When addressing the needs of individuals struggling with suicidality, the approach taken can have a profound impact on their outcomes and overall well-being. Historically, the mental health and criminal justice systems have sometimes intersected in ways that prioritize control and containment-known as carceral approaches-over therapeutic support and healing. While this strategy may aim to prevent immediate harm, it often leads to unintended consequences that can exacerbate mental health challenges. In this blog post, we’ll explore the impacts of carceral approaches on clients navigating suicidality and discuss why a shift towards compassionate care is crucial.

 

Understanding Carceral Approaches in Mental Health

Carceral approaches involve using methods derived from criminal justice practices, such as involuntary hospitalization, restraints, confinement, or punitive surveillance, in the management of mental health crises. These methods are often justified as necessary for ensuring the safety of the individual and the community. However, such approaches can be highly traumatic, especially for individuals already experiencing severe emotional distress.

 

Key Impacts on Clients

 

1.   Reinforcement of Feelings of Powerlessness and Hopelessness

One of the primary issues with carceral approaches is that they can amplify feelings of powerlessness, which is often a core component of suicidal ideation. When individuals are subjected to involuntary hospitalization or physically restrained, it can reinforce the belief that they have lost control over their lives. This sense of powerlessness may intensify their hopelessness and despair, potentially worsening their suicidal thoughts.

Research indicates that people who have experienced involuntary psychiatric interventions are more likely to report increased levels of trauma and mistrust toward mental health services in the future (Katsakou & Priebe, 2006). This can create barriers to seeking help later, perpetuating a cycle of isolation and mental health struggles.

 

2. Traumatization and Retraumatization

For clients with a history of trauma, particularly those with experiences of violence, abuse, or confinement, carceral approaches can trigger retraumatization. Involuntary confinement or physical restraints may mirror past traumatic experiences, leading to severe emotional distress and potentially exacerbating symptoms of PTSD or other mental health conditions.

The impact of retraumatization is particularly concerning for marginalized populations, such as people of color, LGBTQ+ individuals, and those with a history of incarceration, who are disproportionately affected by systemic biases in mental health and criminal justice systems (Mental Health America, 2023).

 

3. Stigmatization and Criminalization of Mental Health

When mental health crises are treated through a carceral lens, there is a risk of further stigmatizing individuals with mental health challenges. Clients may feel criminalized or treated as dangerous for expressing their distress, which can lead to feelings of shame and self-blame. This stigmatization not only isolates individuals but also reinforces societal perceptions that mental illness is a crime rather than a health issue.

Research has shown that individuals who experience criminalized responses to their mental health crises are less likely to seek professional help in the future, fearing judgment, discrimination, or punitive action (Livingston, 2016).

 

4. Barriers to Therapeutic Alliance

Trust between a client and their mental health provider is a cornerstone of effective therapeutic intervention. When carceral approaches are employed, it can severely damage this trust, making it difficult for individuals to engage openly in therapy. Clients may feel that their autonomy is undermined, leading to resistance to treatment and a lack of faith in their providers’ intentions.

Building a therapeutic alliance is essential in suicide prevention, as it encourages open communication and creates a safe space for individuals to express their thoughts and emotions without fear of punitive consequences (Jobes, 2016).

 

The Need for a Shift Toward Compassionate, Non-Carceral Approaches

Given the significant drawbacks of carceral approaches to suicidality, a shift towards compassionate, client-centered care is essential. Here are some alternative strategies that can offer a more supportive environment for individuals in crisis:

Trauma-Informed Care

Trauma-informed care recognizes the prevalence of trauma in individuals’ lives and emphasizes safety, choice, and empowerment. By understanding the impact of trauma, mental health professionals can offer support that respects the individual’s experiences and promotes healing rather than harm.

 

Collaborative Safety Planning

Collaborative safety planning involves working with clients to create a structured plan that outlines steps they can take when they are experiencing suicidal thoughts. This process is non-punitive and focuses on empowering individuals to identify their triggers, coping strategies, and sources of support. It enhances their sense of control and self-efficacy.

 

Crisis Intervention Teams (CIT)

Community-based crisis intervention teams composed of mental health professionals and peer support specialists can respond to individuals in crisis without resorting to police involvement or involuntary measures. CIT models have been shown to reduce the need for hospitalization and improve outcomes for individuals in distress (Compton et al., 2014).

 

Peer Support and Lived Experience

Involving peer support workers-individuals with lived experience of suicidality or mental health challenges-can provide a sense of understanding and connection that traditional clinical approaches may lack. Peer support can reduce stigma, increase engagement in treatment, and offer hope to those navigating their mental health journey.

 

Conclusion

Carceral approaches to supporting individuals navigating suicidality can often do more harm than good, leading to increased feelings of powerlessness, trauma, and stigmatization. By shifting to compassionate, trauma-informed, and client-centered approaches, we can create a system that genuinely supports healing and empowers individuals to seek help without fear of punishment. Understanding the profound impact of how we respond to crises is crucial to improving outcomes for those struggling with mental health challenges.

 

References

Compton, M. T., Bakeman, R., Broussard, B., Hankerson-Dyson, D., Husbands, L., Krishan, S., Stewart-Hutto, T. (2014).
The police-based crisis intervention team (CIT) model: Effects on level of force and resolution, referral, and arrest.
Psychiatric Services, 65(4), 523-529.
Jobes, D. A. (2016). Managing Suicidal Risk: A Collaborative Approach. Guilford Press.
Katsakou, C., & Priebe, S. (2006). Outcomes of involuntary hospital admission-a review. Acta Psychiatrica Scandinavica, 114(4), 232-241.
Livingston, J. D. (2016). Mental illness-related structural stigma: The downward spiral of systemic exclusion and discrimination.
Canadian Journal of Psychiatry, 61(8), 385-392.
Mental Health America. (2023). Disparities in mental health treatment.
Retrieved from https://www.mhanational.org/