Inmates Getting MH Care, But Quality Unknown

The chances are good that prisoners can get mental health care if they need it, according to a new report from the Department of Justice Bureau of Justice Statistics (BJS). The quality of that care, however, remains unknown.

The report, “Mental Health Treatment in State Prisons,” found that 89 percent of state adult correctional facilities provided some type of mental health service to inmates.

The survey captured data from June 2000 and is based on the 2000 Census of State and Federal Adult Correctional Facilities. The report featured data collected from all 1,558 state adult correctional facilities, although some facilities did not respond to each question.

The report, released on July 15, found that a range of mental health services is being provided—65 percent of the 1,558 state facilities conducted psychiatric assessments, 51 percent provided 24-hour mental health care, and 71 percent provided therapy and/or counseling by trained mental health professionals. The types of therapy provided were not determined in the census.

Furthermore, 73 percent of state correctional facilities administered to inmates a range of psychotropic medications, including antidepressants, stimulants, sedatives, and antipsychotic medications. Sixty-six percent of the facilities helped released prisoners obtain community mental health services.

In 2000, 1 of 8 prisoners used one of these mental health services, according to the BJS.

The incidence of mental illness among prisoners is significant—approximately 16 percent of all state inmates in this country were identified as having a mental illness in 2000, according to the BJS. This translates to 191,000 state prisoners out of a total of 1,179,214.

Last year 79 percent of this group received psychotherapy or counseling, and 60 percent received psychotropic medications.

Quality Unknown

Jeffrey Metzner, M.D., chair of APA’s Council on Psychiatry and Law, has done extensive work in state prisons and was not surprised that most state correctional facilities were providing mental health services to inmates.

“I think the findings are accurate. That’s the good news,” said Metzner. “Unfortunately, the survey was unable to access the quality of health care being provided.”

Metzner pointed out that there are several ways to gauge the quality of mental health care provided in prisons. For instance, asked Metzner, are there adequate numbers of mental health staff with credentials to provide services to inmates with serious mental illness in a particular prison?

“The answer is no in many state prison systems,” stated Metzner, who explained that rapid growth of the inmate population in the last 15 years hasn’t been accompanied by an increase in the mental health staff needed to treat mentally ill inmates.

It also depends on how the prisoner is serving his or her time. “If the conditions of confinement involve being locked in a 70-square-foot cell 23 hours a day for months at a time, it is unlikely that patients with mental illness could receive adequate mental health services,” Metzner said.

The report also found that 12 percent of the men inmates received therapy and counseling, while 27 percent of women inmates received these services.

“Women come in [to the prison system] with more problems than men,” said Cassandra Newkirk, M.D., chair of APA’s Consortium on Special Delivery Settings. She has worked in prisons for 20 years.

“The majority of female offenders have been physically or sexually abused as children or adults, and subsequent psychological problems and substance abuse are more prevalent among female prisoners for this reason.”

Indeed, a 1991 BJS survey showed that nearly 70 percent of women inmates had reported being subject to either sexual or physical abuse prior to incarceration.

The same survey showed that 65 percent of women inmates used drugs regularly prior to serving time in prison.

Newkirk also pointed out that women in the general population tend to seek out psychiatric and psychological services more than men do—and the prison setting is no different.

While BJS found that 155 state facilities across 47 states had segregated confinement for patients with psychiatric disorders, North Dakota, Rhode Island, and Wyoming lacked those confinement facilities. Thus, in these states, inmates with mental illness needing separate confinement are placed in state hospitals, prison infirmaries, or in special-needs units within general confinement facilities.

“Inmates appropriate for these units generally have had difficulty functioning in a general population environment due to symptoms related to their serious mental disorders,” commented Metzner.

Some prisoners with mental illness may be less fortunate and end up without care. Of the 1,500 adult state correctional facilities surveyed, 125 reported that they provided no mental health service to inmates.

So what happens to an inmate with mental illness who happens to be confined in one of these facilities?

“This is the $64,000 question in various class-action suits,” said Metzner, who explained that there have been many successful lawsuits related to the adequacy of mental health services provided in a certain prison.

According to Metzner, inmates and families file the suits because the inmates aren’t screened for mental illness or they were still sent to a prison that didn’t provide them with psychiatric care.

“Mentally ill inmates who are sent to such prisons receive inadequate care that often results in excessive suffering, deterioration in their clinical conditions, and increased behavioral disturbances that often lead to very restrictive confinements,” said Metzner. ▪