Copyright 2006 Madison Newspapers, Inc

April 3, 2006 Monday
ALL EDITION

SECTION: FRONT; Pg. A1
LENGTH: 1449 words
HEADLINE: 25% OF INMATES NEED TREATMENT;
PRISONS SPEND LITTLE ON MENTALLY ILL
BYLINE: By Anita Weier The Capital Times
BODY:
Wisconsin's state prison system is overwhelmed with mentally ill people -- about one-fourth of its 22,000 prisoners.
However, only 4 percent of the state's corrections budget was spent on mental health in 2003, when 25 percent of the prisoners also had mental illness issues, according to the American Correctional Association's Corrections Compendium in September/October 2004.
One measure of the problem is prison suicides.
The Wisconsin Department of Corrections' Committee on Inmate/Youths Violent Deaths, which includes public representatives, in 2004 identified several inmates who committed suicide and had not seen a psychiatrist for months.
A 14-year-old who committed suicide in 2001 had not seen a psychiatrist for 176 days, and a 17-year-old who committed suicide that same year had not seen a psychiatrist for 94 days. A 21-year-old who committed suicide in 2004 had not seen a psychiatrist for 87 days and a 30-year old who committed suicide in 2004 had not seen a psychiatrist for 76 days.
Three of the suicides had been seen more recently by other psychiatric staff, though the 14-year-old had not been seen for 34 days and the 17-year-old had not been seen by them at all.
*
Three times more: Prisons were never intended as facilities for the mentally ill, yet that is one of their primary roles today, according to a 2003 report by Human Rights Watch.
"Many of the men and women who cannot get mental health treatment in the community are swept into the criminal justice system after they commit a crime," the report said. "In the United States, there are three times more mentally ill people in prison than in mental health hospitals."
Dr. Kevin Kallas, mental health director for Wisconsin's Department of Corrections, agreed that people with mental health problems are finding their way into the criminal justice system in increasing numbers.
The Department of Corrections has about 100 psychology staff, as well as 25 psychiatrists, who have medical degrees. Additionally, there are 11 crisis intervention workers and 326 full-time-equivalent social worker positions.
But those staffers must deal with more than 5,000 inmates with mental health needs.
Corrections officials said they could not come up with a number for the percentage of funds dedicated to mental health treatment in the current state budget. But a departmental report said that in the 2004 fiscal year, the Corrections Department would spend about 8.4 percent of its overall adult prison budget for health care in general.
The average annual cost for health care was $4,073 per inmate in the 2005 fiscal year, lower than Michigan and Ohio, but higher than states such as Kentucky and Indiana.
*
Limited help? The Wisconsin prison system's high suicide rate -- 25 per 100,000 compared with a national level of 14 per 100,000 -- is a challenge that the department is trying to address by providing mental health services and training staff to recognize symptoms and causes of suicidal behavior, officials said.
"We have put a lot of emphasis on this area," department spokesman John Dipko said. In recent years the Department of Corrections hired Kallas, improved coordination of mental health services with prison security, and established a multidisciplinary work group to develop a roadmap to better treat mental health issues for inmates in segregated settings.
Parts of a suicide prevention plan have been implemented and others are near completion, but some key gaps include improving mental health staffing ratios and increasing the number of treatment-oriented beds for inmates, according to a departmental work group report in February.
*
Sorting them out: Here's what an arriving inmate can expect at a Wisconsin prison:
"Every inmate gets a psychological screening by a member of the psychiatric staff within the first couple of days after arrival in intake facilities. If needed, they are referred to a psychiatrist," Kallas said. "On the day of arrival, a nurse does a screening. Questions are asked in person and the nurse assesses medical and mental health issues."
If inmates are on psychotropic medication, they are referred to a psychiatrist.
If they answer positively to questions about depression or being suicidal, or if they are hearing voices, they are referred to a psychologist, who provides assessment and treatment. The person may need counseling or may need to go to clinical observation status and may be referred to a psychiatrist for medication.
"There is a whole tier of assessments. A person can be referred to a psychologist or psychiatrist at any point," Kallas said.
"A person can get meds and then get better or just go off meds. An inmate can go off meds even if a psychiatrist thinks he or she needs them. It's a constitutional issue. We would have to go to court to get a Chapter 51 commitment to force them to take meds. Our psychiatrists try to convince them; it's always easier to do it voluntarily."
*
Beyond Corrections: Treatment for the seriously mentally ill occurs at the WisconsinResourceCenter in Oshkosh, which treats the most troubled inmates after referral by the Department of Corrections. The center is managed by the state Department of Health and Family Services, not Corrections.
"We do custody and mental health treatment of inmates referred from the prison system. We take the worst suicide risks from all of Wisconsin, but we're not strictly about suicide," said Byran Bartow, director.
"To do mental health care you can't just lock people up. Most come here from segregation or come here instead of going to segregation."
His focus at the ResourceCenter is treatment, Bartow said.
"We work like any mental health treatment center. We do an interdisciplinary assessment and develop with the patient an understanding of their concerns and needs. We look at the record to see problems Corrections had with the individual. We have a very broad interdisciplinary program -- an integrated program that uses nurses, psychiatrists, psychologists, social workers and therapists. We do individual and group therapies."
Inmates are in treatment all day, every day, he said.
"We retain people so they can't get away, and we treat them," Bartow said.
But the ResourceCenter has a capacity of just 404 slots -- 60 of which are now being used for sex offenders. There is a staff of 441 in three shifts, 372 of whom are treatment staff.
Assessment at the ResourceCenter takes three or four weeks and the average stay is nine months.
A goal is to teach people how to manage mental illness successfully, so they are not violent in prison or in the community if they are released.
"With the chronically ill, success in the community means that they have gainful activity and are crime-free, and obtain some basic satisfaction in their lives," Bartow said.
"It is important to the prison system to have a facility like the ResourceCenter. But they need more ResourceCenter assistance. Corrections needs more mental health services overall. But that is up to the Legislature.
"If an inmate needs emergency transfer to WRC, this occurs on the same day. For less acute situations, there is a waiting list. At any given time, there may be 20 to 30 inmates on this list. It may take several weeks for an inmate on the wait list to be transferred. However, inmates on the list continue to be monitored for signs of needing more rapid transfer," Kallas said.
John Easterday, associate administrator for mental health and substance services for the Department of Health and Family Services, oversees the ResourceCenter.
"The purpose of the center is to treat and return to DOC (Department of Corrections) mentally ill inmates who cannot be handled in the correctional system or need more intensive mental health treatment," he said. Men are treated at the ResourceCenter; women are treated at the nearby Winnebago Mental Health Institute or the Taycheedah Correctional Institution. The Racine, Dodge, Oshkosh and Columbia correctional institutions also have special management units.
"Our real plan at the ResourceCenter is to get people back into the general (prison) population. Some people go to the community, discharged on parole, but most go back to the general population," Easterday said.
"We have more staffing than the correctional system -- more psychiatrists, psychologists, social workers, educational staff and therapy staff. Inmates are observed much more intensively and engaged more in groups. It is more intensive treatment, with therapy and medication and activities. We have more people watching, and we do put people on suicide watch.
"I know DOC does a lot and is trying to do more. We are a more intensive treatment program that tends to reduce the risk."
E-mail:
LOAD-DATE: April 4, 2006