Research Roundup: Incarceration can cause lasting damage to mental health

Incarceration can trigger and worsen symptoms of mental illness — and those effects can last long after someone leaves the prison gates.

by Katie Rose Quandt and Alexi Jones, May 13, 2021

We often talk about the disturbingly high numbers of people with mental health disorders locked up in prisons and jails. But less attention is paid to the ways in which incarceration itself perpetuates this problem by creating and worsening symptoms of mental illness. Research shows that, while it varies from person to person, incarceration is linked to mood disorders including major depressive disorder and bipolar disorder.

The carceral environment can be inherently damaging to mental health by removing people from society and eliminating meaning and purpose from their lives. On top of that, the appalling conditions common in prisons and jails — such as overcrowding, solitary confinement, and routine exposure to violence — can have further negative effects. Researchers have even theorized that incarceration can lead to “Post-Incarceration Syndrome,” a syndrome similar to PTSD, meaning that even after serving their official sentences, many people continue to suffer the mental effects.

Incarceration itself is inherently harmful to people’s health

Many of the defining features of incarceration are linked to negative mental health outcomes, including disconnection from family, loss of autonomy, boredom and lack of purpose, and unpredictability of surroundings. Prof. Craig Haney, an expert on the psychological effects of imprisonment and prison isolation, explains, “At the very least, prison is painful, and incarcerated persons often suffer long-term consequences from having been subjected to pain, deprivation, and extremely atypical patterns and norms of living and interacting with others.” And as Dr. Seymour L. Halleck has observed, “The prison environment is almost diabolically conceived to force the offender to experience the pangs of what many psychiatrists would describe as mental illness.”

Family disconnection

By its very nature, incarceration separates people from their social networks and loved ones. In 2018, when researchers at the University of Georgia analyzed the relationship between prison conditions and mental health in 214 state prisons, they found that people incarcerated more than 50 miles from home were more likely to experience depression. This isn’t surprising: Psychologists have long known that people with social support and positive family relationships tend to have better psychological wellbeing.

Similarly, in a 2015 review of the research on the impact of prisons on mental health, separation from family and friends emerged as a major stressor for incarcerated people; it was also associated with psychological distress. In fact, many people described this separation as the most challenging aspect of their incarceration. Goomany and Dickinson, who authored the review, found that even when incarcerated people receive visits from family members, the prison environment makes it harder for them to connect. Correctional facilities are built and operate around the goal of security, and these “regulations and security measures inevitably impact on the relationships between prisoners, their families, and children.”

Separation from children can be especially distressing for incarcerated women. As one 1998 article in Behavioral Sciences & the Law noted, “Separation from children is one of the most stressful conditions of incarceration for women and is associated with feelings of guilt, anxiety, and fear of losing mother-child attachment.” A 2005 study found that “most mothers described an intense focus on feelings of distress, depression, or guilt.” One mother in that study explained her feelings: “All I’d do was cry. It is horrible being away from your kids, especially when they the only people who care for you.” Another said, “I was very hurt, depressed, crying constantly, and worried.” The study noted that 6 percent of the mothers interviewed described themselves as suicidal early in their incarceration; as their separation from their children continued, 22% “continued to focus intensely on their distress.”

Loss of autonomy & lack of purpose

Incarcerated people have virtually no control over their day-to-day lives, including when they wake up, what they eat, what their jobs are, and when they have access to recreation. This can lead to feelings of dependence and helplessness. The three main studies included in Goomany and Dickinson’s review all concluded that this loss of autonomy harms mental health. Once again, this makes sense; we know people feel better and have better mental health outcomes when they have control over their surroundings.

Similarly, incarceration is often characterized by boredom, monotony, and lack of stimulation. Many incarcerated people have limited access to education, job training, and other programming that can fill their time and become a meaningful part of their lives. In a 2003 study of incarcerated people in England, participants reported that lack of activity and mental stimulation leads to extreme stress, anger, and frustration. Some reported using unhealthy coping mechanisms to manage boredom, including substance abuse. The 2018 University of Georgia study mentioned earlier also found that people in prisons with limited access to work assignments experienced higher levels of depression. Once again, this fits with psychological research that shows meaninglessness and a lack of purpose can lead to symptoms of anxiety, depression, and hopelessness.

