Feature

One in 100 U.S. adults is in prison or jail. In fact, the United States leads the world in incarcerating its people, locking them up at a rate five to eight times that of Canada and Europe. Prisons are overcrowded, violent and offer few evidence-based rehabilitation programs. Yet, 95 percent of inmates are eventually released, often bringing the trouble in prison back to society.

Psychologists need to take some of the blame for this problem, said speakers at an APA 2009 Annual Convention session on using psychological science to enhance crime prevention, prison treatment and post-release parole.

Despite all their expertise in behavior change, skill-building and treatment design, psychologists haven't done nearly enough research to determine the type of rehabilitative and substance abuse programs that work in prisons, nor have they translated existing research into prison policy, the speakers added.

"Psychology hasn't protested much as prisons have become very punitive," said Joel Dvoskin, PhD, of the University of Arizona College of Medicine. "You couldn't design a system that was more likely to create a dangerous high-crime country if you set about it. With all the knowledge of psychology ... our entire criminal justice system does almost everything wrong."

But there's hope, he and others pointed out. As crime continues to be a problem, it's becoming clear to policymakers that the tough-on-crime approach alone won't work, so there's growing interest among stakeholders in treatment programs. California, for example, recently announced that it's assembling a team responsible for making the state's prisons more rehabilitative, said Dvoskin.

"The time is right for a sea change in attitude, policy and practice," he said.

The power of praise

One critical change is to design better prison treatment programs and rehabilitative interventions, since many are one-size-fits-all, Dvoskin said. As psychological research shows, effective programs are tailored to inmates' criminality, race, religion, age and other factors, he added. But that's not how prisons typically operate.

"That's exactly contrary to the value of American prisons, where the watchword is firm, fair and consistent, where everybody gets treated the same," he noted.

Praise and reinforcement are also missing, Dvoskin said. Research shows that praise is a powerful behavioral change agent, yet few prisons use praise to encourage good behavior.

"A lot of the strategies focus on punishment and gaining immediate compliance, not necessarily thinking of the long-term implications for behavioral change," said Paula Smith, PhD, of the University of Cincinnati Corrections Institute.

To change that, psychologists can train correctional officers on how to prompt and reward positive behavior and reduce misconduct, allowing mental health professionals to have backup on the front lines, she said.

"The inmates really spend the majority of their time with the correctional officers," noted Smith. "The impact they would exert is an important piece of harnessing long-term behavioral change."

A few prisons also have creative approaches that researchers could build on, said Smith, who assesses prison treatment programs. One Ohio prison has trained its corrections officers to do structured, positive skill-building with inmates, she said. Each officer carries "skill cards" to use when they coach offenders who act out or initiate fights.

"They can capitalize on those teachable moments," she said.

Mentally ill offenders

Prisons are also failing mentally ill offenders, said Jeremy Mills, PhD, of Carleton University in Ottawa. An estimated 15 percent of U.S. inmates struggle with mental illness, and few get quality treatment, he said. Studies show mentally ill offenders are also more prone to physical and sexual abuse than other inmates.

"What have we done to address the needs of mentally ill offenders? Precious little," said Mills.

The co-occurring disorders literature recommends treating both problems simultaneously, since inmates are grappling with both mental illness and a propensity toward criminal behavior, said Mills. But that dual approach can be tricky to implement, he said. Research shows that most mentally ill offenders are in jail for a tendency toward criminal behavior that's unrelated to their mental illness, so there's often resistance among mental health professionals to treating both and risk "criminalizing" mental illness.

Further complicating integrated treatment of co-occuring disorders is the fact that prisons are often seen as places to punish people for their offenses, not to treat them for their mental illness, stress or suffering, he said. That needs to change for prisons to become more rehabilitative, he said. And psychologists should be front and center in the push for these changes, added Dvoskin.

"Probably the single most important area for behavior change in the U.S. is crime," said Dvoskin. "We are the experts in behavior change, so why aren't we taking a leadership role in changing these pernicious behaviors?"