Feature

Even though rates of serious mental illness are higher in prisons, funding for mental health services has been reduced in many areas. Indeed, at the end of last year, there were 182,000 inmates in the federal prison system alone--and only 400 doctoral-level psychologists providing services for them.

"We end up being a catch-all for those who have significant mental health needs," said John Baxter, PhD, psychological services administrator for the Federal Bureau of Prisons and a panelist at a 2005 APA Annual Convention session on challenges and solutions for mental health services in U.S. correctional institutions.

According to panelist U.S. Deputy Surgeon General Rear Adm. Kenneth Moritsugu, MD, mental health services in correctional facilities primarily treat severe disorders.

"Most care is focused on psychopharmacology and recovery," he said at the session, sponsored by APA's Board for the Advancement of Psychology in the Public Interest (BAPPI) and Board of Professional Affairs. "We still have far to go in this arena. We need to use all resources at hand--psychologists, MDs and chaplains, for example--to improve care for body, mind and spirit of inmates."

Challenges

The biggest challenge in corrections today is how to bring criminal justice and mental health together, agreed panelists at the session, chaired by BAPPI member Allan S. Noonan, MD, dean of the School of Public Health at Morgan State University.

Moritsugu suggested that APA and other associations develop education and training programs in public health and correctional health. This would bring more trained professionals into the correctional system and provide students a valuable link to professional associations, he noted.

More trained professionals and treatment options are sorely needed, said Roberto Potter, PhD, a sociologist with the Centers for Disease Control and Prevention, who cited statistics from psychologist and U.S. Rep. Ted Strickland, PhD (D-Ohio), to back up his point: 284,000 people suffering from manic depression or schizophrenia are arrested every day in America.

"Jail is like the elephant in the room," noted Potter. He wondered aloud: Prisons have longer terms for treatment, but is treatment really available? Do prisons make the mentally ill worse? And what about when inmates are released? How should the system care for former prisoners to ensure they're not trapped in an endless cycle of arrest and treatment?

Some of those questions could be answered by more research in the area, said Moritsugu. "We're sorely sparse in data and hard evidence in correctional health," he explained. Baxter agreed: "Who's coming in the door? We have some sources, but they're mostly self-report, family anecdotes and some clinical interviews."

Roles for psychology

Psychologists, agreed the four panelists, are in a prime position to improve correctional mental health. And, said Baxter, there are multiple roles for them. "Psychologists wear many hats in our settings," he said.

Among them, said Joel Dvoskin, PhD, president of Div. 41 (American Psychology-Law Society) and past-president of Div. 18 (Psychologists in Public Service) are the following roles:

  • Screening.

  • Intake, evaluation and classification.

  • Treatment of mental illness and psychological crisis.

  • Drug rehabilitation.

  • Criminal rehabilitation.

  • Staff training.

Dvoskin even suggested that a community psychology model should be modified to fit the prison environment.

"We need community services within prisons as much as we do outside," Dvoskin said. "And the adequate number of trained staff should be present in every jail and prison."

In closing, Baxter recited a famous quote from Fyodor Dostoevsky: "The degree of civilization in a culture is reflected in the condition of its prisons." If you agree with that observation, Baxter said, "we must act. If we work together, we can treat and manage this population."

Jennifer Daw Holloway is a writer and editor in Washington, D.C.