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Inmate Perceptions of Mental Health Services
Robert D. Morgan and Alicia T. Rozycki
Texas Tech University Scott Wilson
Correction Care Solutions and
Kansas Department of Corrections
With the increasing rise in the U.S. prison population, meeting the mental health needs of inmates before,
during, and after incarceration remains an obstacle. What are the mental health experiences of inmates?
For what types of problems are inmates willing to seek help, and what are the barriers to their service
utilization? This study investigated inmates’ attitudes and perceptions toward mental health services and
examined whether these attitudes and perceptions vary with respect to ethnic group membership or
among inmates of differing security levels. Implications of these findings for psychologists, including
psychologists not employed in correctional settings, are highlighted.
Much has been written about the provision of mental health
services in correctional settings, including psychologists’ roles and
responsibilities in such settings (Boothby & Clements, 2000; Far-
rington, 1972; Morrissey, Swanson, Goldstrom, Rudolph, &
Manderscheid, 1993; Pallone & LaRosa, 1979); however, there is
a paucity of information about inmates who seek mental health
services. What type of mental health service providers do inmates
prefer to see? For what types of problems do inmates seek ser-
vices? What are the barriers inhibiting inmates’ willingness to seek
mental health services? These questions must be addressed to
ensure appropriate service delivery.
Of particular relevance for psychologists are the therapeutic
needs of these clients. Inmates are a culturally diverse population,
and with training focused on an awareness and appreciation of
multicultural issues, psychologists are already prepared for work-
ing with many of the issues presented by this population. However,
much more information about the needs and service utilization of
this special population is needed.
A variety of mental health services (e.g., individual psychother-
apy, group psychotherapy and psychoeducational groups, sub-
stance abuse programs) is available to incarcerated offenders (Ad-
ams, 1985; Osofsky, 1996; Pallone & LaRosa, 1979). These
services appear to respond to a wide variety of mental health
problems, such as depression, anger management, psychotic symp-
toms, anxiety, and institutional adjustment issues, exhibited by
inmates (Boothby & Clements, 2000); however, inmates’ mental
health needs are typically identified from investigations of the
types of problems most frequently treated by mental health pro-
fessionals. In other words, no research elucidates the types of
problems for which inmates state they would be most willing to
seek mental health services. Thus, it is possible that inmates need
(or want) services that mental health professionals in correctional
settings are not currently providing. Unfortunately, only one in-
vestigation of inmates’ service utilization was found in the litera-
ture. This study concluded that inmates with greater levels of
disability were more likely to receive mental health services
(Steadman, Holohean, & Dvoskin, 1991); however, this study did
not address inmates’ perceptions and attitudes toward mental
health services, nor did it investigate the types of services for
which inmates are most likely to seek help.
Nevertheless, it has been speculated that inmates’ attitudes
toward rehabilitation programs tend to be negative (Rappaport,
1982), as inmates do not want to expose their vulnerabilities or
experience ridicule from others (Kupers, 2001). It is further spec-
ulated that suspiciousness is prominent (e.g., Mathias & Sindberg,
1985) because inmates view therapists as cops and treatment
sessions as snitch sessions (Mobley, 1999). They may also be
fearful of how documentation of mental health services may be
used against them as they progress through the criminal justice
system (Kupers, 2001). Although clients’ perceptions of treatment
services may have a direct impact on the effectiveness of such
services (e.g., Palmer, 1991), the accuracy of these speculations
regarding inmates’ perceptions of and attitudes toward mental
health services remains uninvestigated. Certainly, an identification
of incarcerated offenders’ reported barriers (i.e., biases, negative
ROBERT D. MORGAN received his PhD in 1999 from Oklahoma State
University. He is associate chair of psychology and an assistant professor
in the APA-accredited doctoral program in counseling psychology at Texas
Tech University. His general research interests are in correctional psychol-
ogy with emphasis on mental health treatment, forensic assessment, and
professional development and training issues.
ALICIA T. ROZYCKI received her MA in 2003 from Texas Tech University.
She is currently a doctoral student in the APA-accredited doctoral program
in counseling psychology at Texas Tech University. Her primary research
interests are in substance abuse, clinical geropsychology, correctional
psychology, and emerging adulthood.
SCOTT WILSON received his MS in 1994 from Emporia State University. He
is a licensed clinical psychotherapist and the mental health coordinator for
Correction Care Solutions and the Kansas Department of Corrections. His
general research interest is in correctional psychology.
WE WISH TO THANK the Kansas Department of Corrections, specifically
Debbie Bratton and Angie Weber, for their assistance in completing the
data collection for this study. We thank Christine Robitschek for her
helpful comments on a draft of this article. This research was supported by
a grant from the Texas Tech University Research Enhancement Fund.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Robert
D. Morgan, Box 42051, Department of Psychology, Texas Tech Univer-
sity, Lubbock, TX 79409-2051. E-mail: robert.morgan@ttu.edu
Professional Psychology: Research and Practice Copyright 2004 by the American Psychological Association
2004, Vol. 35, No. 4, 389–396 0735-7028/04/$12.00 DOI: 10.1037/0735-7028.35.4.389
389
perceptions) to mental health services would enable providers to
target these barriers in efforts to reach a larger number of inmates.
Furthermore, little is known about inmates’willingness to seek
mental health services. New Zealand inmates who had prior help-
ful counseling experiences were more likely to utilize prison
mental health services (Deane, Skogstad, & Williams, 1999), but
little additional information is available. Of particular concern in
correctional mental health, given security issues and demographic
variability, is that perceptions of mental health services by inmates
across varying security levels, as well as ethnic groups, remains
unexplored.
