Ontological effects of incorporating mental healthcare within the carceral state
The stated goal of mental healthcare—to assist the client in reaching healing and empowerment—and the goals of the carceral system—to control and correct—are fundamentally at odds. Bringing mental health treatment under the carceral purview renders this treatment a mechanism of growing and maintaining the carceral state and of enacting its goals of control and punishment. Our analysis of participant perceptions of their mental health care while in a supervised population clearly expresses these themes.
Punitive rather than therapeutic
When implemented by the carceral state, practices meant to be therapeutic in other contexts are experienced as punitive by both the representatives of the carceral state and those it incarcerates. This is clearly conveyed by Leah, a 25-year-old woman, who described an instance during her incarceration when she was committed to the psychiatric ward and spent a period of time in solitary confinement following an altercation with a corrections officer. In recounting this experience, she highlighted her heightened sense of confinement while in the psychiatric ward:
From Seg, I went to the turtle tank, which is where they don't give you no clothes. You've got like this big robe with Velcro, and they sit you in there for like a day. And then from there I went to the Psych ward for like 15 days. They're legally only supposed to hold you there seven, and I was there 15 days. The only reason why I got out was because I slid a note under the door to [corrections officer] and I had told him that I know I'm being held here against my will, and now it’s a matter of legality, and if I need to, I will have my niece, who's in the military. That same day I got put out, and I got put on the compound…
The way Leah and the corrections officer communicated about her confinement in the psychiatric ward suggests that both of them understood this to be a disciplinary measure in response to her behavior, rather than a genuinely therapeutic measure undertaken to facilitate her healing and rehabilitation.
Similarly, Carter, a 33-year-old man, described being transferred to a maximum-security prison after displaying symptoms of a schizophrenia exacerbation. Despite having a known diagnosis, he was not receiving medication in prison and began experiencing symptoms of his condition. As punishment for his behavior, he was transferred to a higher-security facility. Although he was later able to successfully petition the prison to resume his medical therapy, he still remained in a high-security facility even after his mental health condition was recognized and treated. He stated:
I was a level three in a level four or five prison…Like, I had like 10 months left but they had me in jail with people that was doing 65 and 100 years, like people that got homicides and everything like that. You got – I got 10 months. You got me around people that's doing 35 and all of this.
In this way, Carter described a sense of being overzealously punished and classified as a higher-order criminal as a result of the manifestations of his mental illness. While mental illness may often go undiagnosed in prison, Carter’s case illustrates that even when mental health conditions are recognized, they may still be handled by the carceral system in a punitive manner, reinforcing both the systemic criminalization of mental illness and the dominance of carceral goals like retribution over therapeutic goals for supervised individuals.
These patterns were also identified in community settings by individuals on parole or probation. Cora, a 36-year-old woman, described requesting a signature from a mandated mental health provider to confirm her treatment adherence. Despite her compliance with the program, her request was met with scorn and hostility. She recalled,
Her demeanor and her whole approach to me was so disrespectful … I'm coming here respectful and coming on time and coming dressed appropriate. I'm not coming flamboyant, I'm not coming high. I do my urines clean. I'm doing my end of the program so if you're supposed to be in my corner, supposed to [be] a social worker, you're supposed to be, like, meet these goals and this and that; you're tell me that on one end but you're not even helping me accomplish one goal with just a signature so you're not really, like, on the same page with what you say. So you're not practicing what you're preaching to me. So I feel like how am I gonna listen to a place like this, like what kind of program is this really?
The adversarial and derisive behavior of Cora’s provider stood in stark contrast with Cora’s expectations of a mental health provider: to help her set and accomplish goals and to be “in my corner.” In this way, Cora’s provider – rather than allying with Cora to provide therapeutic care –perpetuated the punitive tone and the message of moral inferiority that is characteristic of carceral systems.
Control rather than empowerment
Many participant stories also reflected perceptions that their mental health treatment was part of a broader effort to control them, rather than a means of empowering them to achieve mental health and personal healing.
