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Home> About Us> What We Believe> Position Statements >Position Statement 56: Mental Health Treatment in Correctional Facilities

Position Statement 56: Mental Health Treatment in Correctional Facilities

Policy

America’s prisons and large city jails are now its largest mental hospitals.[1] It is axiomatic that Mental Health America supports effective, accessible mental health treatment for all people in correctional facilities who need it. But the issue is more complex, and includes an effective classification system to protect vulnerable prisoners and effective protection of the human rights of prisoners with mental illness. Notwithstanding their loss of their liberty, prisoners with mental illness retain all other rights, and these must be zealously defended.

Background

The Mental Health America has a policy on juvenile justice[2] that includes the most important considerations for all prisoners who need mental health treatment. The material that follows tracks the juvenile justice policy.

Prisoners with mental illness are especially vulnerable to the difficult and sometimes deplorable conditions that prevail in jails, prisons and other correctional facilities. Overcrowding often contributes to inadequacy of mental health services and to ineffective classification and separation of prisoner classes. It can both increase vulnerability and exacerbate mental illness. A correctional facility is a very bad place to put a person with mental illness, and Mental Health America is on record in favor of maximum reasonable diversion.[3] But more and more, America is locking up people with mental illness.

Mental Health America believes that placing prisoners with mental illness in institutions, especially correctional facilities, imposes special obligations on society. Jails, prisons and other correctional facilities have a duty to provide medical services, including mental health services, and to provide protection from harm. These services are basic human rights of every prisoner with mental illness. Correctional facilities are properly expected to exercise special vigilance in dealing with every prisoner with mental illness because his or her ability to assert these human rights may be impaired. Mental Health America believes that these treatment obligations are greater than the treatment rights currently enforced by the courts as a matter of American constitutional law.

Delivery of mental health services to prisoners in correctional facilities is the responsibility of all professionals at a facility, including psychiatrists, psychologists, social workers, nurses, correctional counselors, correctional officers, and facility administrators. Mental Health America believes that correctional facilities must be sufficiently staffed with mental health professionals, and that such professionals have special obligations to:

• advocate to correct conditions which interfere with or are inconsistent with basic human rights;
• advocate to improve mental health services and to oppose malpractice;
• train all personnel about the signs of mental and emotional problems and basic mental health principles; and
• oppose discriminatory treatment based on race, religion, gender, ethnic background, mental health condition, or sexual orientation.

Mental Health America commits itself to protecting the human rights of people with mental illness who are incarcerated in the criminal justice system. This includes their rights under the U.S. Constitution, as currently recognized by the courts, but goes beyond. Mental Health America will defend the human rights to adequate medical and mental health care, to protection from harm including staff abuse, and to a facility in which the vulnerable can be protected. If the most vulnerable cannot be protected, they should not be confined.

Mental Health America and its affiliates should work to inform members of law enforcement and correctional groups, judges and attorneys, mental health professionals and advocates, prisoners and their families, the community and the media about the rights of prisoners with mental illness and the way in which local and state governments are responding to the need or failing in their duty.

Mental Health America also commits itself to identifying and addressing the forces that contribute to the disproportionately high involvement of persons from ethnic and racial minority communities in the criminal justice system. A system that incarcerates so many so differentially as ours is inherently unjust.

Treatment During Confinement

When prisoners in need of mental health treatment must be confined in correctional facilities, certain principles should be observed:

1. All prisoners should be screened upon admission by trained personnel for mental health and substance abuse problems. When the screening detects possible mental health problems, prisoners should be referred for further evaluation, assessment and treatment by mental health professionals.  Prisoners who are already receiving treatment before they enter should be assisted in continuing treatment. All prisoners who are not released within one week should have behavioral, mental health and substance abuse evaluations completed by qualified mental health staff by such date.

2. Prisoners who suffer from acute mental disorders or who are actively suicidal should be placed in or transferred to appropriate medical or mental health units or facilities and returned to general population only with medical clearance. Correctional facilities that do not employ mental health staff should have written arrangements with local medical or mental health facilities for providing emergency medical and mental health care.