Of interest for mental health providers in correctional facilities
of differing security levels or restrictiveness is the potential con-
flict between therapists’goal of providing rehabilitative services
versus their goal of providing general mental health services
(Morgan, 2003; Morgan, Winterowd, & Ferrell, 1999). General
mental health services in correctional environments focus on “spe-
cific emotional distress and adjustment difficulties”(p. 604),
whereas rehabilitation is geared toward the reduction of recidivism
and societal reintegration (Morgan et al., 1999). Although inmates
in varying levels of environmental restrictiveness value differing
therapeutic factors (MacDevitt & Sanislow, 1987), it remains
unclear what inmates across differing security levels perceive as
their mental health needs.
Of possibly greater significance are the attitudes and perceptions
toward mental health services among inmates of various ethnic
groups. For example, it is commonly understood that African
Americans frequently underutilize mental health services
(O’Sullivan, Peterson, Cox, & Kirkeby, 1989; Snowden, 1999). Of
particular relevance for inmate populations is that correctional
settings do not foster feelings of trust and security, as previously
alluded to, nor do they facilitate self-disclosure (e.g., Halleck,
1960), issues compounded by recent findings regarding cultural
mistrust, especially for African American clients (e.g., Whaley,
2001a). Cultural mistrust impacts the attitudes and behaviors of
African Americans, including mental health services utilization
(Whaley, 2001b), an issue that may be even more prominent given
that the majority of mental health professionals in correctional
settings are Caucasian (Ferrell, Morgan, & Winterowd, 2000).
Thus, it is essential to identify specific barriers experienced by
ethnically diverse inmates that will inhibit their willingness to seek
mental health services.
The purpose of the present study was to describe male inmates’
attitudes and perceptions of mental health services. It seems rea-
sonable to suggest that inmate biases toward mental health services
may reduce the likelihood of voluntary treatment participation.
Therefore, we anticipated that this study would provide useful
information for assisting mental health professionals in addressing
inmate biases (e.g., during new inmate orientation sessions), so
that inmates would be more comfortable accessing services when
needed. More specific hypotheses were that inmates of differing
security levels and ethnicities would seek services for differing
reasons (e.g., maximum-security inmates would be more interested
in general mental health services, whereas minimum-security in-
mates would be more interested in rehabilitative services) and
would identify different barriers to their willingness to seek ser-
vices (e.g., maximum-security inmates would report more concern
than lower security level inmates about barriers to counseling, such
as concern about being seen as a snitch).
Inmates’Attitudes and Perceptions of Mental Health
Services Survey
A two-page survey was developed to assess inmates’previous
experiences with, and attitudes and perceptions toward, mental
health services. The survey was written at a sixth-grade reading
level and queried a range of mental health related issues, including
types of previous experiences related to mental health both before
and after adulthood (i.e., age 18 years), participation status (i.e.,
voluntary or involuntary/mandated), and quantity of services re-
ceived. Participants were asked to respond to some questions (e.g.,
“After age 18, approximately how many hours of counseling have
you received during any incarceration?”) with open-ended re-
sponses and were asked to respond to others with a checklist and
ranking of responses. For example, when asked, “What type of
mental health services have you participated in during your adult
life (since age 18)?”they were provided with several response
options (e.g., “voluntary individual counseling while incarcer-
ated”) and instructed to check all that applied. In addition, partic-
ipants were asked about their preferences regarding the types of
mental health services available to them, as well as the types of
mental health providers they would prefer to see, and were asked
to respond using a rank-order response format.
Inmates were also queried about the types of problems for which
they would consult a mental health professional and the barriers or
concerns that would influence their decisions about whether to
seek mental health services. Inmates were asked to respond, using
a 5-point Likert-type scale (from 1 ⫽very likely to 5 ⫽very
unlikely), to questions about the likelihood of their consulting a
mental health professional for a variety of concerns under four
broad categories: (a) relationship issues (e.g., problems with other
inmates, divorce or relationship problems), (b) emotional issues
(e.g., stress or anxiety regarding their incarceration, sad or de-
pressed feelings), (c) health related issues (e.g., problems sleeping
too much or too little, problems with serious or chronic disease),
and (d) other mental health issues frequently a focus of treatment
in correctional settings, such as substance use problems, lifestyle
or criminal-behavior problems, severe mental illnesses, or sexual
problems. Inmates were also asked, using a 5-point Likert-type
scale (1 ⫽very influential, 3⫽unsure, and 5 ⫽very uninfluen-
tial), about 15 potential reasons that they might not seek mental
health services (e.g., “unsure how to access mental health ser-
vices,”“concerned about being seen as a ‘snitch,’”“concerned
about being seen as weak”).
Three correctional facilities representing differing security lev-
els (i.e., maximum, minimum, and a reception and diagnostic unit
[RDU] for newly admitted inmates) from a department of correc-
tions in one Midwestern state were used in this study. Participants
were recruited at their respective facilities through a verbal invi-
tation to participate in a study that assessed their perceptions of
mental health services. The only participation criterion placed on
inmates was that they be able to read and write in English. Data
collection for this study was completed in accordance with insti-
tutional research guidelines as approved by the Texas Tech Uni-
versity Institutional Review Board for the Protection of Human
Subjects as well as the Evaluation and Research Division of the
state department of corrections in which this study was completed.
