Magazine article Corrections Forum

Challenges in Inmate Mental Health

Magazine article Corrections Forum

Challenges in Inmate Mental Health

Article excerpt

The scope of mental health problems in correctional facilities is diverse and challenging. Although diagnosis and treatment services are provided at nearly all jails and correctional facilities around the country, many obstacles affect the level of care that inmates receive for their mental illnesses.

The high prevalence of mentally ill prisoners is considered a consequence of the deinstitutionalization of mental health programs nationwide, which have resulted in the incarceration of the mentally ill. Two to four percent of inmates in state prisons and 1.0 to 1.1 percent of jail inmates have schizophrenia or another psychotic disorder, according to the National Commission on Correctional Health Care's (NCCHC) clinical guidelines for the treatment of schizophrenia in correctional institutions. The guidelines also cite the fact that many of these mentally ill inmates have other risk factors "associated with a higher incidence of violent behavior," such as substance abuse, neurological impairment, and poor impulse control.

One of every eight state prisoners was receiving mental health therapy or counseling services in mid-2000 (Bureau of Justice Statistics Special Report: Mental Health Treatment in State Prisons, 2000), and nearly 10 percent were receiving psychotropic medications, such as antidepressants, stimulant, tranquilizers, sedatives and other anti-psychotic drugs. The use of these drugs was the most common in facilities specializing in mental health confinement.

Corrections Staff Often Overwhelmed

The sheer number of people that are incarcerated with preexisting mental illness is the crux of the problem, according to Cassandra Newkirk, MD, director of mental health at Riker's Island in New York.

The large numbers of mentally ill inmates, ranging from depressed and sometimes suicidal to schizophrenic and a variety of other serious illnesses, can sometimes overwhelm the corrections staff. Not all staff members are trained to handle the mentally ill, while some facilities just don't have staff members who are specially trained in the area of mental health. Corrections or jail staff members, whether or not they are part of the health care team, may not have training or experience in dealing with depressed and/or suicidal people-another shortcoming for those who need experienced caregivers.

An added problem in the lack of adequately trained staff members to handle mentally ill inmates is the fact that many prisons are located in remote areas where there is often a lack of trained healthcare workers. In addition, many of the older jails and prisons are not pleasant places to work, according to Newkirk.

The high numbers of mentally ill inmates, lack of adequate staff, lack of properly trained staff, and the prison location and available workforce all contribute to the scope of mental health problems in prisons and jails today. Add the lack of available funding for corrections mental health services, and you have a huge scope of the problem facing the treatment of inmates with mental illnesses.

"My practitioners do the best they can with what they have," points out Newkirk.

Stressed Out Inmates

"Inmates with schizophrenia or other psychotic illnesses are under more stress from incarceration," explains says Gary Seven, MD, CCHP, regional medical director, MHM Services, which serves the Oakwood Correctional Facility, Columbus, Ohio. "When they violate rules, they are transferred to maximum security. Many of them have been segregated, causing their mental illness to deteriorate further."

Even though the facility is maximum security, inmates are taken out of their cells for a minimum of 10 hours a week, for daily visits with a psychiatric nurse, and to participate in group and individual counseling and programs. The programs range from learning how to control anger to substance abuse to music and art therapy.

A schizophrenic inmate in a medium security facility, for example, who discontinues his medication and becomes paranoid or delusional and attacks another inmate may be placed in solitary confinement. …

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