Friday, August 3, 2012

Mental Health Care in Idaho Prisons

The basic idea behind the article is to imagine this scenario "the Director of the agency you are interning for wants to run for political office this year. She needs to know the full story on the issue of mental health care in Idaho prisons, which will come up on the campaign trail. She has asked you to develop a written briefing on the issue, as well as make a suggestion on what side of the issue she should take. If you do a good job she will hire you to help with her campaign, as well as be on staff if she wins." 

                                                                    Introduction: Issue, Policy, Problem:  
“ At any given time in many states, one in six ( a rate three time higher than the general population) inmates are suffering from a serious mental disorder such as schizophrenia, bipolar disorder, or major depression” (Cassel, 2007) During the 1980s and early 1990s, the pace of deinstitutionalization accelerated as states realized they could save funds by closing hospital beds. In 1955 there had been 558,239 patients in the state mental hospitals; by the end of 1994, this figure had decreased to 71,619, meaning that 87 percent of the hospital beds had been closed. The fate of the discharged patients was not seen as a concern to politicians or local law enforcement officials. (Torrey, 2010) Many correctional officers and prison administrators are ill equipped to work with mentally ill prisoners. Correctional officers come into the correctional field expecting to deal with prisoners but are undertrained and under educated when it comes to dealing with serious mental illnesses.

In 2008 a state prison warehouse that Gov. C.L. "Butch" Otter wanted to turn into a 300-bed facility to house people the state deems too dangerous to themselves failed to come to fruition. Instead this warehouse was turned into a facility called Correctional Industries, a self-sustained shop that trains offenders in medium and lower level custody the ability to learn a marketable trade. Correctional Industries employs staffers to teach skills like carpentry, metal working and print services. The items that are built here are sold to the private sector for profit and the money generated is used to fund the program. While a very innovative way to generate money using the prison population, it still does not address the growing population of inmates who need psychiatric help. Instead of a dedicated facility, inmates with mental illnesses are housed in administrative segregation at the Idaho Maximum Security Institution. If they are violent or have violent tendencies they are placed in individual cells and are allowed out only one hour a day in segregated recreational yards that are 10’ by 10’ chain linked “cells”. It is important for Idaho to embrace a methodology of recovery and fund the building of a mental health facility that is staffed by those trained to deal with serious mental illness. Not to simply lock them away in a cell and hope that by medicating them they will simply be “out of sight, out of mind”.  In this analysis the scope of the issue will be identified as well as the impact this topic has on our community and state. It will also address several methods that can be implemented to provide a continued quality of life for those diagnosed with mental illness as well as move the care of mentally ill people from the hands of the Idaho Department of Corrections to the hands of trained professionals.

