Telemedicine and Mental Health in Jails a New Tool for an Old Problem

Article excerpt

Historically -- and operationally -- one of the major problems for jail administrators has been handling inmates who are, or appear to be, mentally ill. An increasing number of inmates with mental illnesses are coming through facility doors as systemic deinstitutionalization sweeps across the nation.

Many jails are ill-equipped to provide mental health services for a variety of reasons:

* Because of their size or locale, many jails have little or no mental health assistance available, either internally or within the community. According to recent statistics, there are more than 3,300 jails and detention centers in the United States. Eighty-three percent of these facilities have 249 beds or fewer; 1,579 jails house 49 inmates or less. It is extremely difficult for many small facilities to have the level of mental health services that should be provided. There may be little or no mental health professionals in the surrounding communities capable of providing assistance to the agency.

* Lack of funding of mental health agencies prevents the provision of adequate local services. In South Carolina, for example, the Department of Mental Health has not had a significant budget increase in several years, yet the number of people each clinical staff member is expected to see and follow has grown dramatically. Caseloads, not only for that department, but for other agencies in the state, have grown in number and complexity.

* A lack of cooperation and communication between the facility and the mental health services provider may exist. It appears that in many areas, frustration and ignorance flourish because of a lack of communication between program and security staff -- especially concerning an explanation of their respective roles, and how they should complement each other's operations and not denigrate the other.

* An increasing workload on the mental health provider impacts its ability to provide timely services. As mentioned, caseloads on mental health professionals have greatly increased. This is due in part to the deinstitutionalization of the chronically mentally ill, increased entry of juveniles into family court and general session court systems, and an increased emphasis on sex offender programs nationwide. As a result, even in those areas in which mental health programs are available, the timeliness of service delivery can be significantly eroded -- to the point where the program becomes ineffective.

HOW DO WE ADDRESS THE PROBLEM?

Unfortunately, there still are some local detention agencies that provide only the level of mental health care that can be provided by a local hospital emergency room. Since third-party insurance payers exclude those in the criminal justice system, some facilities have been able to contract for mental health providers using inmate welfare funds. Others can tap into local indigent mental health care or regional teaching facilities, using psychiatrists, social workers and psychiatrists in training. One method that recently has become available is telepsychiatry.

During the past 30 years, the use of telemedicine has grown dramatically. Since its inception, the needed technology has become less expensive, more reliable and of better resolution. This allows more applications in medicine in general, and more recently, in all areas of psychiatry, including forensic psychiatry. The application of telemedicine has resulted in easier access to expertise and a significant cost reduction while maintaining high-quality patient assessment and care.

In 1994, the U.S. Department of Justice, in conjunction with the Department of Defense, established a Joint Program Steering Group (JPSG) designed to facilitate the use of military technology and developments in the criminal justice community. One project that came out of the JPSG was a three-year program on the application of telemedicine in the federal prison system. This project, which ended in late 1998, was supervised by JPSG's Biomedical Technology Department. …