Editorial: Mental Health in Prisons

In this issue of Psychodynamic Psychiatry, Mulay, Kelly, and Cain argue that psychodynamic psychotherapy is under-utilized in prisons.

They note that jails contain a disproportionally large number of mentally ill inmates (Torrey, Zdanowicz, Kennard, Lamb, Eslinger, Biasotti, & Fuller, 2014). Many of the incarcerated mentally ill suffer from psychoses, bipolar disorder, serious addictions, suicidal depressions, and multiple disorders simultaneously (Mumola & Karberg, 2006).

Although some prisoners have antisocial personality disorder, most do not (Black, Gunter, Loveless, Allen, & Sieleni, 2010). Some have committed serious crimes and may be career criminals. Others are simply people who for one reason or another have broken the law and in some cases become entangled in a web of legal and bureaucratic machinery.

It is important to be aware of gender differences when thinking about the institutional treatment of the mentally ill. Men with certain types of psychiatric disorders are likely to be imprisoned, whereas women are more like to be treated in hospitals and clinics. This is probably primarily because men are more violent than women but may also reflect gender differences in relational style as well. In any case, a psychotherapist who works in jails must be prepared to treat men with multiple psychiatric diagnoses and predilections toward violence. The vast majority of mentally ill inmates do not receive appropriate counseling services.

Mulay, Kelly, and Cain note that psychodynamic psychotherapy is effective across diverse diagnoses (Fonagy, 2015) and point out that lengthy sentences of many prisoners make them candidates for such treatment. They suggest ways in which psychodynamic psychotherapy could be studied should it be implemented. In order to fully understand their reasoning, however, social context must be taken into account. What are prisons actually like? In fact, standards of care are often low because of limited resources. Even a casual visit to Rikers I