Lee, a 56-year-old man, discussed an encounter in which he attempted to refuse a psychiatric evaluation after being involved in an altercation with another incarcerated individual. In response to his attempted refusal, the Correctional Emergency Response Team (CERT) was brought in to force him to comply, which resulted in Lee being pepper sprayed, beaten, stripped, and put into a four-point restraint. He recalled,
After they took the restraints off and all that and then they said, ‘The psychiatrist want to see you.’ I’m already down there now. Don’t you know, when I got out and went in there to see the psychiatrist, don’t you know he asked me, he said, “How can I help you?” [Laughter] I could have killed him. I just got assaulted and beat up and I didn’t ask to see you in the first place, and he’s gonna talk about, “How can I help you?”
On the surface, the therapist’s question suggests both a desire to help Lee and a pretense that Lee has some degree of agency regarding how he would like to be helped. However, the act of violently forcing Lee to participate in this “therapeutic” interaction undercuts the theoretical empowerment offered by mental health treatment in this carceral space and reinforces the controlling nature of the interaction.
The carceral state’s use of mental health treatment to control was also apparent in individuals’ accounts of treatment while on parole and probation. For instance, Logan, a 35-year-old male, described feeling as though the mental health of supervised populations was being sabotaged to reinforce carceral power. While on probation, he experienced a conflict with his roommates, in which his psychiatrist and case workers became involved. In describing the ways that case managers handle the personal issues of individuals on probation, Logan stated,
Logan: It's just screwed up, on top of screwed up, on top of screwed up, on top of screwed up. But we get paid money. As long as things are screwed up, we get paid. So we want to kind of keep them screwed up. You know what I mean?
Interviewer: It gives them a job?
Logan: Yeah. And if the—you know, they—they kind of betting that the situation would get worse. You know what I mean? By that I mean, I'm either going back to jail or I'm going to be hospitalized.
Interviewer: That's what they assume?
Logan: That's what they're—that's how they're playing it. You know what I mean?
Interviewer: Instead of, like, you're doing better.
From Logan’s perspective, individuals who are presumably employed to work in concert with mental health providers to support the wellbeing of individuals on probation actually benefit from setbacks in the mental health and social wellbeing of their clients. In this way, mental health treatment is rendered unproductive when contained within a system designed to protect and reinforce its own economic gains and those of individuals who are invested in the system.
This theme of ‘control rather than empowerment’ also arose frequently in discussions of medication. Carter described how his medication regimen was modified in prison, stating, “they really went up on my meds when I went to jail. I didn’t feel the same.” He elaborated on this, saying,
Yeah, ‘cause when you went to jail they were like we're gonna try you on this and I feel like they using me as a lab rat… Risperdal had me zombied out. I didn't like that feeling. I was quiet, wouldn't talk, moving slow…I think they overmedicate you in there so they won't have to deal with you.
Logan voiced a similar perspective when discussing how caseworkers manage mentally ill individuals mandated to treatment: “What can they do? You know? When you got guys that you, like, you know, medicate them and just hope they shut up. You know? Be quiet.” Testimonies like these illuminate how pharmacological treatment, like other modalities of mental healthcare, can be made into a tool of the prison system to suppress and control individuals and consolidate its own power.
Mental healthcare delivered via the carceral state may appear to offer the same components as community-based treatment. However, the experiences described by these individuals emphasize the ways in which it lacks the core therapeutic orientation to help the client achieve healing and empowerment, instead existing to reinforce the carceral goals of punishment and control.
Effects on service delivery
When mental healthcare is engaged without a patient-centered focus, carceral goals of discipline and control supersede therapeutic goals of healing and empowerment. Beyond the potential harm of receiving care that is not primarily meant to benefit the patient, this shift may also result in ineffective service delivery, including ambiguous diagnoses or ill-fitting treatment.