A total of 418 inmates completed surveys, with an estimated
70% participation rate among those inmates offered an opportunity
390 MORGAN, ROZYCKI, AND WILSON
to participate. Of these, 148 (35.4%) were from the maximum-
security correctional facility; 123 (29.4%) were from the
minimum-security correctional facility; and 147 (35.2%) were
from the RDU. The inmates had a mean age of 33 years (SD ⫽
10.08) and were predominantly Caucasian (n⫽196; 46.9%) and
African American (n⫽128; 30.6%). Approximately half of the
participants were single or nonpartnered (n⫽196; 46.9%),
whereas approximately one third were in a significant relationship
(n⫽120; 28.7%), and the remainder were divorced (n⫽75;
17.9%), separated (n⫽17; 4.1%), or widowed (n⫽5; 1.2%). The
average length of education was 11.76 years (SD ⫽2.03). Inmates
were incarcerated for a variety of crimes including the following:
drug- or alcohol-related crimes, such as possession or distribution
(n⫽79; 18.9%); robbery or theft (n⫽73; 17.5%); multiple
violent crimes (n⫽56; 13.4%); murder or manslaughter (n⫽41;
9.8%); sex crimes (n⫽35; 8.4%); multiple nonviolent crimes
(n⫽31; 7.4%); assault or battery (n⫽18; 4.3%); aggravated
assault or aggravated battery (n⫽12; 2.9%); and other types of
offenses (n⫽38; 9.1%). Participants were serving a median
sentence of 51 months, with a life sentence being the modal
sentence. At the time of this study, the inmate participants had
served a mean total of 77 months (SD ⫽79.2) of their adult life in
prison and/or jail. The inmate participants in this study are grossly
representative of all U.S. inmates. More specifically, inmates in
our study were roughly equivalent with regard to age and the crime
for which they were convicted when compared with all inmates
incarcerated in federal and state facilities; however, the partici-
pants in our study included an overrepresentation, by approxi-
mately 10%, of White inmates compared with Black inmates when
compared with national averages (Harrison & Beck, 2002).
Before reporting the results of this study, a few limitations
should be noted. This study was limited to adult male inmates in
state correctional facilities; thus, the generalizability of the results
to other incarcerated offenders is unknown. More specifically,
these results may not generalize to female or federal inmates. In
addition, this study assessed inmates’perceptions during a time of
incarceration, and it is unknown how offenders’perceptions of
mental health services may differ during times when they are not
incarcerated. Last, although attempts were made to record re-
sponse rates, a data-collection error limited the utility of this data;
thus, only an estimated response rate is available.
Prison Security Level and Inmate Differences
Preliminary analyses were conducted to determine if inmates in
correctional facilities of differing security levels (i.e., maximum
security, minimum security, RDU) are in fact different or unique in
several respects. For example, it was anticipated that inmates in
maximum-security settings would have been incarcerated for more
violent crimes and would be serving longer sentences than inmates
in the minimum-security and RDU settings. It was also anticipated
that maximum-security inmates would have served more time in
adult correctional facilities than either of the other two groups, that
they would tend to be older, and that they would report, on
average, fewer partnered relationships because of the duration of
their incarceration. As hypothesized, results indicated that
maximum-security inmates were indeed convicted of more violent
crimes,
2
(2, N⫽383) ⫽33.77, p⬍.001, and were serving
longer sentences, F(2, 397) ⫽44.74, p⬍.001. We also found that
Black inmates were incarcerated for longer sentences than their
White counterparts, F(1, 309) ⫽4.42, p⫽.036, but there were no
differences between Black and White inmates’security level
placements (p⬎.05).
Results also indicated that maximum-security inmates were less
likely to be partnered or married,
2
(2, N⫽413) ⫽18.5, p⬍.001.
Maximum-security inmates had also spent, on average, more of
their adult lives incarcerated than had newly incarcerated inmates
(p⬍.001), but not more than the minimum-security inmates (p⫽
.078). There was no significant difference (p⬎.05) with regard to
the age of inmates, regardless of security level. These differences
indicate that it will be meaningful to analyze inmates’perceptions
of mental health services from the perspective of the differing
inmate groups, as mental health professionals may be working
with different offender typologies, depending on the type of cor-
rectional environment in which they are employed.
Inmates’Mental Health Histories
The results of this study indicated that 36% (n⫽149) of
inmates received mental health services prior to adulthood, includ-
ing individual or group counseling (n⫽138; 33%) and/or family
counseling (n⫽89; 21.3%). There was a statistically significant
relationship between institutional placement and mental health
counseling prior to adulthood,
2
(2, N⫽417) ⫽7.357, p⫽.025,
as well as between racial differences and mental health counseling
prior to adulthood,
2
(1, N⫽324) ⫽21.77, p⬍.001. In other
words, inmates incarcerated in the maximum-security setting were
most likely to have received either individual, group, or family
counseling during childhood (43%) compared with minimum-
security inmates (36%) and newly admitted inmates (28%). Fur-
thermore, White inmates were more likely to have received coun-
seling prior to adulthood (44%) than were Black inmates (19%).
