Many mentally ill people are incarcerated in the United States. Not only is treatment delayed or nonexistent in prison, but mentally ill inmates may be treated more harshly because of behavioral issues caused by their illness. So we ask: Are Texas prisons properly identifying inmates that suffer from a mental illness, or are they overlooked and put into the general prison population?
Our hypothesis is that many mentally ill inmates are not identified properly and are kept in the general prison population without treatment. So our null hypothesis would be that nearly all prisoners are treated the same regarding access to treatment, regardless of underlying mental illness.
To test this hypothesis, we would obtain permission from a warden of a typical state prison to review records, interview and assess the prison’s inmates. To motivate cooperation, we would ask the warden about popular items or privileges that would provide incentive for inmate cooperation without causing disruption, perhaps a small monetary incentive or phone calls. We do not want the process to be coercive, but we do want to have a high rate of participation for the results to be generalizable.
For each participating inmate, we would administer a test of mental health/mental illness, the Minnesota Multiphasic Personality Inventory (MMPI). We would use the MMPI-2-RF, the most recent and best studied version of the test. This would allow us to determine the presence of mental illness, as well as allowing quantitative analysis, i.e., severity of mental illness, on a variety of scales.
We would then interview inmates regarding any personal or family history of mental illness, and any previous or ongoing mental health treatment. Where possible, we would review records of such treatment. This would provide us with assurance that the MMPI is not rating people as healthy who are in fact mentally ill, as well as provide us the information we need to determine how the prison currently treats mentally ill inmates. We do this following the administration of the MMPI so that such a discussion regarding mental health does not bias the results nor the scoring of the test.
So prior to our study, the independent variable is the presence or absence of mental illness. Neither treatment nor tests cause mental illness. A dependent variable is treatment of mental illness. In an ideal world, with adequate financial resources and no attempts to game the system, everyone who is mentally ill would receive treatment and everyone who is not mentally ill would not receive treatment. Furthermore, if our study shows a prevalence of untreated mental illness among inmates, hopefully this will cause increased availability of treatment for the mentally ill within our prisons. Our dependent variables in this study are also the scores on the MMPI-2-RF. A variety of mental illnesses will cause higher scores on at least some scales of the MMPI. However, some scores may be amenable to treatment, such as anhedonia; thus the importance of also obtaining as much history as possible.
Our results will show the percentage of inmates receiving mental health treatment and the percentage potentially needing treatment. We will therefore be able to show the level of the gap between current and optimal levels of mental health treatment in prisons in Texas. We expect this gap to be quite large, given the general lack of adequate mental health facilities in the prison system and the lack of prior studies determining the extent of the need.
Our results will also show the scores on the MMPI. These consist of a variety of scales that can be analyzed individually. Do we have a large cohort with high antisocial personality scores, as might be expected from a prison population? Do those with scores indicative of mood disorders tend to receive better treatment than those with thought disorders? Does treatment improve scores?
Measurement issues would center around truthfulness. As noted, we will try to obtain written records rather than relying on verbal history. However, in any paper test given to inmates, there may be a desire to appear more sick than actuality in order to gain benefits, such as spending time away from the prison population while undergoing treatment. There also may be a desire to appear more “normal” than actuality in order to gain different benefits, such as reassuring the warden or guards that one is not a “troublemaker”. Fortunately, the MMPI includes scales designed to measure truthfulness. It has often been used for psychiatric evaluations for the courts, so there is already extensive research on its reliability and validity in criminal populations, and we will compare our results with those.