By Dianna L. Kucera, PsyD
Congress affirmed the duty to protect incarcerated individuals from sexual abuse by unanimously enacting the Prison Rape Elimination Act of 2003 (PREA). The purposes set out by PREA are to establish a zero-tolerance standard for the incidence of prison rape in the prisons in the United States; make the prevention of prison rape a top priority in each prison system; develop and implement national standards for the detection, prevention, reduction and punishment of prison rape; increase the available data and information on the incidence of prison rape, consequently improving the management and administration of correctional facilities; and, finally, protect the Eighth Amendment rights of federal, state and local prisoners. According to the Bureau of Justice between the years of 2009 and 2011 8,763 allegations of sexual victimization in prisons, jails and other correctional facilities were reported, and approximately 10 percent, or 902, of those were substantiated based on follow-up investigations.
As PREA is coming to the forefront of corrections, it is imperative for mental health professionals to understand their role in the implementation of the national standards. Specific mental health standards have been developed to guide clinicians in both preventing and responding to sexual abuse. One of the most important elements in the prevention process is differentiating and separating vulnerable offenders from predatory offenders. In an effort to prevent sexual abuse, the PREA standards require a screening for the risk of sexual victimization and abusiveness. According to the standard the agency shall use the information from the risk screening to inform housing, bed, work, education and program assignments with the goal of keeping separate those inmates at high risk of being sexually victimized from those at high risk of being sexually abusive.
Mentally ill offenders are entering the system at an all-time high. Statistics from the National Institute of Health reported that approximately 1 in 12 male offenders with mental disorders reported at least one incident of sexual victimization by another inmate over a six-month period, compared with 1 in 33 offenders without a mental disorder. The rates of reported sexual abuse were highest among offenders with diagnostic histories of schizophrenia and bipolar disorder.
Offenders with a mental illness are considered highly vulnerable to sexual abuse within the correctional systems for numerous reasons. The symptoms of schizophrenia and bipolar disorder create impaired reality testing, distraction by internal stimuli, disorganization in speech and behavior as well as emotional instability. These offenders can be easily taken advantage of through grooming techniques as well as physical force. Offenders experiencing more of the depressive symptoms of bipolar disorder or the negative symptoms of schizophrenia often isolate and any changes brought on by sexual abuse often go unnoticed. Offenders who are actively symptomatic are considered prime targets for sexual abuse by predators because they are already perceived as unstable. The assumption is made that no one will believe an allegation made by someone that is mentally ill. Another element, which creates vulnerability in mentally ill offenders, is commonly prescribed psychotropic medication. The atypical antipsychotics, SSRIs, trycyclics, mood stabilizers and anxiolytics all have side effects, which may include dizziness, drowsiness, blurred vision, confusion and blackouts.
Offenders with mental illness make up a significant portion of the incarcerated population and are highly susceptible to sexual abuse due to a complex interaction of both symptomology and psychotropic medication. The PREA standards established guidelines to assist in proper screening for sexual victimization and abusiveness, but it is the clinicians within corrections who need to take an active role in ensuring that the information from the screening is appropriately communicated to security staff and administration in order to keep mentally ill offenders safe from sexual victimization.