An Overview of Correctional Mental Health Issues.

Correctional leaders often are faced with two difficult questions regarding mental health: Why should treatment be offered to mentally ill offenders? And how much should be spent? The best response is that offering treatment promotes safer prisons with less violence directed toward staff and other offenders. Correctional administrators also may have a duty to foster the health and rehabilitation of those entrusted to their care. Correctional leaders wish to minimize legal risk within their facilities and want all inmates to reach their potential in prison programming. Ultimately, providing effective mental health care reduces recidivism upon release and promotes safer communities.

"Deinstitutinalization" of state mental health hospitals and managed health care in community hospitals have reduced access to inpatient hospital care, resulting in fewer community hospital beds. As mental health care in community institutions has decreased, the number of mentally ill offenders in prison has increased. A parallel institutional system for mental health care has evolved behind prison walls. Another complication has been the proliferation of illicit substances in the mentally ill. This has amplified the numbers with co-occurring disorders, thereby enhancing the risk of substance abuse-related crime. The potential for violence and recidivism increases if substance abuse in mentally ill offenders spirals out of control.

Complicating this picture is the steady growth in the elderly prison population. As inmates age, their medical and mental health needs increase. Hopelessness and despair are common as these men and women gradually lose contact with their families and face long prison sentences. Elderly offenders' losses progress slowly over time and contribute to grief. Mental health needs of this group are unique and must be addressed to prevent sudden suicide attempts. Treatment of both mental health and substance abuse problems must be individualized to meet the needs of these offenders.

Correctional leaders also must consider the transition of mentally ill inmates to community placements early in the release process. The articles in this issue of Corrections Today by Catherine McVey and Melvin Stokes will stimulate ideas on how this can best occur.

Teamwork between health care and legal departments is needed to address questions regarding offenders who have medical problems and are unable to make informed decisions. Medical legal issues, especially guardianship of elderly offenders, are reviewed by Randall Sears and Laura Failing.

Suicide prevention is a constant concern among correctional administrators. Current prevention strategies are presented by Lance Couturier. For these prevention efforts to succeed, correctional administrators must be supportive, thereby fostering teamwork between treatment and security personnel.

A final question to be answered is the amount of money spent on treatment and how effective it will be. Or: Will the money being spent produce effective results in running safer facilities? E. Ross Taylor discusses guidelines for managing psychotic disorders, outlining the benefits of spending more for advanced medications that may yield increased compliance and functioning for inmates, with a decreased potential for aggression and persistent suicide ideation. Kevin Burke addresses psychiatric issues associated with evaluating and treating hepatitis C, and Edward Haberman reviews mental health problems in geriatric inmates. These topics will impact correctional systems significantly in the coming years.

The issues mentioned above are not going to fade away, but will magnify as prison systems become larger and special populations grow. Resolution will come with cooperation among many correctional security and treatment staff, parole officials, community providers, mental health treatment advocates and elected officials who decide resource funding streams. As correctional leaders, we must increase our knowledge, strive for improved health care and function as public educators to ensure the mental health of those for whom we are responsible.