Art As a Form Of Therapy For Inmates With Mental Illnesses in Zambian Correctional Facilities

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Correctional facilities were originally designed to punish criminal offenders or people who exhibited deviant behavior in society so as to keep the community safe and conducive for all. Over the years, most correctional facilities in the world have become overcrowded and understaffed due to a number of factors such as increase in crime,population, lack of expansion of existing prison facilities and lack of finances to pay wardens and counselors. It has also been seen that most of the inmates in these correctional facilities have mental illnesses that they are not treated for because they are too many and cannot all be attended to.

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In terms of specific illnesses, prison inmates tend to have the same disorders as the general population, but with greater frequency and intensity. According to the American Psychiatric Association (2004), the most common mental illnesses in the inmate population are depression, schizophrenia, and bipolar disorder, a finding that applies to prisons in both the United States and the United Kingdom (Gordon, 2002).

Inmates are also more frequently diagnosed with personality disorders, specifically antisocial personality disorder, which is usually characterized by antisocial or criminal behavior.

In recent years, art and story writing have been seen to be effective forms of therapy for incarcerated men and women as they provide a chance for them to express their emotions and re-evaluate their lives (Schwan, 2011). Several facets of prison life and culture render art therapy a good treatment for inmates. For example, verbal expression of extreme emotions sometimes leads to negative consequences. However, expression through art facilitates an intense expression in acceptable and appropriate ways (Gussak, 2006).

As prison populations are reaching record levels, debates around reading and writing in penal institutions are receiving renewed attention by scholars and policymakers in every country as they bring insight into what happens in these institutions and give recommendations on how to improve them. During the prison mapping exercise conducted by Kamocha (2005), it was observed that although Zambia’s prisons were built prior to 1964 to accommodate 5,500 prisoners, by October 2009 they housed 15,300 which was nearly three times the official capacity. Lusaka Central Prison had a higher number of inmates 1,560 against its holding capacity of 260 representing 503% more inmates than was originally planned (Mwanza, 2012).

Art therapy has a number of definitions, the Canadian Art Therapy Association defines it as the use of the creative process of art making and client reflection to improve and enhance mental, physical and emotional well-being of individuals (Canadian Art Therapy Association, 2017). Art is also defined as, “A form of therapy that helps people resolve conflicts and problems, develop interpersonal skills, manage behavior, reduce stress, increase self-esteem and self-awareness and achieve insight,” (American Art Therapy Association, 2013). Expressive writing is a form of bibliotherapy in which a person learns to put their thoughts, experiences and feelings on paper (Schwan, 2011).

BACKGROUND

Most of the research concerning art therapy for inmates has been done in the 21st century. However the earliest studies date back to as early as the 70’s when art was looked at as a form of counselling in developing self-concept by White and Allen. Silver and Lavin also did a study on the use of art to develop and evaluate cognitive skills. These and other studies gradually helped to develop the concept of art as a form of therapy intervention, usually used on adolescents. However, the aforementioned researchers did not really document how they performed the therapy in detail and the outcomes of their studies. This led other psychologists and art majors to make this an area of research so they could unearth more information. The studies therefore that will be presented in this section will be done so in a funnel shaped manner, beginning from 2000 till date and starting from the USA and UK to Africa and then Zambia.

Gunter (2000) found that art therapy in form of a “squiggle game” was seen to reduce stress reactions in children and adolescents undergoing bone marrow transplants by stabilizing the defense mechanisms of the children while they underwent this period of their lives. Later in 2002, Pifalo did a study on girls and young women who had been sexually abused between the ages of 8-17. He used a combination of art therapy and cognitive behavioral therapy to treat them and a significant reduction of anxiety, PTSD and dissociation was noted in the girls after ten weeks of this therapy.

Two years later, Ferszt et al (2004) did a study in which incarcerated adult women who had experienced the death of a loved one during incarceration undertook art therapy sessions for eight weeks. Seven out of eight of them said they had a positive experience and a safe place to grieve and let out their feelings after the therapy and signs of depression were seen to have reduced by the researcher at the end of the study. In the same year, Gussak worked with incarcerated adult males in Florida, USA looking to improve behavioral functioning and mood in participants of the study. After eight weeks of group therapy, there was an improvement noted in the mood and behavior of participants. Participating in art programs was seen to help inmates establish and maintain relationships with their families as the art could be given as gifts or simply a way to convey the thoughts and feelings that the inmates felt they could not express. It was also a creative way of passing time while looking for employment once they were released (Clements, 2004).

Art therapy has also been used in several studies to treat children and adolescents that have been sexually abused or undergone traumatic experiences in the Western world. In one particular study done in Scranton, Pennsylvania, in the USA twenty seven adolescent females were given therapy for one and a half years. They received residential treatment which included art therapy as part of their rehabilitation for committing felonies and at the end of it, self- esteem levels were seen to have risen in six of the eight participants (Hartz& Thick, 2005). Pifalo did a study as well in 2006 on children and young adults who had been sexually abused in Charleston, South Carolina, USA. He successfully used group therapy to reduce levels of anxiety and PTSD in patients.

