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Structural and Public Stigmas in the American Probation System: Effect of
Deinstitutionalization on Criminalization of Mental Illness.
Babatunde O. Adekson, PhD Student, Counselor Education and Supervision
Warner School of Education and Human Development, University of Rochester.
Introduction
There is a need to contextualize the structural and public stigmas experienced by offenders/probationers with mental illness (PMIs)
within the probation system as evolving from the movement to deinstitutionalize mental health care. The negative public perception
about individuals with mental illness was strengthened by the social and communal frustrations caused by deinstitutionalization (i.e.,
increase in untreated mentally ill individuals in the community). It was also dependent on the socio-historical beliefs about mental illness
and about deviant behavior in American culture. There are convergent themes used in the literature to describe the series of promises
and consequences inherent in the mental health public policies and social programs of the late 1950s and 1960s coined as
deinstitutionalization. The basic premise of this policy was the closure of psychiatric hospitals, with the transition of the most
psychiatrically-impaired individuals into community based medication-assisted and/or psychosocial treatments, and the transition of
other less impaired individuals to their families and into the community (Durham, 1989; Lamb, 1998; Lamb, 2001; Morrow, Dagg &
Pederson, 2008; Newton, Rosen, Tennant, Hobbs, Lapsley & Tribe, 2000; Palermo, Gumz &Liska, 1992). Deinstitutionalization is in some
ways responsible for the systemic disintegration of community based treatment and the decompensation and criminal
institutionalization of cohorts of individuals with mental illness. The argument is that these individuals would have been able to access
services from the once functional psychiatric hospitals or obtain services from community mental health centers (Chaimowitz,
2011;Lurigio, 2011). Consequentially, one of the major consequences of the policies of deinstitutionalization is stigma: the opinion that
an attribute such as having mental illness is discrediting and warrants an aggressive reaction from society (Corrigan, 2005; Goffman,
1963).
•The deinstitutionalization movement
• The deinstitutionalization movement, which started around the 1950s in the United
States, was based on a series of assurances to reform mental health care. The
movement facilitated the mass exodus of persons with mental illness who were
residing in psychiatric hospitals. It sought to provide for the psychosocial care and
treatment of the most chronic and severely mentally-ill back to their communities
and to their families. The proposed success of the movement was also dependent on
the discovery of Chlorpromazine and other advances in psychopharmacology
(Chaimowitz, 2011;Durham, 1989; Lamb, 1998; Morrow et al., 2008).
•Promises and proposed benefits of deinstitutionalization
• Deinstitutionalization was the centerpiece of what President John Kennedy labeled a
‘bold new approach’ to the treatment of mental illness. The movement was
inherently created with expectations that a community-based system of mental
healthcare would be implemented as the primary anchor of care.
•Consequences and effects of deinstitutionalization
• A lot of the problems were structural in nature and have certain cause-effect
relationships with the public’s perception about individuals with chronic mental
illness and the mental health system of care as a whole. Many of the discharged
patients did not return to a supportive home environment linked to treatment. They
experienced limited economic and social supports. And individuals who would have
been hospitalized in the past never made contact with treatment centers in the
community and were left to independently make their way in hostile communities.
The structural issues resulting from the chronicity of
untreated severely mentally-ill people turned into social ills
that became eye sores in a lot of American communities
into which the untreated and unmanaged returned
(Durham, 1989; Lamb, 1998).
Definitions of stigma
Goffman (1963) defined stigma as an attribute constructed because of a perceived or actual
discredited inadequacy, defect, or handicap. According to this definition, stigma then is reinforced
based on the relationship between these attributes and the series of socially constructed stereotypes
about that individual’s discredited imperfections.
Institutional practices and relatedness to structural stigma
Institutional practices “formed by sociopolitical forces [that] represent the policies of private and
governmental institutions [has been identified as a barrier counterproductive to] the opportunities of
stigmatized groups” (Corrigan, Watson, Heyrman, Warpinski, Gracia, Slopen & Hall, 2005). Structural
stigma arises because of the prejudices of individuals in power who endorse legislation and
organizational rules that discriminate against people with mental illness. Sociologists have also
acknowledged that this form of stigma develops as a result of the historic, economic, and political
injustices wrought by prejudice and discrimination in the United States (Corrigan & Kleinlein, 2005).
The key component of structural stigma is not the intent but rather the effect of mandating certain
groups into subordinate positions in society.
