Corrections and the Mentally Ill

Corrections and the Mentally Ill

Justice Center, University of Alaska Anchorage. (Winter 2002). "Corrections and the Mentally Ill." Alaska Justice Forum 18(4): 4. The Alaska Department of Corrections is the largest provider of in-patient psychiatric services in the state. This article reports on the mentally ill in correctional institutions in Alaska and nationwide where, in 2000, one in every eight state prisoners was receiving some mental health therapy or counseling services, and nearly 10 percent (105,000 individuals) were receiving psychiatric medications.

According to data from a prison census conducted by the Bureau of Justice Statistics, in 2000 one in every eight state prisoners was receiving some mental health therapy or counseling services. Nearly 10 percent—105,000 individuals—received psychotropic medications, including antidepressants, stimulants, sedatives, tranquilizers or other anti-psychotic drugs. Alaska reported 9 per cent of inmates receiving such medications. Nationally, about 10 percent of those identified as mentally ill, approximately 19,000 inmates, were receiving 24-hour care in a special housing or psychiatric unit. (This was 1.6% of all inmates nationally.) At the time of the census, Alaska had 93 inmates receiving 24-hour care—2.9 percent of all prisoners in state facilities.

Nationwide, nearly 70 percent of all facilities housing state prisoners offer mental health services to inmates. Forty-seven states, including Alaska, reported mental health/psychiatric confinement as a special function with the correctional department. In general, state prisons screen inmates for mental health disorders prior to placement in a facility.

An earlier BJS study, conducted in 1998, found that mentally ill inmates (who were self-identified in this study) were more likely to be incarcerated for a violent crime: 53 percent of those mentally ill, compared to 46 percent of all other prisoners, had committed a violent offense. These inmates also tended to have longer prior criminal histories. Among the mentally ill, 52 percent reported three or more prior sentences, compared to 42 percent of other state inmates.

The mentally ill inmates also reported high rates of homelessness and unemployment. Among these prisoners, 20 percent reported a period of homelessness in the year before their arrest; 39 percent had been unemployed.

The mentally ill inmates also exhibited higher rates of alcohol dependence than other inmates. Approximately one-third were assessed as alcohol dependent.

The Alaska Department of Corrections is, in effect, the largest provider of in-patient psychiatric services in the state. In the 2000 study Alaska reported 93 inmates receiving 24-hour care; 286 receiving some type of therapy or counseling and 238 receiving psychotropic medicines.

In this state, as elsewhere, the high rate of incarceration of mentally ill persons can be at least partially ascribed to the deinstitutionalization which has occurred over the last few decades. Beginning in the 1960s, advocates for the mentally ill sought to reduce the number of persons in mental hospitals, maintaining that many patients who at that time lived on a long-term basis in such institutions could lead fuller lives outside these facilities if they had access to appropriate medical care and other assistance in the community. Now, while such patients are no longer confined to mental institutions, adequate funding for the necessary network of community care has never materialized, with the result that the mentally ill often lack access to adequate housing, appropriate activities and the medication necessary to maintain stable behavior. Many live on the street or in shelters, under conditions that can lead to deterioration in behavior and involvement with the justice system.

In Alaska over the last two decades, deinstitutionalization has resulted in a gradual reduction in the availability of long-term, in-patient care at the Alaska Psychiatric Institute, the state's only long-term psychiatric facility. Moreover, Alaska communities, particularly in the rural areas, have little provision for emergency psychiatric care. The absence of alternatives can lead to the police being needed to assist with mentally ill individuals who have become unstable and disruptive.

There are other aspects to the problem of mental illness which are particular to Alaska. The state has a high rate of occupational head injuries with no major rehabilitative facility. In addition, Alaska has a high rate of fetal alcohol syndrome. Individuals with these afflictions who are not properly supervised and engaged in structured activity can become disruptive and violent—leading to involvement with the police, courts and Department of Corrections.

The Department of Corrections conducts physical and mental health screenings of all individuals at intake, resulting in approximately 2000 referrals made annually to the department's mental health staff. Treatment is available at all institutions, with psychiatric hospital units at Cook Inlet Pretrial for male inmates requiring this level of care and at Hiland Mountain for female inmates. (There are no DOC beds at API, but an adult secure/forensic unit has beds for court-ordered evaluations, short-term competency restoration and longer stays under certain conditions.) DOC also utilizes telemedicine and telepsychiatry to extend the reach of treatment staff capabilities.

In addition to providing required medical care, DOC conducts programs for all mentally ill felons within its institutions. For inmates in the general population, programs focus on training in anger management, correcting thinking errors, problem-solving and developing a moral framework. Inmates within the treatment units at Hiland Mountain and Cook Inlet have a full daily schedule of intensive therapy and counseling.

The department also attempts to provide a bridge of treatment programs for mentally ill inmates being released. It has contracted with community social service agencies to assist such inmates for a period after release from prison. The agencies guide individuals in finding housing, in structuring their days through jobs or other activities, and in obtaining access to various benefits, including funding for necessary medications,

The information in the preceding article is based on information from the Alaska Department of Corrections and BJS reports "Mental Health Treatment in State Prisons, 2000" (NCJ 188215) and "Mental Health and Treatment of Inmates and Probationers" (NCJ 174463).