Furthermore, Smeijsters & Cleven did an evaluation in the Netherlands, Europe on studies that were done by art therapists on different problem areas. They however focused on treatment of destructive aggression in adults in forensic institutions and cognitive distortions in children (Smeijsters & Cleven, 2006). Results indicated that using painting and stone work to decrease cognitive distortions and aggression adults in forensic institutions proved fruitful and improvements were noted in participants. Art in prison provides practical and psychological benefits that strengthen cognitive abilities and help inmates integrate knowledge, feelings and manual skills (Johnson, 2007).

A year later, Franks &Whitetaker (2007) discovered that weekly group art therapy could be used to treat adults diagnosed with personality disorders in London, UK. Art psychotherapy was combined with verbal psychotherapy sessions. The concept of Mentalisation is used in this study. Mentalisation is seen as the capacity to perceive and understand self and others in terms of mental states. Combination of treatments was effective and personality disorder traits were seen to decrease in all participants by the end of the study.

Erickson did a study in Florida USA, in female county jails to show that inmates who underwent art therapy and did expressive writing would have alleviated levels of distress and trauma symptoms would cease to exist or reduce after the experiment. Scores measuring psychological distress and trauma symptoms showed that both decreased over time for all study participants, however, treatment participants’ scores improved at a greater rate. In addition, the qualitative results were extremely positive, showing that the therapy was effective and well received (Erickson, 2008). It was noted that even just the possibility of participating in creative programs would reduce inmate offences if their good behavior would result in them being able to participate in certain programs (Johnson, 2008). Also, engaging in arts also increased self-esteem and decreased depressive symptoms (Gussak, 2009).

Still looking at the Western world, in 2010, Sutherland and other researchers did a study in Chicago, USA in which group art therapy was used when dealing with sexually abused girls between the ages of 8-11who live in children’s homes to reduce depression, anxiety, low self-esteem and sexual trauma. The Solomon-four group design was used in this experiment. The results showed a significant improvement in depression, sexual trauma and anxiety in the experimental group that was given the art therapy. An Art Therapy Connection Program (ATC) was designed to reach students who had limited or no access to mental health care and showed signs of inattentiveness, sadness, defiance, aggression, truancy and attention seeking. ATC therapists worked with students to help develop self-awareness and self-management skills by integrating art and creativity with therapy. This program helped teachers, support staff and administrators to observe the attitudes and behaviors of students and helped students to express themselves and the problems they may be facing. After a year in this program, aggressive behavior, defiance, sadness and truancy were seen to have reduced in the student’s behavior and there was a gap that was bridged between their inner world and the world around them (Sutherland et al, 2010).

Breiner et al (2012) developed an art therapy anger management program for male inmates in Florida, USA by combining cognitive behavioral therapy with art therapy. Art therapy graduate student interns from Florida State University were placed in local prisons and worked with psychologists to alleviate a number of illnesses. Art was seen to be effective in calming patients, reducing stress levels and nervousness. A study done by the California Department of Corrections revealed that institutions with art programs produced a savings of about $100,000 per annum (Brune, 2007). It was also seen to be a complimentary factor to cognitive behavioral therapy material by making it more understandable to patients and helping them to process the information so as to assess their learning abilities, personality traits and individual differences that influence their ability to process material.

In Africa, there have been some studies done on inmates concerning art therapy. In Nigeria, it was found that female prisoners reported high levels of sleeplessness, depression and emotional stress. It has also been noted that 75 percent of female prisoners suffer from various neuroses compared to 58 percent of male prisoners who suffer from similar illnesses. Some of the things that have been advocated for to make correctional facilities more conducive in Nigeria include adequate mental health professionals, proper counselling to reassure inmates of their self worth and protection against physical and sexual abuse by criminal justice agents (Agomoh, 2013). Correctional facilities consist of people who are on the economically and socially disadvantaged side of society and contrary to the ideal function of these institutions, most inmates are not rehabilitated and become worse in the dilapidating environment filled with violence, anger and hate. Art is a reformative activity that can help counter the negativity and hostility present in the environment. Artwork can even be displayed or sold, giving a sense of pride to the painter and boosting self-esteem and confidence.

In the late 1990s, people in South Africa began to recognize art as a form of therapy and community workers were equipped with therapeutic skills that enabled them to help other members of the community battling with different psychological disorders. The counselors are taught intermediate counselling, psychoanalytic theory and input around issues that are prevalent within the South African context including; the psycho social implications of HIV/AIDS, child abuse, and trauma (Gower, 2008).