Within the carceral setting, the mental health diagnostic process exists along a continuum of ostensibly therapeutic activities that are implemented toward carceral ends. Thus, rather than serving the goal of better understanding and treating the individual, the diagnostic process becomes a means of facilitating control over individuals, namely by labeling and ostracizing them. As such, diagnostic confusion was a prominent pattern in participant narratives, with many reporting that they had received one or more diagnoses they felt were inappropriate or inconsistent. Carter’s experience provides one example. He reported receiving a psychiatric evaluation while shackled to a hospital bed and under the influence of PCP:
I just told 'em like this, “You diagnosed me when I was under the influence. That gives you symptoms like that, so I don't know why you're wanting to evaluate me. Don't evaluate me when I'm blacked out, having symptoms, high. You had me cuffed to a bed, so I was fine. You should've just let me come down, sit for a little while, and then evaluate me. Don't just put me on meds and then threaten me, you're gonna lock me up and do all this or send me back to jail if I don't take meds. That's crazy, but at least evaluate me when I'm like this. Don't evaluate me when I'm under the influence. That gives you them symptoms.”
In his case, his hasty diagnosis enabled the criminal legal system to apply a mandated treatment plan as a form of control and to impose punishments in response to nonadherence. Carter goes on to explain, “I violated probation and all of that so many times for not taking medication.” Clearly the experience initiated at the hospital was not unique but part of a broader pattern of being punished for medication nonadherence. The mandating of medication and the threat of incarceration for noncompliance are both leverage by which this inappropriately-applied diagnosis secures and reinforces carceral control. The diagnosis did not make sense to Carter, but it did not need to do so to accomplish the goals of the carceral system.
Similarly, Logan reported that at various times throughout his life, he received diagnoses that he questioned or outright rejected. However, his entry into the criminal legal system later in life allowed him to see that his legal involvement “adds something else to it.” He indicated that the diagnoses applied to him in the setting of his criminal legal interactions served a different kind of purpose, stating, “I think the whole thing, they’re just finding excuses to kind of make you seem weird or to categorize you or to put you into certain, um, like, you know, ‘He goes in this box.’ ‘He fits this category.’” He also expressed that he felt that having his diagnosis applied within a criminal legal context resulted in the conclusion that “He must be dangerous.” Logan perceived that the true goal of this diagnosis was not to better understand, normalize, and support his condition, but rather to assign labels that rendered his behaviors simultaneously strange, threatening, and manageable. In this way, the use of his diagnosis within carceral healthcare reinforces the recipient as both needing to be and able to be controlled.
Similarly, Cora described a pattern of being repeatedly labeled with a diagnosis of schizophrenia while incarcerated, even though she understood her symptoms to be due to substance use. She felt she was wrongfully placed in the mental health ward at the onset of her incarcerations yet still did not have access to proper treatment. She, like Carter, described being diagnosed in the setting of substance use, “going in and out of the mental hospital at the time I was using” and stated,
They say I got schizophrenia and psychosis but they always say it’s through chemical dependency throughout that, so I really wouldn’t say that, I guess, but when I go to jail, they do say that, so they usually put me in mental health at first because they say, you know, like I'm schizophrenic and whatever, I guess like a danger – whatever. So I just…okay, fine, whatever you say, but they don't give me nothing for it either. I mean if I am psychosis, all that stuff -- I guess it looks good to them on paper but they don't give me anything for it anyway so I don't know what that's supposed to mean.
In this way, Cora, much like Logan, perceived the prison administration to be using her diagnosis to label her as “dangerous” and to sort her into a category that “looks good on paper” for the prison, rather than a category that will result in her getting the appropriate treatment. Additionally, she did not even receive appropriate treatment for the category she was sorted into, again demonstrating that these diagnoses exist for the benefit of the prison system, rather than the individual.
Another participant, Jackson, a 24-year-old male, expressed frustration with his ever-changing diagnoses. In reflecting upon the many mental health evaluations he had received as a result of childhood encounters with law enforcement, he stated, “They changed –come on, they changed the diagnosis like every single year. They changed what I was. Like some of them sounded legitimate, like ADHD and like a spectrum autism. Understandable, but they just kept changing, changing, changing.”
These accounts of diagnostic ambiguity reflect the ways in which clinicians acting on behalf of the carceral state fail to do the work of understanding the individual and their symptoms, instead applying diagnoses that best serve the needs of the carceral state in that moment, leaving individuals confused, skeptical of their care, and uncertain of whether they will receive effective treatment.