Twenty-five percent (n⫽105) of inmates participating in this
study received some type of voluntary mental health treatment as
an adult when they were not incarcerated (i.e., when they were free
in the community). Of these inmates, 79 (75%) participated in
individual counseling, 29 (28%) participated in group counseling,
and 36 (34%) participated in family counseling. On the basis of
chi-square analyses, there were no significant differences (p⬎
.05) between inmates’security level or race and their voluntary
participation in mental health counseling in the community, with
the exception that White inmates were more likely to volunteer for
individual counseling than were Black inmates,
2
(1, N⫽324) ⫽
15.095, p⬍.001. Furthermore, 31% (n⫽129) of the participants
volunteered for mental health services at some time during their
incarceration as an adult (it should be noted that there is some
overlap between those inmates who volunteered for treatment
while not incarcerated and those who volunteered for counseling
services during their incarceration). Of these 129 inmates, 103
(80%) received individual counseling services, 65 (50%) partici-
pated in group counseling, and 9 (7%) participated in family
counseling. On the basis of chi-square analyses, inmates in
maximum-security settings (41%) were significantly more likely
to volunteer for individual counseling compared with minimum-
security inmates (24%) and newly admitted inmates (8%),
2
(2,
N⫽417) ⫽43.383, p⬍.001. Maximum-security inmates were
also more likely to volunteer for group counseling (25%, 13%, and
8%, respectively),
2
(2, N⫽417) ⫽16.611, p⬍.001, but were not
391
INMATE PERCEPTIONS OF MENTAL HEALTH SERVICES
more likely to volunteer for family therapy,
2
(2, N⫽417) ⫽
0.445, p⫽.801. No significant differences (p⬎.05) were found
between race (i.e., Black or White) and voluntary counseling while
incarcerated on the basis of chi-square analyses.
Of the inmates participating in this study, 77 (18%) had been, at
some time in their adult lives, mandated to participate in mental
health counseling during a time when they were not incarcerated.
Fifty (65%) of these inmates received individual counseling ser-
vices, 37 (48%) received group counseling services, and 17 (22%)
received family counseling services. Significant differences were
noted: Maximum-security inmates (7%) were more likely to have
been mandated to attend family counseling while in the commu-
nity than were minimum-security inmates (2%) or newly incarcer-
ated inmates (3%),
2
(2, N⫽417) ⫽6.818, p⫽.033. No
significant differences (p⬎.05) were found for institutional
security level and mandated individual or group treatment in the
community. Furthermore, White inmates (13%) were more likely
to have been mandated to attend group counseling in the commu-
nity than were their Black counterparts (5%),
2
(1, N⫽324) ⫽
4.922, p⫽.027, but were not differentially mandated to attend
individual counseling
2
(1, N⫽324) ⫽0.771, p⫽.380, or family
therapy,
2
(1, N⫽324) ⫽1.186, p⫽.276.
While incarcerated as adults, 90 (22%) of the inmates had
participated in mandatory mental health services, such that 68
(76%) participated in individual counseling, 53 (59%) participated
in group counseling, and 5 (6%) participated in family counseling.
We found no significant relationships (p⬎.05) among race,
security level, and involuntary treatment during incarceration, with
the exception that maximum-security inmates (22%) were more
likely to be mandated to attend individual counseling than were
minimum-security inmates (19%) or inmates in the RDU (8%),
2
(2, N⫽417) ⫽10.686, p⫽.005, with a similar trend for
mandated group counseling,
2
(2, N⫽417) ⫽5.576, p⫽.062.
Inmates were asked about the total number of hours of mental
health treatment they had received as adults, during both incarcer-
ated and nonincarcerated times. As a result of variability in report-
ing (e.g., outliers, narrative descriptors), these data were collapsed
into categories in 25-hour increments (i.e., 0 hours, 1–25 hours,
26–50 hours, 51–75 hours, 76–100 hours, and greater than 100
hours). Table 1 presents the number of hours of mental health
treatment inmates had received as adults during their incarceration
and during times when they were not incarcerated.
Inmates’Service and Provider Preferences
Inmates participating in this study overwhelmingly reported a
preference for individual counseling (n⫽254; 61%) over group
counseling (n⫽28; 7%) or some other form of mental health
service (n⫽20; 5%) if they were in need of treatment. Ninety-
eight (23%) inmates reported no preference for the type of mental
health services they would seek if they were in need of mental
health services.
Approximately 44% (n⫽185) of the inmates participating in
this study indicated a preference for the type of mental health
professional they would work with if they needed mental health
services. According to their median rank order of mental health
professionals, inmates would most prefer to work with psycholo-
gists or professional counselors (median rank ⫽2 for both cate-
gories), followed by psychiatrists (median rank ⫽3), addiction
counselors (median rank ⫽4), social workers (median rank ⫽5),
students or other professionals (median rank ⫽6 for both catego-
ries), and nonprofessionals (median rank ⫽7).
As previously indicated, inmates were asked about the likeli-
hood of their consulting a mental health professional for a variety
of concerns under four broad categories including the following:
relationship issues, emotional issues, health related issues, and
other mental health issues. Inmates, on average, reported that they
were generally neutral about their likelihood for consulting a
mental health professional for relationship issues (M⫽3.5, SD ⫽
1.1), emotional issues (M⫽3.2, SD ⫽1.2), health related issues
(M⫽3.4, SD ⫽1.2), or other mental health issues, (M⫽3.3,
SD ⫽1.2). Furthermore, results of a one-way multivariate analysis
of variance (MANOVA) procedure resulted in no significant dif-
ferences among inmates housed in maximum-security facilities,
those in minimum-security facilities, or newly incarcerated in-
mates, ⌳(8, 696) ⫽1.27, p⫽.25. Therefore, inmates with differ-
ing levels of security classification and in differing phases of their
incarceration did not report differences with regard to those issues
for which they would be most likely to seek mental health services.
In addition, a one-way MANOVA for race also resulted in no
significant differences, ⌳(4, 262) ⫽0.884, p⫽.474; thus, whether
an inmate is Black or White does not negatively influence their
likelihood to seek mental health services for differing problems.
