Inmate mental health care.

Position:Survey Summary - Geographic overview

On average, 26.5 percent of the inmate population was diagnosed as mentally ill on Dec. 31, 2010. according to responses received from 44 of the 47 U.S. adult correctional systems that provided information for this current survey. This is an increase from the previous survey on the topic that was published in the September/October 2008 issue of Corrections Compendium.

Specifically. Minnesota indicated that 25 percent of its male population and 75 percent of females were so diagnosed, but those details were not computed in the average stated above. Arkansas, Mississippi and North Carolina reported that 10 percent or less of their populations were diagnosed as mentally ill. while Alaska. Iowa, Nebraska, North Dakota, Oklahoma, Oregon and Vermont noted such a population at 40 percent or higher. Maine tallied the highest population diagnosed as mentally ill at 70 percent.

When asked to provide the percentage of those diagnosed as seriously mentally ill. the approximate average was nearly 16 percent as reported by 41 of the responding systems.

Mental Health Testing

Each of the 47 responding U.S. systems initially screen for mental health issues at intake. Such screening is completed within 24 hours in Indiana, Louisiana, Massachusetts and Pennsylvania; within seven days in Maryland; within 14 days "in both Florida and Kentucky: and within 72 hours in New Jersey. Newly arriving inmates in New York are first tested by representatives of the New York State Office of Mental Health and then by department staff for suicide prevention.

Following initial screenings and diagnoses of positive mental illness, there still is a waiting list for treatment in seven of the responding systems. North Dakota indicated that there is no waiting list for those considered seriously disturbed.

To pay for such testing and treatment, 54 percent of the responding systems include a line item for mental health in their overall departmental budgets, an increase of 10 percent from the previous survey. Budgets were increased to accommodate the growth in numbers in 20 of the responding systems and remained the same in 12. Due to current economic situations, 11 systems suffered decreased funding for their mentally ill populations.

Staffing Issues

Despite the burgeoning number of inmates diagnosed as mentally ill, 12 reporting systems received a decreased budget for staffing in the field from Jan. 1 to Dec. 31, 2010. At the same time, 19 responding systems showed an increase in their staffing patterns, while 15 systems experienced no changes.

Forty-two responding systems (89 percent) require that special training be given to correctional officers and supervisors working directly with mental health inmates. While Minnesota and South Dakota do not require such training, and South Carolina strongly encourages program participation by its overall staff, Kentucky trains all staff in related mental health issues. Montana notes that it is in the process of developing a training program.

Mental health professionals are required to receive special training on security issues and procedures in 45 of the responding systems (96 percent). Georgia offers orientation and annual 16-hour in-service training and, again, Kentucky trains all staff in security issues and procedures.


Dual diagnosis screening is conducted in 45 of the responding systems (96 percent), while screening in New Mexico covers only inmates with known addictions, and then not by mental health staff. Therapeutic approaches to treatment are quite varied, as described in Table 3. For determining the potential risk of violence in their mentally ill population, 15 responding systems do not identify specific assessment instruments; the methods used by all other reporting systems also are stated in Table 3.

After determining that some of the mentally ill inmates may be at risk for committing violent acts, all but four of the reporting systems--Montana, New York, Ohio and Washington--place those inmates in separate housing units. As for those inmates with serious mental illness and who commit acts of violence, numerous sanctions are in place for the disposition of their cases. Disciplinary hearings are primarily indicated, which include a variety of committee makeup/treatment teams and established procedures.

Medication Procedures

The use of telemedicine for psychiatric services is in place in 36 of the reporting systems, though Washington incorporates the feature primarily in rural areas. Following assessments/screening/evaluations conducted by mental health clinicians, nurse practitioners, psychologists, etc., a staff or vendor psychiatrist is the ultimate prescriber of medications in nearly all the systems.

There are no specific limitations imposed on the use of psychotropic medications in Alaska, Kansas, Louisiana (generally), Maryland, Minnesota, Mississippi, Montana, Nebraska, New Jersey, North Carolina, Tennessee, Texas, Utah and Wyoming. In the remaining reporting systems, formulary or developed nonformulary treatment plans are established, as described in Table 4. In some systems, inmates may be placed only in facilities that already provide available mental health services.