•Other consequences of Deinstitutionalization
Relevant Theories used to explain stigma of mental illness and
deviance
Structural stigma results from social forces that develop over many years to limit and in some
cases eliminate resources and supports needed (Corrigan & Lam, 2007) to be successful in a very
competitive economic and social system. There are two levels of structural stigma found in
society: Institutional policies and social structures. Stigma at an individual level of analysis (i.e.,
public stigma) is the emergence of societal structures that limit and impact the life opportunities
of people with mental illness (Corrigan & Kleinlein, 2005). Public stigma is an interactional
dynamic perpetuated at the individual and group levels that is based on psychological
perspectives, attitudes, and behavior towards a particular person or group. Stigma of criminality
and deviance is distinguishable from the stigma of mental illness. The stigmatized criminal is
conceptualized as a scapegoat, upon whom aggression is displaced from the frustrating agent and
who then turns out to be a catalyst for the “psychic genesis” (Shoham & Rahav, 1982, p. 89) of the
stigma.
•The mentally-ill offender in the criminal justice system
• The total number of ill people who developed relationships with the mental health
system vastly increased and a great burden was placed on the mental health system
of care with limited available resources devoted to the care of those individuals who
needed it the most (Durham, 1989).
• Public stigma and discrimination towards the mentally-ill significantly increased as a
result of the powerful social and psychological disgust towards the increasingly
vagrant, uncared for, and homeless mentally ill population now residing in
communities that witnessed the failed structural policies of deinstitutionalization.
• Another profound consequence of deinstitutionalization has to do with the
criminalization of mental illness which occurred as a result of the structural and
systemic implementation problems in the community-based models of care
proposed in the movement (Chaimowitz, 2011; Grekin, Jemelka & Trupin, 1994).
• As the number of chronic mentally-ill people in the community grew, the total
number of contact between police and the mentally-ill increased as well. In fact,
stigma has been shown to be interactively involved in the processing of the mentallyill into the criminal justice system.
• Mental hospitals no longer had the capacity to take these individuals and are
generally no longer equipped to help resolve crisis situations. As a result, jails and
prisons then became the main institutions for people who could no longer be
tolerated in the community.
• The dire condition of mental health services within jails, prisons and in the criminal
justice system as a whole has been described as a consequence of the criminalization
of mental illness (Lamb & Weinberger, 1998).
• Scholars have described the misuse of jails as mental hospitals and called for active
diversion programs, in the hope that those with mental illness who commit crimes
can be identified as needing a mental health intervention early in the criminal
processing and appropriately removed from the incarceration system to community
based treatment and rehabilitation settings.
• The burgeoning population of offenders within the criminal justice system places an
unprecedented strain on probation agencies. This strain is strengthened by the
serious mental health problems that an increasing number of these probationers
experience.
• This strain is further intensified because the prevalence of mental health issues is
quantified as being more than three times higher in the criminal justice population
than in the general population (Skeem, Emke-Francis & Louden, 2006).
• The over-reliance on the use of coercion and intent of power in the probation system
as a way to enforce treatment compliance, reflects structural stigma. The use of
power and coercion also typically represent collective and macro-level perceptions
about deviant offenders and individuals with mental illness in the probation system.
These types of collective and macro-level practices are operationalized by Corrigan et
al (2005) as structural stigma
There are two factors that inform the general belief that
there has indeed been an increase in the number of
individuals with mental illness incarcerated in jails and
prisons since deinstitutionalization. Firstly, very large
numbers of mentally-ill individuals are now part of the jail
and prison population; And secondly, clinicians and
researchers have observed that a high proportion of
mentally-ill individuals in the criminal justice system
resemble individuals who used to be patients in long term
state hospitals prior to deinstitutionalization.
The use of power and coercion complicates the course of
rehabilitation and treatment services that probation
agencies are designed to provide and creates a number of
challenges for the Probation Officer and probationer with
mental illness’ (PMIs) interaction and relationship.
Probation officers are then forced to use mandates in the
case when expectations of rehabilitation and treatment are
unmet by the probationer and this further complicates the
interpersonal process.
Factors that impact/create structural stigma
Factors that impact/create Public Stigma
Future directions and recommendations for stigma change
-Institutional practices.
-Widely accepted negative perceptions about mental illness in the larger public
-Protest
-Use of certain legal tools (i.e., coercion and mandates)
-Stereotype
-Education
-Cumulative disadvantage or “past-in-present” discrimination
-Prejudice
-Interpersonal contact
-Democratic belief in meritocracy.
-Discrimination
-Capitalist ideologies of cost effectiveness
-Authoritarian personality and social dominance perspectives