Meeting the Challenge of Mental Illness Behind Bars

Posted Mar 19, 2019

Thomas Fagan, PhD, CCHP-MHWhen I began my career as a correctional psychologist more than 40 years ago, the population of seriously mentally ill individuals in correctional setting was quite small and manageable. Through a series of legislative initiatives (e.g., mandatory minimum sentencing) and changing social attitudes in the 1980s and beyond, the population of individuals with serious mental illness slowly grew.

Correctional mental health providers quietly managed these individuals as best as they could, but with a growing awareness that systemic changes would ultimately need to be made in order to accommodate the special needs of this unique population.

Foremost among these changes was a need for greater flexibility in the management of these individuals to accommodate their cognitive and behavioral symptoms, their inability to follow commands and their difficulty with obeying institution rules. Allowing more flexibility in the management of mentally ill people in a system that prides itself on the strict adherence to its rules and regulations was not an easy transition, and in some ways we are still in the midst of this transition.

Correctional systems are aware that change is necessary to effectively manage this population, but still struggle with decisions about how to accommodate the unique challenges of this population while simultaneously managing the larger population. Additionally, administrators are faced with decisions regarding what constitutes adequate staffing and appropriate programming in an era of limited budgets and competing management needs.

In short, correctional systems are facing a serious—and growing—mental health challenge. I use the word “challenge” because of the staggering number of individuals in our jails and prisons with some form of mental illness. Estimates of those with serious mental illness (psychotic, major depressive and bipolar disorders) range from 12% to 20%, and when other mental health disorders (such as anxiety, posttraumatic, sleep and substance use disorders) are added to the list, estimates are as high as 50% to 70%.

The correctional system was never intended to care for large numbers of mentally ill people, and many jails and prisons remain ill-equipped to deal with this population. The current situation has left facilities asking: What do we do with these individuals? How do we care for them? What happens when they are released back into the community? What can we do that will lead to potentially better outcomes, better success and less recidivism?

THE VALUE OF standards

Some insight into these challenging questions can be found in NCCHC’s Standards for Mental Health Services in Correctional Facilities manual, commonly known as “the brown book.” Like the Standards for jail and prison health services, the mental health Standards cover assessment and treatment, behavioral consultation, clinical records, medication management, staffing and administrative issues, personnel and training issues, suicide prevention and intervention, and medical-legal matters—all focused on the provision of quality mental health care. The standards are an indispensable tool to help facilities determine proper levels of care, organize systems and demonstrate that constitutional requirements are being met.

By becoming accredited in mental health services, a facility can verify that it meets NCCHC’s standards for delivering mental health care as efficiently and safely as possible. NCCHC also offers accreditation of health services for jails, prisons and juvenile facilities, and for opioid treatment programs. Your facility can earn one or more types of accreditation based on the programs, services and populations managed within your system. In other words, health services accreditation is not required in order to get accredited for mental health or opioid treatment programs. While basic mental health services are included in the health services accreditation, facilities with more robust mental health services may consider this specialized accreditation that focuses solely on the system of care for patients with mental health needs.

The mental health standards also serve as the foundation for NCCHC’s professional certification in correctional mental health (CCHP-MH). By hiring professionals with the CCHP-MH credential, employers can be confident that their mental health staff knows the NCCHC standards and understands what it means to deal with this unique population in the correctional setting. By becoming CCHP-MH-certified, mental health professionals demonstrate their expertise and gain credibility. I’m proud to carry the credential myself.

– Thomas J. Fagan, PhD, CCHP-MH, is the chair of the NCCHC board of directors. This column first appeared in the Winter 2019 issue of CorrectCare, Vol. 33, Issue 1. Standards for Mental Health Services in Correctional Facilities can be purchased from the NCCHC online bookstore or by calling 773-880-1460.