Mental Health and In-Prison Experiences: Examining Socioeconomic and Sex Differences in the Effect of Mental Illness on Institutional Misconduct and Disciplinary Segregation

Mental health problems have become a common occurrence in American correctional settings. This occurrence is not equally distributed in terms of gender; incarcerated women have higher rates of mental illness incarcerated men (Bronson & Berzofsky, 2017; James & Glaze, 2006). This phenomenon is problematic as research suggests that American correctional institutions are ill equipped to treat and manage inmates with mental health problems (Arrigo & Bullock, 2008; Bennion, 2015; Clark, 2018). This is also true in women’s prisons as they are often tasked to deal with strict budgetary restrictions and have fewer resources compared to men’s prisons (Holsinger, 2014; Stephan, 2008; Toman, 2017). Untreated mental illness in prison may impact prison order and safety for inmates and staff. Signs and symptoms of mental illness and mental health diagnoses are associated with inmate misconduct (Adams, 1986; James & Glaze, 2006; Reidy, Cihan, & Sorensen, 2017; Steiner et al., 2014; Stewart & Wilton, 2014) and may exacerbate the severity of disciplinary sanctions imposed in response to misconduct (Houser & Belenko, 2015). Untreated symptoms of mental illness (i.e. hallucinations, paranoid ideation) can lead to disruptive behaviors, which may distract correctional officers, increasing risk for further disorder (Galanek, 2015). To date, research on the impact of mental illness on in-prison experiences largely ignores the role of gender, socioeconomic status, and mental health treatment. This study seeks to address this gap in research by examining the following issues: 1) the extent and nature of the relationship between mental illness, socioeconomic status, and the in-prison experiences of inmate misconduct and disciplinary segregation, 2) the role of mental health treatment in mediating these relationships, and 3) the role of gender in contextualizing these relationships. Using the Survey of Inmates in State and Federal Correctional Facilities, 2004 (SISFC; US DOJ, 2004), this dissertation examines the general and gendered effect of mental illness, socioeconomic status, and treatment on misconduct and disciplinary segregation. Analyses are conducted first with misconduct as the dependent variable of interest and then with disciplinary segregation as the outcome of interest. Three stages of analyses are conducted for each dependent variable. First, logistic regression is used to determine the main effects of mental illness and socioeconomic status on each outcome. Second, predicted probabilities and tests of group differences are estimated to determine if an interaction exists between mental illness and socioeconomic status. Third, logistic regression using the KHB method is estimated to determine if mental health treatment mediates the effect of mental illness on the dependent variables. Finally, these steps are repeating using gender-disaggregated models in order to examine if differences in these relationships exist for men and women. Findings from this dissertation advance research, theory, and policy in correctional settings. First, results suggest that a diagnosis of mental illness is associated with violent misconduct and placement in disciplinary segregation. This may suggest that inmates with mental illness act out more frequently than those without mental illness, or perhaps correctional officers perceive these individuals as more dangerous than those without mental illness. Second, no interaction effect exists between mental illness and socioeconomic status. Several explanations for this finding are possible. It is possible that the effect of mental illness does not vary by socioeconomic status; perhaps the stigma of mental illness and seeking treatment is so pervasive in society that socioeconomic differences do not matter. However, it may also be true that measures of socioeconomic status used in this dissertation are inadequate; additional measures should be explored in future research. Third, using mental health services consistently mediates the effect of mental illness on misconduct and disciplinary segregation. Here, it may be that providing services is an alternative pathway institutions can use to assist individuals in adjusting to prison life. Finally, gender differences exist in the effect of mental illness on misconduct and disciplinary segregation. Taken together, these findings underscore the importance of examining the influence mental illness and treatment has on inmate behavior and in-prison punishment as well as the need for continued research on the incarcerative experience among women. To conclude the dissertation, a discussion of the findings and implications for theory, research, and policy are provided