Carceral mental healthcare, as an entity aimed at controlling and punishing individuals rather than healing and empowering them, often fails to meet their needs. This is clearly revealed in participant descriptions of inappropriate care they received while incarcerated. In Lee’s case (discussed above), his experience of being forcibly brought to the prison psychiatrist highlights the discrepancies between his needs and his prison-mediated therapy. He recalled,
The psychiatrist really got me, talking about how can he help me. He don’t know. He lucky that he had me in the cage – that cage, they put you in the cage. He talking about how can I help you. How can you help me, I didn’t even ask to see you for one thing? And he said, well you take him back. And I went right back.
For all the struggle and trauma that went into bringing Lee before a provider, he ended up being sent away almost immediately without any treatment or counseling. Because the goal of carceral mental healthcare – to control Lee’s behavior – had already been accomplished, his treatment was abandoned before it started, thus failing to meet his mental health needs.
Participant narratives also reveal how the trend of ill-fitting treatment extends to community-implemented mandated care for individuals on parole or probation. In Jackson’s case, he found his mandated group therapy to be not just ineffective but also directly counter-productive:
It was just like how can you, you know, try to help me out but put me around people that are even in the same boat or doing worse? Like how is that benefiting –how is that motivating me?... It was just I can't be around these people and I can't be talking about that 24/7. Like how can you try to better yourself and talk about drugs and this and that the whole time?
Jackson’s perception that his treatment was not well-suited to his needs and his ensuing frustration reflect how carceral control over mental healthcare results in the loss of individual autonomy.
Similarly, Leah and Ryan both expressed ambivalence about their mandated talk therapy. After hearing from a clinician that she would like to treat him for “trauma,” Ryan, a 36-year-old male, strongly rejected the idea:
No, I don’t need that. I mean, if I need it I would do it. But I don’t need talking about my – that’s in the past. I already closed that chapter right?... I don’t pay attention to that. I focus on what happens now and what I’m gonna do next and what I’m gonna do to prevent that to happen again.
Likewise, Leah discussed the reasons for her aversion to talk therapy:
I don't like talking to people… It's hard. Like, I really like acting like it did not happen. [Laughs] I really do. Like when I lived in –I swear to goodness I was happy in California, I was happy in Florida, and I was happy in New Mexico. Why? Because I could be a completely different person.
While exploring trauma with a trusted provider can be a powerful source of healing, a patient must engage this process willingly when they are emotionally ready and equipped to do so and when they have access to a provider they trust. In both cases, these participants expressed that being made to relive past events with a mandated provider was not what they needed at the time and in fact disrupted their ability to cope or function in their current situation.
Furthermore, Cora, who also received mandated treatment while on probation, described a feeling of being “in the hands” of her providers and a pattern of going through the motions of mandated care without deriving any benefit.
I would say the providers that are mandated provided to me, like if I go to probation and they're like show up to this, please, do this, do that, the court says and they stipulate mental follow-ups, which are mental evaluations, and whoever they send me to and whatever – the people that I just end up in their hands and I just deal with them and, you know, comply and show up and whatever. You know, they ask me a question I'll say yea, nay, whatever, but it's not like I feel like it's doing nothing for me or I want to see them, you know, so…
She also expressed frustration with the mismatch between her mandated care and her actual needs:
I know that, you know, years from now a lot of the things legally were put in place by faults of my own, but at this point how do I get past that? Like okay, on paper I'm this person but I'm more than capable of handing you a sticker or greeting you at Walmart or-or passing you a plastic bag ‘cause you have returns today. I can have a normal conversation, I can count to 10, like there's things I can do. I see people—secretary or greeters and things and I can do above and beyond, but because of my record I get hindered and then, you know, it falls into part and everything… probation's answer is to send me to this place to do outpatient. Like how much outpatient can I do?
In Cora’s case, she felt that being mandated to treatment at all was ill-suited to her needs. While she may have derived benefit from it at one point, it has become repetitive and ineffective and may even have begun to obstruct her goal of finding work. She clearly expressed frustrations with the barriers created by her criminal record and lack of opportunities. However, the carceral system continued to direct her to redundant treatment programs she did not need rather than addressing her stated needs. In all of these cases, the carceral healthcare system denied participants the opportunity to make their own choices and to freely participate in their own care, an important component of effective treatment, and instead offered mental healthcare that functioned primarily to benefit the carceral state at the expense of the individual.
