A court-ordered expansion of California's mental health system for
prisoners could help close a long-running deficit of psychiatrists in the
system and affect funds earmarked to pay psychiatrists in public health
systems throughout the state.
The state has scrambled to improve mental health care for inmates since
U.S. District Judge Lawrence karlton in Sacramento ruled in 1995 that prison
officials showed deliberate indifference to the needs of mentally ill
prisoners. Soon after the ruling, the judge appointed Michael keating as
special master of mental health for the state prison system. In April, still
unhappy with mental health care in California prisons, Karlton ordered the
state to spend more than $600 million to improve mental health services,
including building new hospitals with space for 695 inmates.
Karlton's latest order, which came in July, required Gov. Arnold
Schwarzenegger (R) to ask state lawmakers for the money to hire 552 additional
mental health staff, ranging from psychiatrists to therapists and nurses.
Although the governor had not proposed a breakdown of how many employees would
be hired in any mental health staff category as of press time, state officials
estimated the new hires could cost more than $30 million annually.
The increased focus on filling new and existing mental health staff
positions would be a drastic change from the state's standard hiring practices
and incentives, which resulted in a 23 percent vacancy rate among prison
psychiatrists. The system has about 300 full-time psychiatrists and about 90
vacancies, according to the Union of American Physicians and Dentists (UAPD),
which represents public psychiatrists in the state.
Gary robinson, executive director of UAPD, said the state was unlikely to
fill the open positions or new psychiatrist positions had salaries not been
increased in July. At that time, the prison psychiatrists got a 13.5 percent
court-mandated salary increase—the first since 2003—which raised
the starting salary from $160,000 to about $175,000 a year. Psychiatrists are
slated to get another 5 percent boost January 1, 2007.
"Salary has been a big barrier; that's why [judges and state
officials] had to go for this 13.5 percent raise," Robinson said."
There is not a lot of psychiatrists who want to work in a prison. It's
a tough job."
Robinson said it is "entirely possible" for an increase in
prison psychiatry salaries to lead to an increase in psychiatrist salaries
across the public health care system so that other care settings remain
competitive. The Department of Mental Health (DMH) has since requested a 10
percent increase for DMH psychiatrists.
"For many years there haven't been psychiatrist salary increases, and
they fell behind," he said. "This is catch up now," Robinson
said about the prison system to Psychiatric News.
During the August special legislative session—called to address a
variety of prison health care issues raised by law-suits—UAPD opposed
the construction of new prisons, preferring that the money be invested in more
rehabilitation programs and halfway houses and an expansion of the parole
system. If new facilities are funded, UAPD urged the construction of new
prison hospitals so that the number of prisoners who can be treated for mental
illness and other chronic health conditions can be increased. The union also
pushed for full funding of previously approved mental health staff
Schwarzenegger proposed building or contracting for community correctional
and "re-entry" facilities that would provide mental health care
and other services. An estimated 4,500 female inmates would be moved to
similar facilities, which would free a women's prison for use by male inmates
at a cost of $2 billion.
Phil Angelides, Democratic candidate for governor, promised to boost
education, training, and treatment programs for inmates if he wins in
Schwarzenegger previously announced plans to build two prisons and new
units in existing prisons to relieve extreme inmate overcrowding, estimated to
cost $6 billion, according to Acting Corrections Secretary James Tilton.
In a July report, Keating, the court-appointed master, criticized the state
prison system's mental health effort, saying that the state's Department of
Finance had not sought the necessary resources to bring prison mental health
staffing in compliance with the judge's requirements.
The special master's report did not delineate what positions would be
needed or how much they would cost. It did state that the number of suicides
in the prison system is "soaring." Prisoner advocates said 40
inmates committed suicide last year, and the number increased to 25 inmates in
the first six months of 2006. The number of suicides in 2005 exceeded the
previous record of 36 in 2003.
Many of the suicides occurred in the prisons' "administrative
segregation units" or solitary-confinement cells, where those with
mental illness are often kept.
Randall Hagar, the California Psychiatric Association's director of
government affairs, told Psychiatric News that "obviously the
state's efforts to recruit and retain psychiatrists have failed."
Hagar said the psychiatrist salary increases and additional positions will
likely "create a squeeze elsewhere" in the state public health
system, such as in hospitals and community health centers.
"We expect a domino effect on salaries throughout the health care
system," Hagar said. "We already find vacancy rates throughout the
public health sector that are fairly high and limit access to mental health
Some prisoner-rights advocates have called for creation of a new department
for prisoners with mental illness, or as an alternative that the state move
them to DMH facilities. The only prisoners now treated by DMH are those who
have completed their sentences but are deemed a continuing threat and are
civilly committed. Almost all of the roughly 5,000 patients in state mental
hospitals are forensic patients, said Hagar.
"We feel that mentally ill prisoners ought to be afforded special
facilities to accommodate them," Hagar said. "It's bad enough they
are incarcerated, but at least they need to be cared for
Information on Schwarzenegger's proposed prison system health care
funding increases is posted at<www.ebudget.ca.gov/Revised/BudgetSummary/CLE/8875412.html>.▪