Barriers to Mental Health Consultation
As seen in Table 2, on average, inmates indicated that the
potential reasons for not seeking mental health services presented
to them were not generally barriers that heavily influenced their
decision of whether to seek mental health services. Although these
potential barriers to service utilization do not appear to prohibit
inmates from seeking services, there were significant differences
among inmate perceptions of these barriers depending on their
security placement. More specifically, a one-way MANOVA pro-
cedure resulted in statistically significant between-group differ-
ences, ⌳(28, 670) ⫽2.98, p⬍.001 on the questions of interest,
and Table 2 presents the follow-up univariate and Scheffe´post hoc
analyses. In summary, newly incarcerated inmates (those in the
RDU group) considered questions such as when and how to access
mental health help, the potential length of treatment, the quality of
services they would receive (i.e., concern about seeing non-
doctoral-level providers), and perceptions of other inmates (e.g.,
Table 1
Hours of Mental Health Treatment Received as Adults
Number of hours
Incarcerated
(N⫽362) Not incarcerated
(N⫽383)
N%N%
0 195 54 239 62
1–25 130 36 67 17
26–50 00298
51–75 00123
76–100 00185
⬎100 37 10 18 5
392 MORGAN, ROZYCKI, AND WILSON
seeing them as weak or a snitch) as more influential in their
decision to seek mental health services than did either the
minimum-security or maximum-security inmates. In addition,
newly admitted inmates placed significantly greater emphasis (re-
garding their decision to seek mental health services) on a percep-
tion that mental health services are for crazy people. Last, newly
admitted inmates’decisions to seek mental health services were
more influenced by concern about lack of confidentiality than
inmates in the minimum-security facility, whereas maximum-
security inmates were more influenced than minimum-security
inmates by a concern that the information presented in counseling
would be used against them by prison officials. Race (i.e., Black or
White) was not a factor in reasons that inmates would chose not to
seek mental health services, ⌳(14, 251) ⫽1.562, p⫽.09.
Implications for Correctional Psychologists
Given previous findings by Boothby and Clements (2000),
inmates in this study somewhat unexpectedly indicated no greater
likelihood for seeking counseling for any of the issues or problems
presented in this study compared with any other issues or prob-
lems. Thus, it appears that inmates who would seek mental health
services would do so for any number of issues or concerns, and
those that would not seek mental health services would not do so,
regardless of the nature of the problem, their institution’s security
level, or their ethnicity. Therefore, consistent with current training
in correctional psychology (Ax & Morgan, 2002), psychologists
need to practice as generalists because they are likely to work with
offenders with varying presenting problems. It is not surprising
then that psychology or mental health departments in correctional
settings appear to be moving toward a community mental health
center model where the majority of inmates are self-referred,
with a smaller percentage being mandated to attend counseling
services.
The effectiveness of mandated treatment for inmates has been
debated for some time; nevertheless, a sizeable number (approxi-
mately 20%) of inmates continue to be mandated to attend mental
health services, either in the community or while incarcerated.
When asked what type of mental health services they would prefer,
the inmates participating in this study overwhelmingly indicated a
preference for individual counseling services and, in fact, received
most of their therapeutic services through this modality. This
finding is consistent with reports from correctional psychologists,
who spend approximately 60% of their treatment time in individ-
ual therapy compared with approximately 15% of their time pro-
viding group treatment (Boothby & Clements, 2000). This prefer-
ence, however, does not appear to be related to issues of
confidentiality or possible negative perceptions from other inmates
because inmates did not endorse these items as barriers to
treatment.
Although inmates continue to prefer individual treatment in
spite of the availability and prevalence (e.g., Morgan et al., 1999),
as well as the effectiveness (Morgan & Flora, 2002), of group
counseling services in correctional facilities, the continued in-
crease in the prison population without a parallel increase in
staffing (Clements, 1999) may necessitate increased utilization of
group therapy as the primary means of service delivery. Therefore,
it may be beneficial for inmates to be educated not only about the
availability of group counseling services, but also about the utility
and efficacy of such services. Certainly, individual counseling will
remain an essential treatment modality offered to incarcerated
inmates; however, the potential of group counseling to offer an
effective therapeutic approach to a larger number of inmates may
result in increasing usage.
As previously discussed, it is commonly believed that inmates
are reluctant to access mental health services because of a variety
of concerns, including confidentiality concerns, the potential for
Table 2
Means, Standard Deviations, and Analyses of Inmate Ratings for the Influence of Various Issues
on Their Decision to Seek Mental Health (MH) Services
Type of issue
RDU Minimum Maximum
F(2, 351)MSDMSDMSD
Unsure how to access help 3.15 1.32
a
3.83 1.20
b
3.86 1.33
b
11.38***
Unsure when to seek help 3.06 1.25
a
3.65 1.18
b
3.78 1.34
b
11.49***
MH is for crazy people 3.54 1.30
a
3.82 1.23
a,b
4.01 1.23
b
4.25*
Length of treatment 3.22 1.33
a
3.68 1.17
b
3.84 1.35
b
7.61***
Lack of confidentiality 3.30 1.38
a
3.79 1.20
b
3.65 1.46
a,b
3.91*
Seen as a snitch 3.44 1.50
a
3.98 1.28
b
4.13 1.34
b
8.43***
Seen as weak 3.41 1.50
a
3.87 1.28
b
3.99 1.39
b
5.99**
MH groups are rat groups 3.85 1.26
a
4.07 1.15
a
4.05 1.28
a
1.09
Information will be used against me 3.47 1.45
a,b
3.60 1.42
a
3.08 1.61
b
3.84*
People should deal with their own problems 3.19 1.30
a
3.35 1.35
a
3.30 1.39
a
0.44
Prefer to talk to friends/family 2.76 1.37
a
2.83 1.31
a
3.19 1.50
a
3.28*
No access to a doctor 3.49 1.25
a
3.80 1.21
a
3.69 1.38
a
1.70
Have to see a training or master’s level
professional 3.24 1.29
a
3.64 1.27
a,b
3.98 1.30
b
10.31***
Previous bad counseling experience 3.75 1.30
a
4.08 1.20
a
3.86 1.46
a
1.76
Note. Responses were based on a Likert-type scale: 1 ⫽very likely, 2⫽somewhat likely, 3⫽neutral, 4⫽
somewhat unlikely, 5⫽very unlikely. Values in a row with dissimilar subscripts are significantly different at p⬍
.05, as assessed by Scheffe´post hoc procedures. RDU ⫽reception and diagnostic unit.