The prison experience as trauma
The testimonies of our participants illuminate the obstructive nature of the carceral system for effective mental health service delivery. However, the harmful influence of the carceral state does not end with ineffective treatment for preexisting conditions. The trauma engendered by the carceral system can create de novo mental health problems for individuals. Thus, interactions with the prison system can constitute a setback to mental health not only through the subversion of therapeutic goals, but also by creating trauma in and of itself.
Cora’s story provides a compelling example. She shared with her interviewer a traumatic encounter with a police officer prior to her incarceration. She and her friend were stopped by an officer without reason, assaulted with Mace, and sprayed with a fire hose:
I've been beaten by the [City] police very, very severely. I had a black eye, I had taser marks, I had a pin needle mark. He stuck me with the pin on his badge and I also have pictures of that, that the [Regional] Correctional Facility took as a precaution to them so I won't sue them saying that their officers did it, ‘cause I was horrified. I had to take pictures kind of – you know, I had my top off because a lot of bruises were on my upper part body and the CO – she was crying with me. She said, "You know, I'm sorry that that happened to you but we have to so you won't, you know, take any action against us ‘cause it didn't – you came in like this, it didn't happen here.
Cora’s account of being beaten so badly that the institution incarcerating her was compelled to document proof that they were not responsible illustrates the reality and severity of the trauma that can be produced by the carceral system.
Similarly, Carter stated that prison “messed me up.” Throughout his interviews he recounted various traumatic experiences, including overhearing sexual assaults, losing his mother to cancer while incarcerated, spending 30 days in solitary confinement, and being beaten by his CO while the supervising nurse looked the other way. These experiences have had lasting repercussions; he stated, “I always have nightmares about getting killed.” In this way, the lingering trauma of the prison experience has stayed with Carter and constitutes a psychological hurdle he did not face before.
Leah similarly expressed that the prison experience can be traumatizing. She described being physically forced into a dirty shower by a corrections officer, as well as another traumatic incident that remained off-record due to its sensitivity. In reflecting on these experiences, she stated, “Being in jail can be traumatic though for people. It can be – it’s like a shell shock, it’s like, boom. And if you don’t adapt well, it’s like, oh no. No, no, no, no.”
Finally, Lee’s account of being forced by the CERT team to see the prison psychiatrist speaks to a traumatic experience of physical abuse and helplessness. As previously described, he was tackled, beaten, handcuffed, stripped naked, and choked, all in the course of this incident.
So, I hear them out there, there they go one, there was two, three, and then snatched open the door and ran in there and jumped on my back and started hitting me in my face, put handcuffs on me, punching me all on my side, put my knee in my back, punching me…my face was swollen – IPM – that’s what they call it. Something like that… I already had a jumper on, they drag me all the way backwards all the way to there and they put me in the four-point restraints. I didn’t even have no hands. They had me on my back and they put me in the four-point restraint. I ain’t even have no circulation in my hand. … I didn’t have no feeling in my hand for a good while. So, I’m laying there. So, the other one had his elbow on my throat. You know, trying to cut my air circulation off while they was cutting the jumper off. They was cutting it off, ripping it off…
Much like Cora, Leah, and Carter, Lee recounts an experience of trauma as a result of interaction with the prison system. However, Lee’s experience goes even further, to demonstrate that the trauma enacted by the prison system not only offsets the benefit of mental health services in prison, but that this trauma can even be produced by these mental health services. The psychiatric treatment supposedly offered for Lee’s benefit was the very encounter that created trauma. These testimonies thus illustrate how the prison system undermines mental health not only by transforming healing modalities, but also by creating new trauma that poses an injury to individuals’ mental health.