                                                                                           History and Scope of Issue:
     When the government began closing state-run hospitals in the 1980s, people with mental illness had nowhere to turn; many ended up in jail. With the lack space in hospitals the county jails and state prisons had no other choice but to become the default treatment center. (Staff, 2011) Prisons are overcrowded and the United States has seen a dramatic increase in incarceration rates in both state and federal institutions 2,019,234 people were incarcerated in U.S. prisons and jails by mid-2002. The federal prison population increased by 8,042 persons – 5.7%, between 2001 and 2002. State prison populations increased by 12,440 people – 1%- between 2001 and 2002. Local jail populations increased by 34,235 people – 5.4% between 2001 and 2002. Between 1995 and 2002 the average increase in the incarcerated population per year has been 3.8 % overall – 8.1% for federal prisons.
     But this is not a new issue, in 1841, Dorothea Dix brought to the Massachusetts Legislature attention that the sick and insane were "confined in this Commonwealth in cages, closets, cellars, stalls, pens! Chained, beaten with rods, lashed into obedience." After touring prisons, workhouses, almshouses, and private homes to gather evidence of appalling abuses, she made her case for state-supported care. Ultimately, she not only helped establish five hospitals in America, but also went to Europe where she successfully pleaded for human rights to Queen Victoria and the Pope. (US History, 2012)
        In 1841 Dr. John Galt took over the superintendence of the Eastern State Hospital in Williamsburg, Virginia, the first publicly supported mental state hospital. It was a triumph for the time because it was the first publicly supported hospital dedicated to the sole treatment of the mentally ill.  Dr. Galt, a pioneer in his time in the treatment and the rehabilitation of those suffering from psychological disorders introduced Moral Management Therapy This taught, as Dr. Galt said, that the mentally ill "differ from us in degree, but not in kind" and are entitled to human dignity. Dr. Galt introduced therapeutic activities and talk therapy. He was probably alone among contemporary asylum superintendents to advocate that the psychiatric hospital undertake in-house research and claimed to treat African-American patients on an equal footing with whites. Dr. Galt used restraint very sparingly (one year restraining none) and sought a calming medication to replace restraint. He dispensed opium liberally to patients in a foreshadowing of our twentieth century neuroleptics. In 1857, Dr. Galt was the first to advocate deinstitutionalization and community-based mental health care. Dr. Galt and Eastern State Hospital introduced all the components of the modern psychiatric hospital -human dignity for the mentally ill, therapeutic activities, talk therapy, calming medication, in-house research, deinstitutionalization, and community-based mental health care. (Eastern State Hospital, 2012)
      With these great advances in the care of those with mental illnesses seen almost 141 years ago, the United States and Idaho have regressed greatly due to simply put money. In the 1970 and 1980’s Ronald Reagan was governor of California he systematically began closing down mental hospitals, later as president he would cut aid for federally-funded community mental health programs. It is not a coincidence that the homeless populations in the state of California grew in the seventies and eighties. The people were put out on the street when mental hospitals started to close all over the state. (Fabian, 2004)
                                                                             Perspectives & Analysis of Policy:
      Idaho currently has two psychiatric hospitals State Hospital South in Blackfoot which provides inpatient treatment for adults and children. The hospital works in partnership with families and communities to enable clients to return to community living. The second state hospital is State Hospital North located in Orofino which is a 55-bed psychiatric hospital that provides treatment for adults in psychiatric crisis. The hospital is intended to be of short to intermediate duration with the objective of stabilizing presenting symptoms and returning the patient to community living in the shortest reasonable period of time. The commonality of these hospitals is to provide treatment for short durations of time and get them back into the community, a Band-Aid to the real problem, consistent care and consistent treatment.
      The economic downturn has made an impact on the state of Idaho and the mass unemployment has exacerbated and caused deep cuts in the economic support of public money to the care and treatment of those with mental health issues. Gov. C.L. "Butch" Otter recommended budget for the Idaho Department of Health and Welfare's mental health services division during the next fiscal year, which begins July 1, is about $32.4 million. That's down 4.6 percent from the current fiscal year and a full 19 percent less than in 2008 two years after he took office. The division of Health and Welfare has laid off or left unfilled 35 full-time positions to assist adults with mental health problems, and another 14 positions to help Idaho youth. About 450 people in the past year have been referred to out of state mental health programs or to private providers amid the staffing cuts and budget holdbacks in 2009 and 2010. (Bonner, 2011)  Idaho is sending its problems to other states instead of helping them here and allowing them to re-integrate back into society. When those who commit crimes can’t be sent away they are placed in the Idaho Department of Corrections prison system where the state becomes responsible for their daily needs.
                                                                               Impact of Policy & Analysis:
     Currently, Idaho has no published policy on the treatment of those with mental illnesses. Idaho uses many out of state resources to minimize the cost of dealing with the mentally ill. An example can be drawn from the use of the Oregon’s suicide hotline. Since Idaho does not currently have a hotline, people in crisis are directed to call the Oregon help center. Why? Simply put the state government does not have any financial obligation nor does it need to provide trained counselors or professionals to staff a state center. The State of Idaho provides state funded and operated community based mental health care services through Regional Mental Health Centers (RMHC) located in each of the seven geographical regions of the state.
      The idea of deinstitutionalizing mental health care and the treatment of those who suffer from mental disorders was a well-intentioned idea, the failure to provide outpatient care that revolved around the idea of recovery and the ability to return and function in society is easily one of the biggest failures of the 20th century. Today, in many states including Idaho, the continuation of closing hospitals or limiting the number of beds by administrators and politicians are creating a problem that they either do not want to face or chose not to care. In many cases it is easy to point out problems but a harder task to offer suggestions that will change the direction social services will provide those who need the help. There are many possibilities that politicians and administrators can look at. Some of these are:
1)      Use and incorporate outpatient treatment: In order to ensure that those individuals diagnosed with a serious mental illness get the treatment they need to not return back to jail, prison or hospitals the implementation of an outpatient treatment facility is necessary. An outpatient treatment facility would provide a legal base for providers to ensure that selected seriously mental ill patients follow through with prescribed medication and treatment plans in order to remain in the community.