*p⬍.05. ** p⬍.01. *** p⬍.001.
393
INMATE PERCEPTIONS OF MENTAL HEALTH SERVICES
information to be used against them by prison officials (e.g.,
security classification, parole board recommendations, etc.), the
belief that mental health services are snitch sessions, and the belief
that inmates requiring mental health services are weak. However,
inmates may be less concerned about social pressures and potential
misuses of information than has historically been the case. That is,
inmates participating in this study, on average, reported minimal
concern about these issues and indicated that these were generally
not barriers to their willingness to seek mental health services. This
suggests a potential change in the zeitgeist of the prison environ-
ment where inmates are now more willing to access services with
less concern over the social implications.
Differences existed among inmates of differing security levels;
however, the differences were the opposite of those expected. We
hypothesized that maximum-security inmates, being incarcerated
in stereotypically more machismo settings, would be the most
likely to endorse these items as barriers to their willingness to seek
mental health services. However, it was the newly incarcerated
inmates who reported these types of concerns. One possible ex-
planation for this finding is that newly incarcerated inmates have
preconceived ideas about the social structure within a penitentiary
setting and only later learn that at least some of these stereotypical
perceptions are, in fact, inaccurate. It is also possible that current
prison structures are experiencing a transformation, as inmates
become less concerned about the perceptions of their fellow in-
mates than in years past and are willing to trust mental health
professionals in an attempt to receive therapeutic services. In any
event, correctional mental health professionals need to understand
that newly incarcerated inmates may not self-refer for mental
health services because of these biases. Thus, a system for moni-
toring newly incarcerated inmates must be in place to identify
those inmates in need of services.
Also of note was the finding that maximum-security inmates
were more influenced than minimum-security inmates by concerns
about how prison officials would use information disclosed in
counseling. Several possible explanations exist for this finding,
and correctional psychologists employed in maximum-security
settings need to focus on issues of confidentiality as they relate to
prison officials whenever possible. This could occur early in the
inmates’orientation process (e.g., during the orientation to mental
health services that most systems offer) and should also be a focus
of early treatment sessions.
It is also of no surprise to correctional psychologists that in-
mates incarcerated in maximum-security settings have spent more
of their adult life incarcerated, are currently serving longer sen-
tences for more violent crimes, and are less likely to have the
support of a significant partner. Thus, psychologists and other
mental health professionals providing correctional mental health
services should be cognizant of the particular needs of the inmates
with whom they work.
The results of this study also have implications for mental health
procedures in correctional settings. Orientation procedures for
newly admitted inmates need to include increased focus on how
and when to access mental health services as newly incarcerated
participants in this study indicated these as barriers to seeking
mental health services. As previously indicated, newly admitted
inmates are also concerned about others’perceptions of them if
they seek mental health services (i.e., perceived as weak or as a
snitch). Although this concern appears to dissipate once they are
acclimated to the correctional environment, addressing this issue
during orientation procedures may reduce the delay of service
utilization. Similarly, inmates may benefit from orientation pre-
sentations that deemphasize the focus on mental illness (or crazi-
ness) and include the information that services can be brief.
Inmates in maximum-security settings, on the other hand, may
require increased reassurance about the confidentiality of services
they receive, because they are particularly concerned about how
correctional administrators utilize information disclosed during
counseling sessions. This issue can be addressed directly during
the intake process; however, astute clinicians may also want to
revisit this issue periodically during counseling sessions. Last,
maximum-security inmates appear to be the population in greatest
need of services, given that they were most likely to have received
childhood services, and they were the most likely to both request
and be mandated to receive individual and group counseling ser-
vices. Thus, increased efforts should focus on the mental health
programming needs of these individuals. More specifically, psy-
chologists should identify the particular needs (e.g., criminogenic
issues such as antisocial beliefs, work skills deficits, or anger/
hostility) that contribute to recidivism (Andrews et al., 1990) in
these individuals so that mental health services can be tailored to
match those needs. In fact, this is a critical issue in the effective-
ness of correctional treatment programs as programs should target
high-risk offenders (Andrews et al., 1990; Gendreau, 1996).
Finally, employment strategies in correctional settings may need
to be reevaluated. Inmates in RDUs appear to be more reluctant to
request services from non-doctoral-level providers. Furthermore,
inmates indicated an overall preference for seeking services from
psychologists (or professional counselors), which contradicts the
“emerging trend of hiring nondoctoral-level practitioners to pro-
vide direct client services”(Morgan et al., 1999, p. 603). Thus,
prison and mental health administrators may need to reevaluate
hiring practices with a particular focus on increasing the presence
of doctoral-level providers, particularly in RDUs.
