building would minimize the chances of antisocial personality trait development. Individuals learn defense and coping mechanisms to survive in prison and may adopt these to free life in terms of either becoming overly defensive or by subsequently challenging all authority, breaking rules or victimizing others.
Awareness of social and sensory deprivation syndrome is vital especially when inmates are first released and progress should be monitored by counseling staff being made available as part of the parole team.
The effects of social isolation and sensory deprivation may trigger physical conditions including chronic headaches, fatigue, insomnia, decreased concentration and the inability to anticipate the logical consequences of behavior. Individuals may progress to feelings of helplessness and hopelessness due to their inability to develop a plan for successful community and family integration. This may lead to feelings of profound fear or anger and even the inability to control angry and violent impulses which may lead to re offending. Such individuals need a safe place outside of the family home where access to counseling, group therapy and open communication without the risk of stigma may provide the hope of building a new life
By supporting the positive rehabilitation and reintegration of offenders into the community, crime levels are diminished, public health is enhanced and family and social stability is improved. Given the opportunity, nurses, social workers and other health care professionals can once again provide the hope and other key ingredients necessary to help build healthier and safer communities.