Rapid review report for the Australian National Mental Health Commission STIGMA AND DISCRIMINATION EXPERIENCES AMONGST THOSE WITH MENTAL ILLNESS IN CONTACT WITH THE CRIMINAL JUSTICE SYSTEM
"STIGMA AND DISCRIMINATION EXPERIENCES AMONGST THOSE WITH MENTAL ILLNESS IN CONTACT WITH THE CRIMINAL JUSTICE SYSTEM":
The report is a rapid review commissioned by the Australian National Mental Health Commission.
The authors are Kimberlie Dean, Christie Browne, and Nicholas Dean from the UNSW Psychiatry review team.
The report underscores the profound challenges faced by individuals with mental health issues in the CJS and emphasizes the need for a paradigm shift in addressing these challenges. The findings highlight the urgent need for better understanding, policy changes, and interventions to support this vulnerable population.
Summary
Individuals with mental illness experience stigma and discrimination, and this is compounded when they come into contact with the Criminal Justice System (CJS).
The review explores the literature on this topic, focusing on social/self-stigma and structural stigma/discrimination.
It also considers the experiences of especially vulnerable subgroups with mental illness and CJS contact.
The review emphasizes the need for further investigation and action to understand and reduce stigma and discrimination in this context.
Mental Illness and the CJS:
Individuals in the CJS have a higher prevalence of mental ill-health compared to the general population.
40% of prison entrants reported having a mental health condition, which is nearly double the rate in the general population.
Those with a diagnosed mental illness have higher rates of conviction, incarceration, and recidivism.
The reasons for the higher contact of individuals with mental illness with the CJS are complex and multifaceted.
Stigma and Discrimination:
Those with mental illness experience common stigma, with 37.9% reporting experiencing stigma or discrimination in the past year due to their mental illness.
Stigma affects health outcomes, delays help-seeking, and impacts treatment adherence.
Those involved in the CJS also experience stigma, often having multiple stigmatized identities.
Stereotypes about those in the CJS and those with mental illness overlap, leading to a "double stigma" of being both "mad" and "bad".
Social and Self-Stigma
People with a criminal justice history and mental health problems experience high levels of social stigma.
The media and popular culture play a significant role in shaping public perceptions, often portraying people with mental illness as dangerous or aggressive.
Self-stigma occurs when individuals internalize negative stereotypes about themselves, leading to self-prejudice and self-discrimination.
Structural Stigma and Discrimination:
Structural stigma is defined as the "societal-level conditions, cultural norms, and institutional practices that constrain the opportunities and well-being for stigmatized populations" (Hatzenbuehler & Link, 2014, p.2).
This form of stigma is so ingrained within society that it no longer relies on individual actions. Instead, it's perpetuated by institutional systems, leading to widespread disadvantage and exclusion.
For individuals with mental illness involved in the CJS, structural stigma exists at various levels:
Policing: How people with mental illness are approached and treated by law enforcement can be influenced by pre-existing biases and misconceptions.
Legal Processes: The court system may not be adequately equipped to address the unique needs of those with mental health issues, leading to potential misjudgments or lack of appropriate legal support.
Correctional Systems: Prisons and detention centers often lack the necessary resources and trained professionals to provide proper mental health care. This can lead to neglect and worsening of mental health conditions.
Forensic Mental Health Systems: While designed to address the needs of those with mental health issues within the CJS, these systems can still be influenced by societal biases and lack of understanding.
Health Services in the Community: After release, individuals may face barriers in accessing quality mental health care due to their criminal record or the stigma associated with it.
Housing: Finding stable housing can be a challenge due to discrimination based on both mental health and criminal history.
Vulnerable Subgroups:
Certain subgroups within the population of those with mental illness and CJS contact face even greater challenges:
Women: Female individuals with mental health issues in the CJS may face additional discrimination and challenges related to gender biases.
Aboriginal and/or Torres Strait Islander People: Indigenous populations already face systemic discrimination, and this is compounded when mental health and CJS involvement are added to the equation.
Victims of Crimes: Those with mental illness are at a heightened risk of victimization. Their experiences as victims often get overshadowed by their mental health condition or criminal record, leading to further marginalization.
The structural stigma within the CJS and its various components poses significant challenges for individuals with mental health issues. Addressing these challenges requires a multi-faceted approach that considers the unique needs and experiences of this population, especially the most vulnerable subgroups. The report underscores the need for policy changes, better training, and increased awareness to ensure that individuals with mental health challenges are treated with the dignity, respect, and care they deserve.