Implications for All Psychologists
The results of this study should be of interest to correctional as
well as noncorrectional psychologists and mental health profes-
sionals. Of particular interest to noncorrectional psychologists is
the finding that at least one fourth of the inmates participating in
this study participated in either voluntary or mandated counseling
services during a time when they were not incarcerated (i.e.,
community-based mental health services). Therefore, it is likely
that psychologists, regardless of settings (e.g., correctional, psy-
chiatric, or community), will at various times during their practice
provide therapeutic services to offender clients. Thus, it seems
appropriate that training programs begin to include experiences for
working with this specialized population.
Training implications are further supported by the recent finding
that 6% of California psychologists work in correctional facilities
(Pingitore, Scheffler, Haley, Sentell, & Schwalm, 2001), a rela-
tively large number given that master’s-level therapists may be
correctional administrators’mental health providers of choice
(Morgan et al., 1999). In addition, the interface between psychol-
ogy and law (including corrections) provides a growth opportunity
for psychologists; therefore, it is fortunate that psychology training
programs are already largely prepared for the inclusion of such
394 MORGAN, ROZYCKI, AND WILSON
training opportunities because it may be argued that working with
offender populations is analogous to working with other culturally
diverse clients. In fact, offenders may be one of the most ethnically
diverse client populations in this country, a problem confounded
by the overrepresentation of minorities (especially Blacks) in the
U.S. criminal justice system (see Haney & Zimbardo, 1998; Snell,
1995). It should be noted that ethnicity is only one of several
cultural issues that must be dealt with when working with this
population given issues of the “criminal code”and prison culture
more generally.
Given this heterogeneity of prison populations, it is no surprise
that offenders present with unique problems and challenges that
necessitate specialized skills and knowledge (e.g., impact of sys-
temic punishments on mental illnesses, crisis management for
segregated inmates lacking social support, facilitation of treatment
gains in a punitive correctional environment). Undoubtedly, psy-
chologists are well trained for dealing with issues of diversity in
general and would appear particularly qualified for dealing with
the unique issues and problems presented by offender clients. This
issue appears particularly salient, given that inmates would prefer
to work with psychologists (or professional counselors) rather than
other mental health professionals. Therefore, the inclusion of train-
ing experiences related to treatment of offenders as a diverse
population may prove beneficial to psychologists who find them-
selves working with offender clients.
Although not the focus of this study, the results highlighted the
fact that Black inmates are disproportionately incarcerated and for
longer sentences compared with their White counterparts. As the
discipline of psychology considers its role in advocacy (Dobson,
2002; Fouad, 2002; Levant et al., 2001; Miller, 2002; Safarjan,
2002), psychologists should note that the U.S. legal system is
clearly one governing body that continues to marginalize minori-
ties and thereby warrants the advocacy efforts of psychologists. Of
additional concern is the finding that White inmates were more
likely to have received mental health counseling as children than
were their Black counterparts. This finding is consistent with that
of Herz (2001), who found that White juvenile offenders were
more likely to receive a mental health placement, whereas Black
juvenile offenders were more likely to receive a criminal justice
placement. Although alternative explanations exist for this finding
(e.g., an issue of financial disparity rather than biased placement),
clearly advocacy efforts aimed at affording equal mental health
services to all children are warranted.
Psychologists are likely to be sought out for mental health
services by offenders both inside and outside of the correctional
environment; thus, correctional and noncorrectional psychologists
alike need to be familiar with the mental health experiences,
attitudes, and perceptions of this population. The results of this
study highlight the benefits and the possible necessity of increased
training opportunities and advocacy efforts directed toward of-
fender populations.
References
Adams, K. (1985). Addressing inmate mental health problems: A new
direction for prison therapeutic services. Federal Probation, 49, 27–33.
Andrews, D. A., Zinger, I., Hoge, R. D., Bonta, J., Gendreau, P., & Cullen,
F. T. (1990). Does correctional treatment work? A clinically relevant and
psychologically informed meta-analysis. Criminology, 28, 369–404.
Ax, R. K., & Morgan, R. D. (2002). Internship training opportunities in
correctional psychology: A comparison of settings. Criminal Justice and
Behavior, 29, 332–347.
Boothby, J. L., & Clements, C. B. (2000). A national survey of correctional
psychologists. Criminal Justice and Behavior, 27, 716–732.
Clements, C. B. (1999). Psychology, attitude shifts, and prison growth.
American Psychologist, 54, 785–786.
Deane, F. P., Skogstad, P., & Williams, M. W. (1999). Impact of attitudes,
ethnicity and quality of prior therapy on New Zealand male prisoners’
intentions to seek professional psychological help. International Journal
for the Advancement of Counseling, 21, 55–67.
Dobson, K. S. (2002). A national imperative: Public funding of psycho-
logical services. Canadian Psychology, 43, 65–75.
Farrington, J. (1972). Utilization of psychological constructs by group
therapy participants. Psychological Record, 22, 387–394.
Ferrell, S. W., Morgan, R. D., & Winterowd, C. L. (2000). Job satisfaction
of mental health professionals providing group therapy in state correc-
tional facilities. International Journal of Offender Therapy and Com-
parative Criminology, 44, 232–241.
Fouad, N. A. (2002). Dreams for 2010: Making a difference. Counseling
Psychologist, 30, 158–166.