While inmates have the right to refuse treatment, there are numerous procedures in place for the involuntary administration of psychotropic medications. A medical review panel may be formed; a civil commitment process is executed, as defined by Florida statute or in Wisconsin; medications are permitted in Maine only when there is a court-appointed guardian; short-term medications can be given for up to 72 hours in Mississippi; or permitted only as an inpatient procedure in Texas.

Co-pay plans for mental health services are active in only seven of the reporting systems and the range of payments is from S2 in Utah to $6 in Mississippi.

Release Services

Each of the reporting systems offer some sort of referral to appropriate outside agencies or make appointments with community providers, either prior lo or upon release. Direct referrals are made with area hospitals or psychiatrists for those who need such continuation of treatment, or assistance is given for completing identification papers or social security applications, etc. Placement in specialized housing also may be facilitated if needed. Aftercare services are offered in many of the systems and some even indicate specific timeframes for service provision.

A supply of medications is provided for those being released from mental health treatments ranging from five days in South Carolina and seven days in Arkansas, New Hampshire and West Virginia, to 14 days in 13 systems and up to 30 days in 27 of the reporting systems. Pennsylvania does provide up to 120 days of medications based on the inmate's category at time of release. Prescriptions are not provided in 24 reporting systems. The length of the prescriptions offered by the remaining systems varies from 14 days to 30 days.

For information on surveys featured in this or past issues of Corrections Compendium, contact Cece Hill, CEGA Services Inc., P.O. Box 81826t Lincoln, NE 68501; (402) 420-0602

When asked to provide the percentage of those diagnosed as seriously mentally ill, the approximate average was nearly 16 percent as reported by 41 of the responding systems.

INMATE MENTAL HEALTH Table 1: Numbers SYSTEM INITIAL BASIS USED FOR PERCENTAGE SCREENING MENTAL ILLNESS OF TOTAL DETERMINATION POPULATION DIAGNOSED AS MENTALLY ILL ON DEC. 31, 2010 General ALABAMA At intake DSM criteria. Axis 11% I, chronic and persistent Axis II. presents a clinical picture ALASKA At intake Offender reports, 42% collateral information, clinical interviews ARIZONA At intake History analysis, 25% family relationships, education level, etc.: current mental status; preliminary DSM-IV diagnosis ARKANSAS At intake Prior history, 6%: observed behavior, approx. self-reporting, DSM-IV diagnosis CALIFORNIA No response COLORADO At intake DSM-IV. prior 31% history, observed institutional behavior CONNECTICUT At intake Court Information, 19.5% staff observation, behavior at screening, DSM criteria DELAWARE At intake Face-to-face 20% comprehensive mental health evaluation by a licensed professional: psychiatrist appointment is scheduled if needed. FLORIDA Within 14 DSM-IV criteria 18%, days approx. GEORGIA At intake Self-reporting, 17% prior history, psychological testing HAWAII At intake Prior history, past 22% provider records. DSM-IV diagnosis by professional staff IDAHO At intake Face-to-face 22.7% interviews, review of available records, assessment by professionals if symptoms indicate ILLINOIS No response INDIANA Within 24 Presence of Axis I 19.4% hours disorder, exclusive of substance abuse/dependence and paraphilia (sexual arousal) IOWA At intake DSM-IV criteria and 46.5% review of histories, prior records, symptoms and current medications KANSAS At intake Signs and symptoms, 38% psychological clinical interview, testing and diagnosis KENTUCKY Within 14 Axis I diagnosis 37 9% days LOUISIANA Within 24 DSM-IV; 20% to 25%, hours psychological approx. assessment that includes personality. IQ, achievement, and substance abuse; review of records; a clinical interview MAINE At intake DSM, Axis I and Axis 70% II diagnosis MARYLAND Within 7 DSM-IV. Axis I 18% days diagnosis, interview. analyzing past records MASSACHUSETTS Within 24 DSM-IV, Axis I and 24.6% hours Axis II diagnosis MICHIGAN At intake Exit/entrance 17.1% outlier (unusual pattern), DSM and GAF (Global Assessment of Functioning) diagnosis MINNESOTA At intake Assessment based on 25%, men; having a valid 75%. women diagnosis and relevant functional impairment MISSISSIPPI At intake DSM-IV criteria 6.6% MISSOURI At intake Diagnosis prior to 16.8% history analysis MONTANA At intake Self-reporting, past 25% records: DSM-IV criteria NEBRASKA At intake DSM-IV. Axis I 40% criteria NEVADA At intake Presentence report, 20%, clinical interview, approx. prior records when indicated...

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