2)      Use Mental Health Courts:  Mental illness is a substantial contributing cause to crime in Idaho. Crimes committed by persons suffering from mental illness cause substantial losses to persons and business throughout the state and endanger public safety. In addition, millions of dollars are spent each year on the incarceration, supervision and treatment of mentally ill offenders; Mental health courts in Idaho and other jurisdictions that closely supervise and monitor mentally ill adult and juvenile offenders can oversee their treatment are an innovative alternative to incarceration for certain offenders. Such courts, which can be operated in conjunction with drug courts, have provided a cost-effective approach to addressing the mental health needs of offenders, reducing recidivism, providing community protection, easing the caseload of the courts, and alleviating the problem of increasing prison, jail and detention populations. The goal of mental health courts is to reduce the overcrowding of jails and prisons, to reduce alcohol and drug abuse and dependency among criminal and juvenile offenders, to hold offenders accountable, to reduce recidivism, and to promote effective interaction and use of resources among the courts, justice system personnel and community agencies. (State of Idaho Judicial Branch, 2012)

3)      Shift state fund:   Idaho has the capability to require all county departments of mental health, such as the Department of Health and Welfare, to pay IDOC for all cost associated with treatment of seriously mentally ill prison inmates. This would ease some of the problems IDOC has faced financially over the last few years. As of FY11 the Idaho Department of Corrections (IDOC) has had to handle multiple adversities that have resulted in staff furloughs (un-paid time off), a 23% correctional officer turnover rate and the costs associated with initially training correctional officer at the Peace Officer Standards and Training academy. To illustrate the low priority that Idaho places on the care and rehabilitation of those with mental disorders one needs only to look at Key Strategic Initiatives for FY12 (Correction, 2011) listed on their website. These initiatives are listed in order of importance as stated by IDOC administrators:

1. Reduce staff turnover

2. Population management through the Manage All Populations (MAP) group

3. Substance use disorder services implementation

4. Sex Offender Management Board implementation

5. Secure mental health facility development

6. Management and leadership development

7. Commitment to Quality, quality assurance initiative

4)  Reform treatment laws: Begin with developing and implementing a mandate that provides dedicated treatment for offenders and those individuals that are incarcerated with serious mental disorders. This policy can focus on treatment interventions that can be based on need for treatment standards rather than on dangerousness. The idea of this is to allow mentally ill individuals the ability to seek treatment before they commit a crime, not after. (Torrey, 2010.
There are no guarantees that those incarcerated with serious mental illness will receive any treatment beyond that which is required by federal law. Nor is there any guarantee that by providing treatment in state hospitals will prevent recidivism, crime or even rehabilitation. But the state of Idaho owes it to its citizens to protect them while maintaining the human dignity for the mentally ill. Those with mental illness live in our communities, they shop at our stores, and they may even live next door to you. It is important to provide a way for them to receive the help they need before they commit a crime or become dangerous to those around them.


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