Can Effective Mental Health Treatment Exist In A Criminal Justice System Driven By Profit?

Josh Gravens, now 27, was sentenced to the Bill Clayton Detention Center in Littlefield, Texas when he was 13. He was told to expect a jail stay of nine months, but he spent 42 months under the supervision of the Texas Juvenile Justice Department. He was not fully released until he was 21, having been detained for years without cause, he says. “I never even had a write-up,” he says. “Behavior was never the issue. Grades were never an issue. We engaged willingly and aggressively.”

In Texas, the state contracts corporate prisons to jail juvenile offenders. Compensation per prisoner escalates by level of care. However, these facilities aren’t guaranteed children at specific compensation levels, so it’s often in a corporation’s best interest to keep profitable offenders for as long as possible. This isn’t what correctional supervision is supposed to accomplish, and it seems to be enabled by psychologists who falsify treatment records to extend incarceration times. Texas’s juvenile sentencing system works by assigning indeterminate terms to offenders, with release possible only after a vague set of treatment programs have been fulfilled.

Melvin Tomison, a case manager at Clayton during the time of Gravens’s sentence, spent two hours a day discussing personal problems with the children while providing life-skills instruction. He says 10 case managers had come and gone in the 11 months prior to his arrival. “There were no problems with my reports on these kids for the first five or six months,” he says. “But when a new supervisor came along, every report I filed was wrong. He would edit them to change the meaning of my observations.” In one instance, a 10-year-old’s report of abuse at the hands of his stepbrother was deleted from his file. “That was something that would have made a profound difference in how anyone would view his behavior and psychological state,” Tomison says. “My supervisor wanted to get rid of me,” he concludes, “because I was the only one getting kids out.”

The legal precedent that allows psychologists to testify about the presence of mental disorders is found in the 1962 U.S. Court of Appeals decision Jenkins v. U.S. Use of psychologists as expert witnesses has increased since, but recent investigations have revealed that their testimony is often little more than propaganda. A 2011 study in Virginia found that the state attorney general’s office relies on a small stable of experts in court arguments. These experts side in favor of prosecutors 80 percent of the time. Similar practices are used in 20 states and federal trials.

When a group of unscrupulous psychologists lobbied to add a slew of sexual disorders to last year’s DSM-5–the definitive mental health manual–they revealed the toxic relationship between psychology and prosecution. If paraphiliac coercive disorder, hyper sexuality and other suspect mental illnesses had been allowed to be listed, they would have become available for use in trial. “The civil commitment industry and the psychologists it employs lobbied for these disorders so they could use them in testimony instead of shady ‘unspecified’ diagnoses,” says Karen Franklin, a forensic psychologist in California. Assigning a dependance an “unspecified” diagnosis is a practice employed by co-opted psychologists to justify detention of offenders without legitimate mental illnesses. Having the disorders they proposed officially recognized in the DSM would provide even firmer ground for such convictions, but the disorders are not recognized by he broader medical community and “didn’t even end up becoming ‘conditions for further study,‘” Franklin says, evidence of their tenuous scientific standing. When psychologists lobby for diagnoses as shady as these to be listed in the definitive mental health manual of our age, one can be sure their intentions are far from honest.

Twenty thousand sex offenders are released from our prisons every year. Nowhere has psychology become more removed from its fundamental principles than in the post-incarceration treatment of these offenders. The vast majority are required to undergo mental health treatment, and while community safety can and should be held as these programs’ utmost goal, psychology is corrupted by law-enforcement aims. This means little is done to address the roots of criminal behavior or to protect communities. “Judges and citizens make these treatments for psychotherapy,” says Phil Taylor, who spent 20 years as a licensed treatment provider. “It is not treatment. It is police work.”

Post-release law-enforcement supervision masquerades as therapy in the “containment model,” whereby therapists and polygraphers share information about patients with officers. It is often provided by companies that exist solely to fulfill treatment contracts, which is obviously a perverse financial incentive. Confidentiality is signed away, refusal to cooperate is a mailable offense, and patients are subjected to treatment that would never be tolerated in private practice.

“When states certify practitioners, and definitions and prescriptions come under the control of politically beholden agencies,” says Taylor, “there is an inexorable drift toward treatment as punishment and treatment as post-adjudication inquisition.”

It is akin to assuming anyone convicted of theft is a recidivist and worthy of the same mode of rehabilitation. The containment model lumps together a diverse population of convicts and fails to rehabilitate them. Longstanding evidence-based treatment models could bring real help to these patients, but they are failed by an overzealous state.

With 7 million Americans under law enforcement supervision, the demand for mental health services has never been greater. But professional objectivity and the goals os psychology have been abandoned in pursuit of lucrative contracts.

These compromises set dangerous precedents for the future of mental health policy. They fail to reduce recidivism, fail to promote public safety and fail to alleviate incarceration rates. To promote true public safety, they must be addressed across disciplines and through broader cultural conversations. Until then, the lowest bidder wins.

~~  Galen Baughman and Andrew Extein ~~


Originally appeared in the print edition of Playboy magazine (April 2014)

Leave a Reply

Your email address will not be published. Required fields are marked *