A Washington state prison psychiatrist who reviewed behavioral health services offered by Nebraska’s prison system has recommended some changes in crisis response, staffing, suicide monitoring, medication management and information technology.
Dr. Bruce Gage of the Washington State Department of Corrections provided a 38-page detailed review of inmate mental health services offered through the Nebraska Department of Correctional Services and also suggested a vision of what the department should strive for.
Gage worked with Nebraska's new Corrections director, Scott Frakes, when Frakes was at the Washington Corrections Department. He said he was not being paid for the Nebraska consultation, other than receiving his normal salary.
While the mental health staff in Nebraska prisons is professional and knowledgeable, there are too many vacant positions, Gage said in his report. Also, the department is doing more initial screening than necessary and should focus more on identifying high-risk problems.
People are also reading…
There is a high demand placed on services for inmates who are mentally ill and have other mental conditions that appear to be difficult for prisons to manage.
The sickest mentally ill patients are usually treated in the prisons' residential units or occasionally are admitted to the infirmary, the report said. A state law governing the standard of care in the prisons is interpreted "very broadly" to mean the standard should be the same as in communities.
"Many inmates are receiving mental health services for conditions that most systems would not treat unless compelled by law," Gage said in the report.
The mental health units serve inmates with a wide range of illnesses and conditions including dementia, traumatic brain injury, intellectual disability, personality disorder and major mental illness.
"It is not possible to run an effective program with such diversity both because the services they require are so disparate and because these populations often do not mix well together," Gage said.
The department's mental health staff is doing about 1,500 individual mental health sessions a month, most of those in response to crises or to staff or offender requests, and the staff is not under the guidance of a treatment plan, he said.
Gage also had these observations.
* Information technology systems are limited and outdated. The department lacks “a data system capable of providing real reporting functionality.”
* Crowding in the prisons makes it more difficult to have the flexibility to move inmates promptly as needed. Inmates needing residential services frequently do not get the level of service needed.
* There are not major problems with use of restraints, but Gage raised caution about restraining inmates on hard beds, "which should not occur for any more than a few hours."
* Joint decisions with custody, medical and mental health personnel on suicide monitoring and confinement should be changed and left to the experts in mental health. And being placed on suicide monitoring should not be seen in any way as similar to or as a form of punishment.
Frakes said in a news release he is reviewing the recommendations with the department's behavioral health team, and looking for improvements to make to enhance the system. The inmate population presents significant behavioral health needs, and the department is committed to providing services that both meet their needs and ensure public safety, he said.
The Legislature has been looking into mental health needs of prisons and inmates for more than a year through various committee investigations and interim studies.
Lincoln Sen. Kate Bolz has studied the issues and introduced legislation (LB592) in the 2015 session that applied to mental health screenings, record keeping and civil mental health commitments. She is sponsoring an interim study (LR295) this fall that is examining adequacy of behavioral and mental health treatment in communities that could divert people from being sentenced to prison.
For his review, Gage made a three-day site visit to Lincoln Correctional Center, the Diagnostic and Evaluation Center, the Nebraska State Penitentiary and the Nebraska Correctional Center for Women in York.
He said that as in other correctional settings, Nebraska has seen growth in the numbers of mentally ill inmates, and it serves more severely mentally ill. The most reliable studies show 20 percent to 25 percent of male prisoners and 30 percent to 50 percent of female prisoners need or receive some type of mental health treatment, Gage said. But only 2 percent to 4 percent require hospital or residential level services.
Frakes said he is working with new leaders in the Nebraska Corrections department to make short-term changes. And, he said, he's building a long-term plan that will meet the needs of mentally ill offenders.
The system has added beds to the mental health unit at Lincoln Correctional Center and created a protective management unit at Tecumseh State Correctional Institution.
In the months ahead, Frakes said, the prisons will "continue to build a system of mission-specific housing, providing inmates housing assignments that are consistent with their needs and custody level.”