Thus, there ought to be more suitable facilities for them there. Responding to criticisms of prison medicine by the Royal College of Psychiatrists, Ellis argued that doctors working in prisons possessed specialist expertise when dealing with prisoners whose behaviour posed particular challenges. This was related to wider concerns about the impartiality of prison doctors, and whether they served the interests of their patients or those of the prison authorities.
Specifically, it was suggested that psychotropic drugs were being prescribed to inmates, not to alleviate their conditions and aid their recovery, but in order to control their behaviour, to facilitate the smoother running of the prison, and maintain discipline. Consent to treatment was particularly problematic inside prisons, due to the pressure brought to bear on prisoners to conform to the disciplinary system. Inmates might fear that refusing medication would mark them out as recalcitrant, thus making their choice illusory. Other commentators argued that the sensational coverage accorded to this issue in some quarters, including the medical press, was counter-productive.
The treatment of suicidal prisoners was identified as one such area. This was related to wider concerns about the impartiality of prison doctors, and whether they served the interests of their patients or those of the prison authorities. Specifically, it was suggested that psychotropic drugs were being prescribed to inmates, not to alleviate their conditions and aid their recovery, but in order to control their behaviour, to facilitate the smoother running of the prison, and maintain discipline.
Consent to treatment was particularly problematic inside prisons, due to the pressure brought to bear on prisoners to conform to the disciplinary system. Inmates might fear that refusing medication would mark them out as recalcitrant, thus making their choice illusory. Other commentators argued that the sensational coverage accorded to this issue in some quarters, including the medical press, was counter-productive.
The treatment of suicidal prisoners was identified as one such area. At a Physicians for Human Rights UK conference, it was noted that prisoners who appeared depressed were often secluded in the prison hospital. Return to Background Reading. One more step, then freedom, for the first time in eight years.
He had dreamed about this moment; he had feared it, too. Ahead of him on that April morning in lay the most treacherous passage an inmate can face: the transition back to normal life. More than 40 percent of prisoners who attempt it fail, ending up back in jail or prison. For those who carry mental illness with them, like Nick Lynch, failure looms larger and occurs even more often.
He planned to help Nick enroll in college while taking graduate courses himself; they would navigate this new world together.
For most of his imprisonment, according to Nick, he received little treatment for his mental health and limited access to medicine that helped him. Long stretches in segregation made his illness worse. In an account confirmed by his medical records, he says his condition spiraled downward near the end of his sentence, when he attempted suicide and mutilated himself, biting a piece of flesh the size of a quarter from his own wrist.
His desperate acts finally led to better care, including medicines that eased his symptoms, he says. Like many inmates, Nick used illegal drugs while he was locked up, but says he received no treatment for addiction. What Nick carried with him, walking out of prison, seemed like so much less than what he needed: a few plastic packets of pills, bundled together with rubber bands; an appointment at a treatment center that his dad says he had contacted.
They would celebrate his homecoming together at a gray-shingled tavern on Cape Cod, his family filled with hope and visions of his future. He had been a teenager when he was locked up. Now, he was a man starting over again. He did not know then how briefly his new life would last: days, precious and desperate, leading back to trouble, punishment, and regret.
Mental Health Treatment
Last year, more than 15, prisoners walked out of Massachusetts jails and prisons. More than one-third suffer from mental illness; more than half have a history of addiction. Thousands are coping with both kinds of disorders, their risk of problems amplified as they reenter society. Within three years of being released, 37 percent of inmates who leave state prisons with mental illnesses are locked up again, compared with 30 percent of those who do not have mental health problems, according to a Department of Correction analysis of releases. Inmates battling addiction fare worse: About half are convicted of a new crime within three years, according to one state study.
Despite the vast need — and the potential payoff in reduced recidivism — mental health and substance abuse treatment for many Massachusetts inmates is chronically undermined by clinician shortages, shrinking access to medication, and the widespread use of segregation as discipline. The prison environment itself is a major obstacle to treatment: In a culture ruled by aggression and fear, the trust and openness required for therapy are exponentially harder to achieve.
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And when their incarcerations end, many mentally ill and drug-addicted prisoners are sent back into the world without basic tools they need to succeed, such as ready access to medication, addiction counseling, or adequate support and oversight. That revolving door is enormously expensive, sweeping thousands of released inmates back into jail and prison and adding tens of millions of dollars to state budgets. Yet at that precarious moment when an inmate with mental illness reenters the world — vulnerable and in urgent need of support — he or she has little hope of assistance from the state Department of Mental Health.
