In the post-World War II era, America embarked on the deinstitutionalization movement for chronically mentally ill psychiatric patients. The Communities Mental Health Centers Act of 1963 argued that patients should be treated in the least restrictive environment through the support of community interventions (Rochefort, 1984). Developments of new psychiatric medications at the time, such as Chlorpromazine, allowed for the reduction in numbers of patients in psychiatric institutions. During the last 30 years, community interventions supplemented by occasional psychiatric hospitalizations have been the bedrock of mental health treatment. The shortcomings of the system and resultant reinstitutional-ization of mentally ill individuals has been well-documented (Fakhoury and Priebe, 2007). As early as the 1970s, it was noted that the number of individuals with mental illnesses who were incarcerated was at a level comparable to (or greater than) those in mental health institutions, as individuals with mental illnesses were taken from mental health institutions, put in the communities and then arrested. During the last three years, the National Alliance on Mental Illness (NAMI) has documented the vast budget cuts within state mental health funds (Honberg, Diehl, Kimball and Grutardo, 2011; and Honberg, Kimball, Diehl and Ush, 2011). As noted in the reports, there has been a significant decrease in funding for mental health services across the U.S., while there has been an increase in homelessness, psychiatric hospitalizations and incarcerations.
Prison systems have become the new "psychiatric institutions of last resort." The early warning signs of this problem were met with little funding and support (Lamb and Weinberger, 1998). Early statistics ranged from 10 to 15 percent of incarcerated individuals having a mental illness (Torrey, Stieber, Ezekiel and Wolfe, 1998). However, new data shows an increase to anywhere from 30 percent to 46 percent (James and Glaze, 2006; Craig, Stroud and Deol, 2012). Identifying and raising awareness of the crisis at hand is only part of the solution. Current departments of correction are asked to do more with less as a noble attempt to get by. However, creation of training programs, policies and procedures are at the heart of fixing the problem. Agencies are being told by budget committees that holding out for increased funding is a "Band-Aid approach," and instead they should look for solutions that do not rely solely on funding. Outlined below are some of the changes the Iowa Medical and Classification Center (IMCC) and the Iowa Department of Corrections (IDOC) have made to better facilitate care for offenders with mental illnesses.
Mental Health Curriculum
One of the cornerstones of the culture change in IDOC was the mental health curriculum that was implemented in 2011, and still continues today. Through collaboration between NAMI and IMCC, and with support from the National Institute of Corrections, a training curriculum was developed for all staff. The result was a 16-hour, two-day training on criminal justice and mental health. The training was implemented first at IMCC with 100 percent staff participation, and then later introduced at the other Iowa institutions. The initial results of the training for IMCC have been promising. There has been a reduction in critical incident reports, use of force, time in restraints and assaults on staff and offenders. Specifically. one year after the training, there was a reduction of 375 total critical incident reports and a reduction of 197 in the number of critical incident reports involving mentally ill offenders (Craig, Stroud and Deol, 2012). Moreover, the Forensic Psychiatric Hospital at IMCC began to track time in restraints in hours rather than days. and that averaged about 117 hours per month--most of which were requested by the patient. It should be noted that most of these hours in restraints were requested by the patients. Staff have taught patients to be more proactive, to self-monitor and to self-intervene before they have an outburst. In these situations, patients often request restraints so they know that they cannot act out. and report feeling safer.
The program includes education about the categories of mental illnesses and the biological basis of behavior. These areas provide basic information on types of psychiatric conditions and their underlying symptoms. as well as outline some of the biological mechanisms involved. There is an emphasis on the notion that, in certain circumstances, individuals with mental illnesses are not responsible for their actions. As a result, effective strategies should be utilized to minimize behaviors that lead to the harm of self or others, as well as other serious disruptions in the institution. This should be done by minimizing the use of unduly harsh methods. Community NAMI volunteers describe their unique experiences living with or caring for individuals with severe mental illnesses, thus providing the staff with some empathic experiential perspectives. The training also includes role-playing scenarios that allow participants to practice some of the new techniques they have learned and to receive feedback. Lastly, there is a section on taking care of one's self. Compassion...