Race and carceral mental healthcare
As noted earlier, people of color – particularly Black Americans – are disproportionately targeted and confined by the criminal legal system. Thus, in addition to the many other burdens of disproportionate incarceration, the Black population also bears the brunt of the myriad problems that arise from carceral mental healthcare. The experiences of Isaiah and Sammy regarding their interactions with police around mental health speak to how the intersection of mental healthcare and the carceral state can disadvantage people of color.
In his interview, Isaiah, a 46-year-old Black man, described experiencing symptoms of mania in the context of a known bipolar disorder diagnosis. Isaiah recognized what was happening and went to the emergency room several times to seek psychiatric care. Rather than admit him and treat his condition, however, the hospital security attempted to force him to leave, ultimately resulting in an altercation and Isaiah’s arrest. In discussing the incident, he says,
I don't believe that everybody's racist but I think certain people in certain positions... can be, you understand, and it's disheartening. And they use their position to do whatever that they feel... Because if I was going to the hospital three or four times there was no reason why they shouldn't have admitted me, you understand? I was reaching out for help and they did not help me.
Despite persistently seeking necessary healthcare as would seem appropriate, Isaiah’s symptoms and persistence were perceived as criminal, and he was instead diverted to the criminal legal system. He attributes this response to the racism of the hospital staff and further acknowledges how they use their power in the health care system to exercise their racism – to “do whatever they feel.” This reflection underscores the fact that Isaiah did not merely experience anti-Black discrimination on its own; rather, it occurred in the context of a separate power imbalance: the hierarchy between a patient and medical provider. The medical power imbalance, together with the involvement of the criminal legal system, served to magnify the harm caused to Isaiah by the racial bias of individual providers.
Sammy, a 60-year-old White man, had very different experiences with the carceral system. Despite having recurrent struggles with substance use, including a few police encounters, he was never incarcerated. Reflecting on this, he stated,
Well, I mean just in my own case I know, like, being caught maybe once or twice buying drugs on the street, I mean I think because I was White it was different. It's just like, you know, get some help, go to a meeting or something like that. That's the way they treated with me.
In this way, Sammy perceived the police and the carceral system at large as having reacted to his substance use with a race-based script. His story is almost an inverse of Isaiah’s. Isaiah presented to a healthcare setting to seek help for a mental illness but was instead diverted to the prison system. By contrast, Sammy’s encounters with the criminal legal system took place in a non-healthcare setting and could easily have resulted in his incarceration. However, because he was White, he was diverted from criminal legal involvement, and his substance use was treated as a health issue, rather than a crime. In other words, as a White man, he was able to access mental healthcare outside of the carceral space. Furthermore, he continued to benefit from extensive life-saving treatment and services related to his diagnoses throughout his life without ever being subjected to the same criminalization that Isaiah experienced.
The contrast between their stories illustrates how the criminalization of mental illness does not apply to all people in the same way; rather, its application reflects both individual and systemic racism. As Fisher et al. (2006) note, “how the ‘problem’ of offenders with mental illness is framed plays a major role in the interventions proposed to address it.” In this way, a race-based script for the framing of atypical behavior can result in life-changing differences in criminal legal involvement for individuals of different races, such as Isaiah and Sammy.
Outcomes / strengths-based analysis: adapting and using Carceral mental healthcare to individual advantage
Despite the myriad ways in which carceral mental healthcare serves to disempower and control individuals, participants found just as many ways to exercise agency and resistance in these situations. Whether by taking ownership of their own care as possible, engaging mandated care on their own terms, or using mandated mental health treatment to access linked social services, participants found ways to identify and fulfill their own needs, rather than rejecting mental healthcare as a whole. The following sections expand upon each of these examples in greater detail.
Taking ownership of one’s own mental healthcare after criminal legal involvement
Many participants described adapting their formerly problematic, prison-oriented care to serve their own needs, goals, and wellbeing. For example, Isaiah, who was arrested while seeking mental healthcare at a hospital, was able to get established on a medication regimen that effectively controlled his symptoms while in prison, after a long process of advocating for himself. Furthermore, he has continued investing in and personalizing his mental healthcare after gaining freedom from the criminal legal system. He stated of his current clinician, “I love it. I enjoy going to see her.” Regarding his medication, he shared, “I take it on my own behalf. I feel like that’s part of my freedom…” While his mental healthcare was once incorporated within his prison experience, Isaiah now freely engages with his care outside the criminal legal system and of his own volition and thus associates it with freedom.