A study was done in which three different psychologists were interviewed to determine the views of psychologists who practice art therapy in their fields of work and to see how art therapy is practiced in South Africa. The results showed that the participants of the study greatly approved of art therapy. They believed it helped clients to express themselves and unlock certain parts of their minds that might otherwise have been hidden. It was also seen as a useful medium of therapy for both children and adults, therefore it caters for a wide range of clients age wise. Another point stated was that it was good way to reflect, made therapy more engaging and was a good communication tool. Furthermore it was seen to cater for any kind of cultural background, making it easier to use. Lastly, it was also noted that art therapy was a good way to access the subconscious and emotional parts of a person and bring out suppressed traumatic memories (Gower, 2008).

Other benefits of art include the fact that it promotes health in individuals, stress and health complaints are reduced and the immune function is improved for both physical and psychological health. Art also provides access to multiple modes of intelligence, thinking, communicating and problem solving (Gardner, 1982). Psychological horizons are also enhanced through art. It shows how different cognitive styles, modes of representation and even processes considered to be deviant in certain contexts can open us up to creative possibilities and untapped powers of the human spirit. Apart from that, it increases consciousness, helping people to understand their reality, altered states and dreamtime (Schlitz et al, 2005). Lastly, art is social in that it represents cultural differences and creates a community. It reflects social change and can be used in conflict-resolution (Black, 1992).

Narrowing it down to Zambia, inmates in correctional facilities are overcrowded and as a result, do not receive adequate mental health care. In 2014, an audit was done on the National Security and Foreign Affairs on the Rehabilitation and Re-integration of Prisoners in Zambia. The audit was motivated by the fact that the Zambian Prisons Service was funded an amount of money to improve the state of the correctional facilities especially after many Members of Parliament and organizations raised concerns on the conditions of correctional facilities in Zambia. They expressed concern on the levels of congestion and the conditions in which prisoners lived in. Also, it has been noted that many inmates are never fully rehabilitated and fail to cope in society. The report given revealed that prisons do not subject prisoners to psychological counselling or therapy, there is a shortage of officers to conduct social counselling, and correctional facilities do not have qualified psychologists to conduct psychological therapy. Correctional facilities also do not maintain records for individual or group social, psychological or spiritual counselling and most did not have chapels to host chaplaincy programs. Furthermore, those detained under His Excellency’s Pleasure were detained in prisons, instead of mental health institutions and did not receive any therapeutic treatment programs due to lack of psychologists and psychiatrists. It was concluded that there was no systematic coordination between Zambian Prisons Services, churches and the community at large due to lack of effective communication between them. Sensitization programs are also not as effective and ex-convicts are exposed to stigma from the community. Although art has been realized as a form of expression in Zambia, it has not been used a therapeutic treatment for inmates in correctional facilities (Chifungulu, 2014).

An NGO called Zambia Therapeutic Art provides art therapy courses to help bridge the gap in psychological approaches to mental health care. A study done on inmates in Lusaka Central Prison showed that about 63.1 percent of the population suffers from mental illnesses (Nseluke, 2011). A number of mental health professionals were trained in 2015 and 2017 by this NGO and the findings showed that therapeutic art gives positive results such as increased communication between therapists and their patients, increased knowledge of the patient, patients felt that they had an opportunity to be heard and expressed their feelings of recovery. Art is beneficial to patients in that they are able to access their memories and feelings, their concentration levels are improved, they are more relaxed, they engage more in social activity and they are distracted from the symptoms of their illnesses (Hill et al, 2018).

STATEMENT OF THE PROBLEM

The number of incarcerated men and women diagnosed with mental disorders is growing day by day due to many factors, in and out of correctional facilities (Mwanza, 2012). A study in 2011 by Nseluke found that the prevalence rate of mental illnesses in incarcerated men and women at Lusaka Central Correctional Facility was 63.1 percent and men and women who were married were less likely to develop mental illnesses by 40 percent. As at September 2017, it was recorded that 20-30 percent of the general Zambian population have mental health problems (Chokwe 2017). Because, those who are incarcerated have limited access to mental health treatment, traditional therapies such as cognitive behavioral therapy, EMDR, and exposure therapy which require intense and individual counseling attention are not practical in a prison setting. . Research has shown that when men and women are incarcerated, they tend to lose their identity and have a problem with identifying in society when they are released leading to frustration, depression and recidivism in most cases (Brinkman, 2017).

JUSTIFICATION OF THE STUDY

In Africa, Zambia specifically, there have been limited studies done on this form of therapy for inmates. This study will increase knowledge on this subject and offer recommendations on how best to perform this form of therapy in our environment as opposed to studies done in the US and UK. The art therapy treatment used in this study can be applied in group settings allowing more inmates to receive treatment and cater for more than are being treated at the moment. The studies done over the years have shown that this treatment can be used for adults and adolescents in these institutions and is cost effective while reaching out to as many patients as possible. It will also help tackle the problem of incarcerated men and women losing their identity and reduce chances of recidivism by giving them a chance to re-identify themselves and treat disorders that may hinder their re-entry into society.