CARTAS AL DIRECTOR
THE BASIC NEEDS OF PRISONERS IN EASTERN EUROPE CORRECTIONAL INSTITUTIONS AND ITS IMPLICATIONS FOR MENTAL HEALTH. THE LITHUANIAN CASE
NECESIDADES BÁSICAS DE LOS RECLUSOS EN LAS PRISIONES DE LA EUROPA DEL ESTE Y SUS IMPLICACIONES EN LA SALUD MENTAL. EL CASO DE LITUANIA
V. Kasperunas
Head of the Medical Division. Prison Department at the Ministry of Justice. Lithuania.
Directora de la división médica del departamento de prisiones en el Ministerio de Justicia. Lituania.
I will provide a bit different psychological approach to the imprisonment. The main purpose of this paper is to establish the psychosocial characteristics of offenders serving their sentences. These psychosocial characteristics make impact to the mental wellbeing and hereinafter are defined as needs, the deprivationof which determines patterns of non-adaptive behaviour as well as the further crime commitment, Analysis of Lithuanian case would be treated, though with reservations of course, as representing the situation of the Correctional Systems in the whole region of Eastern Europe.
Mental Health refers not only to the absence of illness or disorder. World Health Organization defines mental health as “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stress of life, can work productively and fruitfully, and is able to make a contribution to her or his community“.
In other words, mental health necessitates the optimal satisfaction of deficit needs, which force a person to use tension and discomfort-reducing behavioural patterns, as well as needs of personal growth. Therefore to structure the presentation I shall use the hierarchy of needs provided by Abraham Maslow. The Maslow‘s hierarchy is used for classification purposes only, without emphasizing the other aspects of the theory. It is assumed that the satisfaction of the needs of all levels can lead to a good mental health.
1. The fulfilment of physiological needs., necessary for common survival, in Correctional institutions of Eastern Europe is secured by the legislation. For example, Order of the Minister of Justice on approval of the Internal Order Regulations of Correctional Establishments (State News, 2003, No. 76 –3498) states, that „All prisoners should be treated in the way to preserve their health and dignity“. But theCode of Penal Enforcement provides that offenders are divided into three groups – lightweight, common and disciplinary – according to the way of they behave (Table I).
In summary, the phone calls of offenders from disciplinary group are very limited, not even speaking about the possibility to meet dear people. Therefore, we may conclude that the satisfaction of sexual need of offenders is very limited and some studies showed that “the absence of heterosexual intercourses in prisons increases the violence during the imprisonment and after the discharge to the community. The hunger of sexual intercourses itself is the symbolic form of castration and humiliation of heterosexual males and supplemented with possible homophobia or homosexual panic, the direct road opens for paranoiac thoughts, fairs and finally to sallies of violent behaviour“.
The other issue is related to the limited accountability. This legal concept is defined in the Criminal Code of the Republic of Lithuania, but in reality is not applied. Persons are recognized as being not accountable for their actions only when they have a severe mental disability. In such cases mandatory treatment is provided. But persons with personality disorder, which is not treated as a severe mental disability receive a simple custodial sentence, which is usually served in the disciplinary group due to the particular behaviour, the personality disordered may show. Therefore, a person, who in the countries of Western Europe would receive treatment, in the countries of Eastern Europe is simply locked in the penalty isolator.
The similar situation is with drug addicted offenders. It became very easy to attain illicit drugs at places of imprisonment and the need of detoxication increased considerably (notwithstanding that such service is not provided in Correctional System of Lithuania yet at all). The drug addicts for the usage of drugs are punished with custodial sentences although the famous Norwegian criminologist prof. Matiessen has been expressing idea, that drug users, like other people with mental disorders, should be treated compulsory instead of being punished.
2. Safety needs are satisfied when the quiet surrounding and stabile way of life is secured. On one hand, it is assumed that the strictly structured regime ensures the stability and monotony; therefore the symptoms of mental disorder can stabilize or even decline when a person gets into correctional institution. On the other hand, the monotony bears perpetual tension, due to unpredictive relationship between offenders and officers and among offenders themselves.
In Correctional Establishments of Lithuania, like of other Post-Soviet countries, the system of castes is still very alive. The representatives of the lowest caste are constantly and habitually put-upon and humiliated by the other offenders. According to the internal offenders ”legislation“, it is forbidden to live in one cell with them, to be at one table or to have bath at the same time. But it is permitted to “lend“ illicit drugs, cigarettes and other goods, to prompt illegal gambling and, subsequently demand to return it back with huge interest or to abuse them sexually of physically. The only way for “disadvantaged“ to avoid abuse is to search for patronage of officers by providing them with information about the other inmates, but at the same time stir more wroth of the upper caste. Therefore we may conclude that the offenders can easily get into a vicious circle, where the mental state of a person has been injuring patently and beyond retrieve.