Unpredictability

These feelings of anxiety and depression can be exacerbated by the unpredictable nature of the carceral environment. As the Behavioral Sciences & the Law article mentioned above explains, there are numerous rules in prisons and jails that do not exist in the free world — many of which are ambiguous and only enforced erratically. The authors note that “institutional rules are enforced selectively, depending on factors such as inmate-staff relationships, staff member’s mood, the severity of the rule violation, and the convenience of rule enforcement.” This lack of clarity and predictability can contribute to feelings of uncertainty and stress.

Cruel conditions make a negative environment worse

Even a relatively “humane” prison or jail can contribute to negative mental health outcomes for the reasons outlined above. But the reality is that poor conditions in prisons and jails cause significant additional suffering and trauma. As the World Health Organization explains, “There are factors in many prisons that have negative effects on mental health, including: overcrowding, various forms of violence, enforced solitude or conversely, lack of privacy, lack of meaningful activity, isolation from social networks, insecurity about future prospects (work, relationships, etc.), and inadequate health services, especially mental health services.” This list of mentally damaging conditions accurately describes most U.S. jails and prisons.

Overcrowding & punitiveness

Many jails and prisons throughout the country are overcrowded, which makes the inherently negative carceral environment even worse. Overcrowding often means more time in cell, less privacy, less access to mental and physical healthcare, and fewer opportunities to participate in programming and work assignments. Correctional administrators may respond to overcrowding by forgoing screening and monitoring of vulnerable people. A 2005 study found that overcrowding is highly correlated with prison suicide.

The 2018 study from the University of Georgia similarly found that overcrowding and punitiveness are correlated with depression and hostility. The researchers noted that punitive environments “likely set inmates on edge, making them overly hostile or even depressed.”

Solitary confinement

Being put in solitary confinement, which is a common practice in many prisons and jails, is especially harmful to mental health. As we discussed in a briefing last year, the stress caused by spending time in solitary confinement can lead to permanent changes to people’s brains and personalities. Depriving humans — who are naturally social beings — of the ability to interact with others can cause ‘social pain,’ which affects the brain in the same way as physical pain. A 2000 study found that people were significantly more likely to develop psychiatric disorders while in solitary confinement than while housed in non-solitary units.

Trauma from experiencing and witnessing violence

Prisons and jails are extremely violent places. People often experience traumatic verbal or physical assaults and dehumanization at the hands of correctional officers. And the various stressors in a carceral environment also increase the chances of violence between incarcerated people. Researchers in a 2009 study found that experiencing violence during incarceration was significantly related to “aggressive and antisocial behavioral tendencies as well as emotional distress.”

In fact, even witnessing violence behind bars can be traumatizing, as we have discussed previously. Exposure to violence in prisons and jails can exacerbate existing mental health disorders or even lead to the development of post-traumatic stress symptoms like anxiety, depression, avoidance, hypersensitivity, hypervigilance, suicidality, flashbacks, and difficulty with emotional regulation.

Lasting effects

Some researchers suggest that the trauma people experience behind bars can lead to Post-Incarceration Syndrome, a syndrome that shares characteristics with PTSD. A 2013 study of 25 released lifers found that participants experienced a specific cluster of mental health symptoms, including institutionalized personality traits (like distrusting others, difficulty maintaining relationships, and problems making decisions), social-sensory disorientation (issues with spatial reasoning and difficulty with social interactions), and social and temporal alienation (the feeling of not belonging in social settings).

Similarly, a 2019 literature review found that incarcerated people experience high rates of Potentially Traumatic Events, often shortened to PTEs. The review further revealed that experiencing PTEs behind bars was strongly correlated with rates of PTSD upon release.

We often think of incarceration as something people live through and from which they can ultimately be released. But the reality is that time spent in prisons and jails can create a host of collateral consequences that haunt individuals even after release. As the research shows, incarceration can trigger and worsen symptoms of mental illness — and those effects can last long after someone leaves the prison gates.