Correctional administrators should ensure that the results of the initial receiving mental health screening - along with subsequent screenings, assessments, and evaluations - inform the decisions that follow regarding housing, programming, and treatment.  Mental health screeners serve as gatekeepers who, in turn, must communicate effectively with correctional staff responsible for housing and program decisions.

Once mental health staff have determined the inmate has a mental illness, several decisions follow.  Mental health staff must develop an individualized treatment plan that recognizes the specific needs of each inmate.  They also must work with correctional staff to determine the housing unit and programs to which such persons should be assigned.  Information about decisions made at one institution must be passed along to the staff at the institution that next receives the inmate.

The first series of recommendations under this policy statement addresses the use of medications in correctional settings.  The development over the previous 15 years of new types of psychotropic medications, such as atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs), has increased dramatically the prospects of recovery for people with mental illness.

The prescription of medications, however, should be only one component - not the central focus - of a treatment or case management plan.  Historically, staff at many correctional facilities have overrelied on the use of psychotropic medications and, in many cases, sedative-hypnotic medications, simply to pacify and to control inmates with mental illness and others believed to be disruptive.  This reveals a common prejudice about inmates with mental illness:  they are noncompliant, difficult to manage, violent, and otherwise undeserving of clinical attention or services.  This is a view current clinical research and practice does not support.

Recommendations:

a.

Include the most appropriate psychotherapeutic medications in prison and county correctional institution formularies.

b.

Develop and adopt jointly standardized clinical decision protocols (i.e., algorithms) that are based upon research conducted on a national level.

c.

Require, at a minimum, that (1) mental health-specific case management services and (2) effective, research-based behavioral and counseling interventions accompany the use of medication.

d.

Develop and provide programs for inmates with co-occurring disorders.

e.

Facilitate access to professional psychiatric services by using telepsychiatry in systems where inmates are distributed across a large geographical area or in locations where there is a shortage of psychiatric service providers.

f.

Review mental health services provided to ensure that they are evidenced-based.

g.

Ensure the cultural competency of all programs for inmates with mental illness.

h.

Provide mental health treatment and services that are gender-specific.

i.

Recognize the distinct programming needs of special populations with mental illness, such as the elderly, the developmentally disabled, those with chronic medical problems, substance abusers, and sex offenders.

j.

Develop graduated housing options for inmates with mental illness that ensure the safety of staff and inmates and prepare inmates, when appropriate, for transition from specialized housing to general population units.

k.

Provide disciplinary hearing officers with the proper orientation and training to make informed decisions about offenders with mental illness.

l.

Ensure continuity of services when inmates are transferred to a different facility.

m.

Require appropriate staff to review mental health information received with the transferred inmate and to respond accordingly.

n.

Identify appropriate technology and protocols for the development of an electronic patient records system.