Treating Mentally Ill Inmates

By Gater, Laura | Corrections Forum, January/February 2006 | Go to article overview

Treating Mentally Ill Inmates


Gater, Laura, Corrections Forum


The mentally ill make a more substantial proportion of those incarcerated than of the general population. A 1999 study reported that an estimated 283,000 inmates in prison or jail were mentally ill (Mental Health and Treatment of Inmates and Probationers, U.S. Dept. of Justice, Bureau of Justice Statistics, July 1999). Female inmates reported a higher rate of mental illness than males. Not surprising to many, mentally ill offenders reported high rates of homelessness, unemployment, alcohol and drug use, and physical and sexual abuse prior to their current incarceration.

The good news is that the pieces of the puzzle are being put into place for treatment of mentally ill inmates, according to those interviewed for this article. Newer, more effective drugs, along with cognitive behavioral therapy, and teaching self-management skills all play a part in improving treatment and behavior.

Upon intake, inmates who need mental health services are identified immediately, and all prisoners can be referred to mental health services at any time they need help.

Often they have temporary symptoms. "If they aren't mentally ill, they could have at-risk symptoms for suicide and other problems that aren't mental illness," says Carole seegert, Ph.D., a senior psychologist for MHM Services, Inc., in Georgia. "Many of them are self-medicated and are now trying to deal with a new environment without their 'crutch.' These inmates are generally seen by an upper-level psychiatrist or psychologist for an evaluation to determine what level of care they need: outpatient, inpatient or crisis housing."

In Georgia, as in many other states, the different treatment options available to inmates depend on the facility in which they are housed.

"What dictates the degree and intensity of treatment is their condition," explains Jeff Kesler, PsyD, VP, Correctional Medical Services (CMS), St. Louis, Missouri. CMS, along with other mental health service providers, offers a continuum of care, treating the inmate from intake through release and often helps provide and/or arrange transitional and aftercare when the inmate is released.

Compliance Not Mandatory

Charles Woodley, PhD, Montgomery, Ala., chief psychologist for MHM, notes that the compliance rate is linked with the quality of the overall inmate treatment program.

"If the individual refuses treatment, we encourage him," Woodley points out. "If he refuses services and suffers from severe mental illness, we become more aggressive with the implementation of treatment. We can provide involuntary medications in order to bring them under control and improve his quality of life. The inmate has the right to refuse treatment and refuse medication. If he does so, we follow a due process measure. The chief psychiatrist and I and a lay adviser-who is anyone at the facility who will be the inmate's advocate and make sure his wishes are heard-will call a hearing. The inmate may attend the hearing and represent himself."

CMS's Kesler knows that for many whom are incarcerated, it may be the first time in their life that they are receiving mental health treatment.

"Many prisons provide very good mental health treatment," he says. "If an inmate doesn't show up for an appointment, we go find them. Their access to care and treatment options far exceed that in the community."

Innovative Ideas

The Mental Health Consensus Project, coordinated by the Council of State Governments, has helped states receive technical assistance that facilitates communications between correctional facilities and mental health agencies. Some of the states' projects include analyzing and replicating a discharge planning program for offenders with serious mental illness and developing a process by which prison and behavioral healthcare can be synchronized systemwide (Kan.); identifying and analyzing jail and behavioral healthcare data to track outcomes for a population and assess impact of re-entry programs (Philadelphia); and collecting and analyzing data from jail and community mental health centers for offenders with major mental illness referred to a diversion program (Orange County, FIa. …

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