The ensurance of physical and mental health care also belongs to the category of security needs. It should be noted that in the Lithuanian Prison Department‘ s financing policy, the health care is not emphasized, since there is no separate line for the refund of health care services in the annual budget. After receiving financial requests from the imprisonment establishments Department gives resources only for paying salaries for the staff and purchasing necessary medicaments. Unfortunately concrete health care services and programs for inmates are not financed. In other words, the budget foreseen for the whole penitentiary system is not sufficient (the biggest part of it goes for guaranteeing activities of penal execution system, such as security and supervision, meanwhile rehabilitation programs are mostly considered to be unnecessary luxury). Therefore it would even be naive to expect receiving the new generation’s anti-depressants or anti-psychotics. Psychotherapeutical or national correctional programs for inmates suffering from personality disorder are not delivered as well. I remember one of my patients with deep borderline personality disorder, who once, in order to seriously injure himself, deliberately swallowed an open safety-pin, which was stuck in bread. Everybody believed he was cheating and when finally the X-ray examination was accomplished it was too late to make a surgery by the way, he also refused to lie under the knife), thereby he died. Who is to blame in this case? I would like to leave this question open.
3. Love and belonging needs. It may seem a bit strange to speak about these needs in the context of penal enforcement. The satisfaction of love and belonging needs are not (and should not be) regulated by the legislation anyhow. I believe, everybody agrees that love is a very private business therefore nobody would entrust this delicate thing to the institution. But I would like to talk about these needs from the psychological perspective because they are frustrated for most of the inmates since the very early childhood. During psychotherapy sessions it becomes obvious that males, who presently are violent and abusive, have experienced a severe physical or sexual abuse, neglect and/or rejection. Most of offenders have spent their childhood in care homes, hence accumulated a complete baggage of negative impact of institutions. Violence is the most intense expression of lovelessness, therefore, J.Gilligan states, that “violence kills the spirit even though the body still functions”.
Shame and humiliation cause psychological pain and when this pain becomes intolerable, inmates start to believe that the environment entails such a big suffering; therefore they try either literally to escape from prison or behave in a self-destructive way in order to be taken to the hospital. Unfortunately the new place very quickly become unbearable alike the previous one. Therefore a certain number of inmates migrate between correctional institution and hospital during the entire sentence.
In summary I would like to emphasize that the needs of love and belonging relate to the needs of being listened and accepted. All those needs can be realized during counselling sessions. But the lack of psychologists, psychiatrists and social workers and the focus on security rather than treatment retards the process of recovery, rehabilitation and crime prevention.
The other category consists of esteem needs, which are very (directly) connected to the needs mentioned above, therefore I shall not analyse them more properly.
Self-actualization needs could be satisfied via occupation and employment. According to prof. Matiessen, occupation is one of the four core elements of Correction (the rest three are: education, discipline and psychosocial support). On one hand, occupation helps to maintain the skills of self-sustenance; on the other hand, it gives a kind of structure and a sense of life. However only about 20 % of all offenders’ population in Lithuania are employed, even though the item 73.4 of Internal Order Regulations of Correctional Establishments in Lithuania states that “it is necessary to provide the opportunity for inmates to develop their capabilities and competencies, which would increase the perspective of successful reintegration into society after the discharge”.
From the perspective of employers, offenders are not recognized as good workers, because they are not motivated for productiveness and quality; very often the equipment is broken and material destroyed or stolen. Therefore most of the enterprisers do not want to waste efforts for creating work places for inmates, because the Government of Lithuania has not yet been supporting the employment of offenders during their imprisonment notwithstanding it supports the employment of people from other risk groups (disabled, jobless etc.).
Whereas job places are not provided for everyone who wishes to be employed during the sentence, the selection criteria are quite strict especially violating the rights of disabled and/or drug addicted inmates. The job is a big advantage in Correctional Establishments; therefore sometimes correctional officers preclude inmates with personality disorders from getting employed in order to express personal antipathy towards them. Despite the occupation is one of the forms of rehabilitation, offenders suffering from mental disorders are not provided with and even prohibited from it.
CONCLUSIONS
1. Offenders are very often officially perceived as a homogeneous group and such homogenization has important implication on the disregard of prisoners’ individuality, thus on the inadequacy of services provided for them. However they are not a homogeneous group and the diversity of offenders’ needs requires the application of different measures. The idea that the penalty should be individualized urges to be implemented legally and practically.
2. Currently no special (national) correctional and/or treatment programs are provided for inmates with special needs, but the practice of Western countries shows, that the special attention should be focused on them. Here I would like to mention that Prison Department of Lithuania presently implements the national program of “the Prevention of child sexual abuse”, prepares for handling world wide known instruments of future violence risk assessment and management. These are the first steps to address help to the inmates with so-called special needs.
3. The attitude towards the penal enforcement is still based on emphasizing the isolation of inmates from the society and the guaranteeing of activities of penal execution system, such as security and supervision. It is necessary to change these attitudes focusing more on the need of treatment and rehabilitation as well as the (mental) health care overall.
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