Gendreau, P. (1996). Offender rehabilitation: What we know and what
needs to be done. Criminal Justice and Behavior, 23, 144–161.
Halleck, S. L. (1960). The criminal’s problem with psychiatry. Psychiatry,
23, 409–412.
Haney, C., & Zimbardo, P. (1998). The past and future of U.S. prison
policy: Twenty-five years after the Stanford Prison Experiment. Amer-
ican Psychologist, 53, 709–727.
Harrison, P. M., & Beck, A. J. (2002, July). Prisoners in 2001. Bureau of
Justice Statistics Bulletin (NCJ 195189). Washington, DC: Office of
Justice Programs, U.S. Department of Justice. Retrieved April 10, 2003,
from http://www.ojp.usdoj.gov/bjs/pub/pdf/p01.pdf
Herz, D. C. (2001). Understanding the use of mental health placements by
the juvenile justice system. Journal of Emotional and Behavioral Dis-
orders, 9, 172–181.
Kupers, T. A. (2001). Psychotherapy with men in prison. In G. R. Brooks
& G. E. Glenn (Eds.), The new handbook of psychotherapy and coun-
seling with men: A comprehensive guide to settings, problems, and
treatment approaches (pp. 170–184). San Francisco: Jossey-Bass.
Levant, R. F., Reed, G. M., Ragusea, S. A., DiCowden, M., Murphy, M. J.,
Sullivan, F., et al. (2001). Envisioning and accessing new roles for
professional psychology. Professional Psychology: Research and Prac-
tice, 32, 79–87.
MacDevitt, J. W., & Sanislow, C., III. (1987). Curative factors in offend-
ers’groups. Small Group Behavior, 18, 72–81.
Mathias, R. E., & Sindberg, R. (1985). Psychotherapy in correctional
settings. International Journal of Offender Therapy and Comparative
Criminology, 29, 265–275.
Miller, D. (2002). Advancing mental health in political places. Profes-
sional Psychology: Research and Practice, 33, 277–280.
Mobley, M. J. (1999). Psychotherapy with criminal offenders. In A. K.
Hess & I. B. Weiner (Eds.), The handbook of forensic psychology (2nd
ed., pp. 603–639). New York: Wiley.
Morgan, R. D. (2003). Basic mental health services: Services and issues. In
T. Fagan & R. K. Ax (Eds.), Correctional mental health handbook (pp.
59–71). Thousand Oaks, CA: Sage.
Morgan, R. D., & Flora, D. B. (2002). Group psychotherapy with incar-
cerated offenders: A research synthesis. Group Dynamics: Theory, Re-
search, and Practice, 6, 203–218.
Morgan, R. D., Winterowd, C. L., & Ferrell, S. W. (1999). A national
survey of group psychotherapy services in correctional facilities. Pro-
fessional Psychology: Research and Practice, 30, 600–606.
Morrissey, J. P., Swanson, J. W., Goldstrom, I., Rudolph, L., & Mander-
scheid, R. W. (1993). Overview of mental health services provided by
395
INMATE PERCEPTIONS OF MENTAL HEALTH SERVICES
state adult correctional facilities: United States, 1988 (Mental Health
Statistical Report No. 207). Rockville, MD: Substance Abuse and Men-
tal Health Services Administration.
Osofsky, H. J. (1996). Psychiatry behind the walls: Mental health services
in jails and prisons. Bulletin of the Menninger Clinic, 60, 464–479.
O’Sullivan, M. J., Peterson, P. D., Cox, G. B., & Kirkeby, J. (1989). Ethnic
populations: Community mental health services ten years later. Ameri-
can Journal of Community Psychology, 17, 17–30.
Pallone, N. J., & LaRosa, D. S. (1979). Mental health specialists and
services in correctional facilities: Who does what? Journal of Offender
Counseling, Services, and Rehabilitation, 4, 33–41.
Palmer, T. (1991). The effectiveness of intervention: Recent trends and
current issues. Crime and Delinquency, 37, 330–346.
Pingitore, D., Scheffler, R., Haley, M., Sentell, T., & Schwalm, D. (2001).
Professional psychology in a new era: Practice-based evidence from
California. Professional Psychology: Research and Practice, 32, 585–
596.
Rappaport, R. G. (1982). Group therapy in prison. In M. Seligman (Ed.),
Group psychotherapy and counseling with special populations (pp.
215–227). Baltimore: University Park Press.
Safarjan, B. (2002). A primer for advancing psychology in the public
sector. American Psychologist, 57, 947–955.
Snell, T. L. (1995). Correctional populations in the United States, 1993
(No. NCJ-156675). Annapolis Junction, MD: U.S. Department of
Justice.
Snowden, L. R. (1999). African American service use for mental health
problems. Journal of Community Psychology, 27, 303–313.
Steadman, H. J., Holohean, E. J., Jr., & Dvoskin, J. (1991). Estimating
mental health needs and service utilization among prison inmates. Bul-
letin of the American Academy of Psychiatry and the Law, 19, 297–307.
Whaley, A. L. (2001a). Cultural mistrust: An important psychological
construct for diagnosis and treatment of African Americans. Profes-
sional Psychology: Research and Practice, 32, 555–562.
Whaley, A. L. (2001b). Cultural mistrust and mental health services for
African Americans: A review and meta-analysis. Counseling Psycholo-
gist, 29, 513–531.
Received April 22, 2003
Revision received September 2, 2003
Accepted September 4, 2003 䡲
396 MORGAN, ROZYCKI, AND WILSON
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