Doctoral Dissertation Research: Mental Health and Recidivism Rates in American Jails

美国最大的监狱也是美国最大的精神卫生保健机构。监狱中精神疾病的比例过高一直是公职人员面临的一个长期挑战，尽管各大城市都在进行改革，使监狱变得更具治疗性，并缩小监狱规模。监狱和监狱一样，既有惩罚功能，也有监禁功能；事实上，监狱和监狱囚犯是美国唯一拥有宪法权利的医疗保健群体。由于监狱主要限制那些在法庭上受审的人，监狱影响着大量人口，并与更广泛的犯罪、警察和法律过程动态相关。然而，在人口迅速变化的情况下，被诊断患有严重精神疾病的人被监禁的时间更长，而且更有可能在获释后被重新监禁。此外，尽管一些县努力缩小监狱规模，但其中许多县的监狱精神疾病发生率有所上升。了解导致这一趋势的因素对于指导刑事司法和心理健康实践至关重要。除了资助一名人类学研究生在实证、科学数据收集和分析方法方面的培训外，该项目还将通过向官员和利益攸关方广泛传播其研究结果来增进科学理解。研究将在纽约市和洛杉矶的监狱系统进行。这不仅是该县最大的两个系统，也是近年来进行了重大改革的两个系统。这两个地点的法律和政治压力引发了公众的辩论，即监狱是否足以满足被监禁者的需求，以及监狱的整体规模。然而，虽然纽约的监狱人数大幅下降，但洛杉矶的监狱人数仅略有下降。研究人员在这两个地点都进行了人种学研究，并参加了临床和社会科学培训项目，特别适合研究这一同时存在于临床、法律、政治和文化现象的现象。在考察这些机构中精神卫生保健的意义时，调查人员将把他们的民族志注意力集中在监狱临床团队上。作为对法院如何仲裁宪法规定的监狱护理权利的分析的补充，调查人员将观察临床医生在实践中如何解释和实施这一授权。这项研究将涉及机构人种学，包括参与者观察、半结构化访谈和绘图，以及对公共监督听证会的法律分析。他们还将探讨在这些环境下，哪些因素会影响诊断和治疗，以及在囚犯获释后，社会工作者如何为他们寻找资源。这些人种学发现将为精神健康倡导者和临床医生、监狱管理人员和政策制定者提供关于影响机构护理提供和县应对严重精神疾病能力的上下文相关变量的指导。这一奖项反映了NSF的法定使命，并通过使用基金会的智力价值和更广泛的影响审查标准进行评估，被认为值得支持。

America's largest jails are also the country's largest providers of institutional mental health care. The overrepresentation of mental illness in jails has been a persistent challenge for public officials, even as major cities have pursued reforms to make jails more therapeutic and reduce their size. Jails, like prisons, have both punitive and custodial functions; in fact, jail and prison inmates are the only group in the United States who have a constitutional right to health care. Since they primarily confine those who are being tried in court, jails affect a large population and are dynamically related to wider processes of crime, police, and the law. Amidst that rapidly changing population, however, people diagnosed with serious mental illness are incarcerated longer and are more likely to be reincarcerated upon their release. Moreover, despite efforts by some counties to reduce the size of their jails, many of these counties have witnessed an increase in the rates of mental illness in their jails. Understanding the factors causing this trend is critical to guide criminal justice and mental health practice. In addition to providing funding for the training of a graduate student in anthropology in the methods of empirical, scientific data collection and analysis, the project would enhance scientific understanding by broadly disseminating its findings to officials and stakeholder groups.The research will be conducted in the New York City and Los Angeles jail systems. These are not only two of the largest systems in the county, but also two that have undergone major reforms in recent years. Legal and political pressure at both sites has sparked public debate about the adequacy of the jails to meet the needs of those incarcerated as well as overall jail size. However, while New York has witnessed a significant decline in its jail population, Los Angeles has achieved only modest declines. The investigators, who have done ethnographic research at both sites and are situated in clinical and social scientific training programs, are particularly well suited to study this simultaneously clinical, legal, political and cultural phenomenon. In examining the meaning of mental health care in these institutions, the investigators will focus their ethnographic attention on jail clinical teams. Complementing an analysis of how courts have arbitrated the constitutional right to jail care, the investigators will observe how clinicians interpret and enact that mandate in practice. The study will involve institutional ethnography, including participant observation, semi-structured interviews, and mapping, and legal analysis of public oversight hearings. They will also explore what factors influence diagnosis and treatment in these settings, as well as how social workers identify resources for inmates upon their release. These ethnographic findings will offer guidance to mental health advocates and clinicians, jail administrators and policy makers regarding the context-dependent variables that shape institutional care delivery and the capacity of counties to respond to serious mental illness.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.