Rates of mental illnesses among inmates in the U.S. have been as high as ever – the latest public Bureau of Justice mental health report indicates that about 20 percent of prison inmates have a serious mental health illness and 30 to 60 percent of inmates have substance abuse problems. The stats don’t stop there. Each year, approximately 75 percent of female inmates and 63 percent of male inmates will experience a mental health problem that requires health services.
As these rates continue to rise, the U.S. prison system struggles to find solutions to the lack of resources and to resolve conflicts of interest between healthcare providers and security protocols (Exworthy, 2012). In the northwest United States, correctional mental health faces unique challenges given the prevalence of prison systems in the region and facilities’ long history of being perpetually understaffed, especially within underserved, typically rural communities (WICHE, 2015).
There are three primary sources of mental health providers that correctional facilities typically draw from. First, facilities typically staff a few mental health providers as full-time or part-time employees. Additionally, physicians and nurses who are state employees can be allocated to juggle work among multiple facilities. Lastly, facilities may also have the capacity to individually contract physicians and nurses to supplement care.
Correctional facilities staff utilize a variety of types of mental and behavioral health professionals. These include licensed psychologists, psychiatric nurse practitioners, social workers and counselors, in addition to psychiatrists. Unfortunately, supply fails to meet the demand as each of these mental health providers may have upwards of 90-100 cases. This overload has created a gap in care. According to a clinical psychologist at Mission Creek Corrections for Women in Belfair, Washington, while there may be sufficient care for acute needs, inmates needing long-term ongoing care are simply unable to receive such (Humphreys-Gallegos, Personal Communication, 2016). Therefore, there may be higher rates of relapse and some patients may end up even worse off than before treatment.
The department of corrections of each state is responsible for providing the majority of financial and staff resources as well as coordinating admissions between facilities to get inmates the health services they need. Support from the state government comes from state budgets, legislators, governors’ budgets and other sources.
Every state department has a unique relationship with the correctional facilities. In Alaska, all fifty-four of its correctional providers are state-employed. They are allocated among twelve facilities totaling over five thousand inmates, with a reported 65 percent living a mental health issue (Alaska Department of Corrections, 2014).
Contracting has become a more popular second option in Washington as providers often divide their week working at multiple sites at higher rates. As contracting becomes a more viable option for providers in Washington, the true scarcity of correctional providers in the state and financial limitations the states face become more apparent.
Telepsychiatry is one viable solution to the staffing issues at correctional systems in the Pacific Northwest. At correctional facilities, telepsychiatry increases access to care for inmates and helps to create smoother entry for providers to work in the corrections communities in states’ most rural areas, thereby increasing the supply of mental health practitioners. In addition, telepsychiatry makes the delivery of care more efficient, as it has been shown to reduce transportation costs, inmate housing costs and additional security costs, among many other expenses that are associated with the current corrections system (Deslich, 2013).
Individual state departments can also benefit by being able to allocate their psychiatric resources more efficiently to a variety of facilities while lowering costs in doing so. Having providers accessible over the internet decreases (but does not eliminate) the need for keeping providers on site and allows the provider to see patients from multiple sites with just a few clicks of the mouse.
Telepsychiary and telemedicine solutions are growing in popularity (Deslich, 2013). It’s clear that new technologies and services become more available, healthcare facilities of all types will benefit from the increased access to health care providers. There are a few correctional facilities in the Pacific Northwest that are using or considering telepsychiatry services to increase mental health care. When the rest come on board, facilities will see reduced costs, increased access to appropriate care for inmates and a better allocation of time and other resources.
1) Bureau of Justice Statistics (BJS). Retrieved March 10, 2016, from http://www.bjs.gov/index.cfm?ty=pbdetail
2) Exworthy, T. (2012). Commentary Treatment for Prisoners: A U.S. Perspective. Retrieved March 10, 2016, from http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.20120p276
3) Western Interstate Commission for Higher Education. (2015). Retrieved March 10, 2016, from http://wiche.edu/pub/wiche-six-decades-collaboration-west
4) 2014 Alaska Offender Profile – Alaska Department of Corrections. (2014). Retrieved March 10, 2016, from http://www.correct.state.ak.us/admin/docs/Final_2014_Profile.pdf
5) Deslich, S. (2013). Telepsychiatry in the 21st Century: Transforming Healthcare with Technology. Retrieved March 10, 2016, from http://perspectives.ahima.org/telepsychiatry-in-the-21st-century-transforming-healthcare-with-technology/#.VuIlp4SYdSU
About the Author
Nathan Kung will soon graduate from Columbia University with a B.A. in neuroscience and business management. He envisions a world where every person can reach their fullest potential without being held back by mental health challenges. To Nathan, this means that all of us have come to acknowledge the significance of mental health alongside physical health concerns and understand the need to raise current standards of care for mental health.