Last year, 90 percent of the estimated 6, inmates with mental illness who were released from jails and prisons got little or no help from DMH as they tried to find treatment in the community, according to numbers provided by the state. Limited by longtime public and legislative indifference, Massachusetts prisons have struggled to adopt the long view when it comes to spending on mental health care.
The consultant, MGT Inc. Part of the savings came from drastically reducing prisoner prescriptions, targeting medicines with abuse potential — medicines that are also, for some patients, the most effective at controlling symptoms — and largely ending treatment for ADHD. Some experts say such sweeping cutbacks, especially for inmates with ADHD, can increase disruptive behavior and, perversely, the use of segregation as punishment. Short-changing care has other consequences: unreasonably heavy caseloads for clinical staff at some prisons, which strictly limit the care each inmate gets, according to a dozen current and former prison mental health clinicians who spoke to the Globe.
The full-time mental health staff in the prisons is 25 percent smaller now than in , though the number of inmates in treatment is similar, state data shows.
Three former clinicians and a former clinicial supervisor said some state inmates who need long-term help do not get it because supervisors resist adding patients to the already crushing caseload, sometimes refusing repeated requests. Stacy, who was abruptly fired last year, believes she lost her job because she pushed for inmates to get more and better treatment — and was vocal when she thought their care fell short. She filed a complaint with the Massachusetts Commission Against Discrimination, alleging retaliation by her employer.
Correction department leaders said they have not heard of supervisors restricting the mental health caseload, but they acknowledged that clinical decisions are made by the for-profit company that provides mental health care in prisons.
But MPCH, in turn, referred all questions about the care it provides back to state correction officials. They hypothesized that savings resulted from the move to a single vendor; previously, the prison system used separate contractors for mental health and medical care. The prisons have acknowledged the need for more specialized care, creating a handful of separate units to treat inmates with serious mental illnesses. By most accounts, those units represent a major step forward.
A similar shortage of care seems to exist for addiction, which is rampant in prisons. State corrections officials say at least 65 percent of state inmates — at least 5, men and women — suffer from substance use disorders. Yet they maintain only specialized beds for addiction treatment. They say that is plenty, and that inmates who want help receive it. Several prison mental health clinicians strongly disagreed, questioning the quality and availability of treatment. A study this year by the Council of State Governments Justice Center found 22 percent of DOC inmates released in had no access to addiction treatment before leaving prison.
Of those who did have access in one nine-month period, fewer than half actually received it: 39 percent refused help and 17 percent enrolled but did not finish. Jeri Walker, a psychiatrist who treated state inmates for five years. Long before he got locked up — when he was just a kid — Nick Lynch was already struggling with his mental health. He was always in trouble at school. When he was 8 years old, his mother sought help for him at a psychiatric hospital for children. At 10, he was so disruptive he was often suspended from school. His first diagnosis, as a child, was ADD, attention deficit disorder.
Hospitalized again at 14, he was diagnosed with bipolar disorder, his father said. A doctor prescribed new medication, but Nick loathed the side effects and stopped taking it. He started smoking marijuana instead. He tried living with his dad in Florida, but he got kicked out of school for selling weed. Years later, both of them would look back at that moment, finally understanding its full portent.
Mental disorders and incarceration history
Looking back on his younger self, he said, felt like he was looking at a different person. His school expulsion at 16 was only the beginning. He pleaded guilty; a judge sentenced him to six to eight years in state prison. Along the way, he says, he got little mental health care, and faced skepticism from clinicians about his symptoms, which he says included bouts of crippling anxiety and paralyzing depression.
Use of medication was discouraged, says Nick; when he did get some, it usually made him feel worse. Eventually he gave up, he says, and stopped asking for help. Instead, he gave in to rage and fear, getting into frequent fights with other inmates.
Why America’s Largest Mental Health Institutions are Prisons and Jails | Arundel Lodge
Suicide — once a shadowy and distant possibility — became real to him, vivid and familiar. Half a dozen of his friends hanged themselves or overdosed in prison, including the man who had showed him the ropes when he first got to Walpole. At times, Nick contemplated death himself.
Related history of mental health in prisons
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