3. Mental health services should be available to prisoners 24 hours per day, seven days per week. Treatment should be provided in an atmosphere of empathy and respect for the dignity of the person. It should be strengths-based and recovery-oriented. A reasonable array of mental health interventions should be available, including the full range of available medications. The type of intervention should be tailored to meet the prisoner’s needs, with family consultation unless the prisoner rejects it, and should be delivered by qualified mental health staff who are trained to deal with crises as they arrive. When medications are used, they should be consistent with the treatment plan and monitored by a qualified mental health professional.

4. Special treatment should be available to prisoners who are sexually abused, who have substance abuse problems, health problems, educational problems, histories of family abuse or violence, and who are sex offenders. Programming in facilities should be appropriate to the person’s age, gender and culture. Linguistically and culturally appropriate therapy should be provided. Under no circumstances should a prisoner be penalized for seeking or receiving or declining mental health treatment.

5. Correctional facilities should train staff to use behavior management techniques that minimize the use of intrusive, restrictive, and punitive control measures. Facilities should have written guidelines for the use of seclusion, room confinement, and restraints. These guidelines should be made clear to persons in custody. Distinctions should be made between the use of seclusion and restraints for custodial-administrative purposes and those made for therapeutic purposes. When restraint must be used to prevent injury to self or others, there should be stringent procedural safeguards, limitations on time, periodic reviews and documentation. Generally, these techniques should be used only in response to extreme threats to life or safety and after other less restrictive control techniques have been tried and failed.

6. Under no circumstances should prisoners be the subjects for medical research without proper ethical review and informed consent.

7. Prisoners should have a discharge plan prepared when they enter the correctional facility in order to integrate them back into the family and the community. This plan should be updated in consultation with the prisoner’s family (as appropriate) and community treatment facilities before the prisoner leaves. It should include the continuation of treatment, therapy and services begun in the facility. Correctional facilities should take an active role in promoting continuity of treatment for those released.

8. Facilities should take extra precautions to assure against suicide by prisoners living through mental illness. Facilities should have a suicide prevention plan that includes appropriate admission screening, staff training and certification, assessment by qualified mental health professionals, adequate monitoring, referral to appropriate mental health providers or facilities, and procedures for notification of the prisoner’s family (unless refused).

9. Facilities need to identify and treat co-occurring disorders, and particularly substance abuse, and to provide support in the facility and in the transition to the community.
   

Specific Rights

Mental Health America affirms the specific rights of people with mental illness confined in correctional facilities listed here because they have the most potential to be abridged in correctional settings:

• The right to adequate medical and mental health care, to protection from harm including staff abuse, and to a facility in which the vulnerable can be protected: a safe, sanitary and humane environment
• The right to informed consent to treatment. Staff should discuss with the prisoner the nature, purpose, risks, and benefits of types of mental health treatment.
• The qualified right to refuse treatment, including psychotropic medications, on the same basis as any other person. [4]
• The right to the least restrictive environment and the least intrusive response to an apparent need for mental health services.
• The right to be confined in a place that can provide the treatment needed.
• The right to confidentiality in the delivery of mental health services and in mental health and related facility records.
• The right to have regular and timely access to medical and mental health staff who are culturally competent and qualified to provide adequate treatment and supervision.
• The right to be transferred to an appropriate medical or mental health facility or unit when conditions warrant.
• The right to be free from corporal punishment, chemical restraints, and sexual abuse or coercion.
• The right to assert grievances, to have grievances considered in a fair, timely and impartial manner, and to exercise rights without reprisal.
• The right to an individualized written treatment plan, to the treatment specified in the plan, to periodic review and revision of the plan based on the prisoner’s needs. The family should participate in the development, review, reassessment and revision of both the treatment plan and the discharge plan, unless the prisoner refuses such participation.
  

[1] United States Department of Justice, “Mental Health  and Treatment of Inmates and Probationers”(1999).

[2] Mental Health America Policy Number 37, “Children With Emotional Disorders in the Juvenile Justice System”(2000).

[3] Mental Health America Policy Number 50, “In Support of Maximum Diversion of Persons with Serious Mental Illness from the Criminal Justice System”(2003)

Page last updated: 09/20/2007