Similarly, Carter described a process of making his mental healthcare his own once he was no longer under the restrictions of parole. Despite his frustrations with mandated treatment and his multiple parole violations for refusing medications that made him feel like a “zombie,” Carter did not reject mental healthcare when his parole ended. Rather, he engaged his clinicians in a discussion about a more appropriate medication and continued his involvement in therapy. He describes therapy’s main benefit as having “just somebody to talk to. Sometimes you need people to run stuff by before you do something crazy. You need somebody to talk to.”
For both Isaiah and Carter, the criminal legal system provided a doorway to mental healthcare, however imperfect or imperfectly motivated, which they were then able to continue on their own terms and to their own benefit.
Ambivalent or piecemeal engagement in mandated services
Unlike Carter and Isaiah, individuals who remain under parole or probation may not have as much flexibility to take control of their mental healthcare. Still, while mandated treatment was often ill-suited to participants’ needs, many endorsed a degree of willingness to derive some benefit from it, even while recognizing that the treatment and the system administering it were flawed.
For instance, despite his deep distrust of his caseworkers and their motives, Logan affirmed that his participation in his mental healthcare was at least partially voluntary. He stated, “if I felt it didn’t help me … it wouldn’t matter to me, like, going to jail for a year or two,” and, “I just take from it what I can.” Logan judged that being reincarcerated for noncompliance would be favorable to participating in aimless treatment, so his continued participation in care indicates that he derives some degree of benefit from the care, even if it is complicated by the problems he discussed.
Ryan described a similar sentiment toward his mandated therapy: “I mean, I can learn from them or I just grab what I need and the rest, I throw it out.” Despite an incomplete acceptance of the principles and premise of his therapy, he acknowledged there may still be something to learn. While distrusting of carceral agents and resistant to mandated care, both Logan and Ryan chose to selectively engage their care, determining for themselves what was most valuable for their needs.
Acquiring social services distinct from mental healthcare via mandated treatment
Finally, a number of participants described using their mandated mental healthcare to gain access to other services or to achieve goals distinct from mental health. One prominent example was access to social services. For example, despite Leah’s reluctance to participate in therapy, her therapist did help her apply for State Administered General Assistance (SAGA) for her family. Similarly, Carter used his contact with his case manager as a means of maintaining housing security, stating that this allowed him to be diverted to Crisis and Respite in the event of a schizophrenic episode, rather than going to jail and potentially losing his home.
I'm gonna keep my case manager longer when I move out and see how things go, ‘cause last time when I had my own apartment before I went back to jail if I get too worked up from being a paranoid schizophrenic, too nervous, anything, they let me go to Crisis & Respite and stay for two weeks…And then they let me come back, but you gotta keep your case manager. They give you the choice if you want to keep the case manager or not. I keep it ‘cause if something goes wrong at least you've got something to fall back on.
Cora described using her mandated inpatient treatment program to connect with a case worker, who supported her in various ways, providing financial advice and rides and helping her to find housing and employment.
Really she helps me with anything that I want, like if I want to get back into school. We did a list of short-term goals and long-term goals. She's trying to help me get my license. They don't do it personally, they don't fund it personally, but we're gonna find the avenue that we have to go to and get it done. And she brings me for rides like to appointments really. It's really…Yeah. And she doesn't leave my side until I find either work or housing. That's what she told me.
Interviewer: And has this – have you ever been assigned someone like that before?
Cora: Never. I feel like if this would've happened years ago, it would’ve helped me, you know, have another advocate.
In these ways, individuals exercised some control of mental health treatment avenues to access much-needed social and personal resources, even outside the realm of mental health.
Overall, participants exhibited a wide variety of responses and adaptations to their mental healthcare, reflecting the diversity of the needs and experiences of formerly incarcerated individuals. While each participant’s story is different, these responses often represented the result of years of repeatedly encountering and iteratively adapting to carceral mental healthcare.