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Old 06-16-2005, 07:09 PM
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horsegal horsegal is offline
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Exclamation Revolutionizing Mental Health Care in Ohio Prisons

Revolutionizing Mental Health Care in Ohio Prisons


Reginald A. Wilkinson, Director
Ohio Department of Rehabilitation and Correction

The Correctional Psychologist, July 1995

A new approach to the treatment of mentally ill prisoners means safer, more manageable prisons and ultimately a safer Ohio. A comprehensive health care delivery system, using specially trained teams, will give mentally ill inmates the opportunity to improve their ability to function and make them less likely to commit new crimes.

Ohio's prison system had originally been created as part of the Department of Mental Hygiene and Correction, and has had a long history of working with Ohio's Department of Mental Health (DMH). The Ohio Department of Rehabilitation and Correction (DRC) became a separate department in 1972, but maintained a strong working relationship with DMH.

With the onset of the current administration in 1991, it was determined that the dwindling of mental health services in Ohio's prisons, due to prison crowding and indistinct missions, was unacceptable. The two departments decided to collaborate to provide better programming and services to mentally ill offenders. As a result, the under-utilized Oakwood Forensic Center was transferred from DMH to DRC, and recommissioned as the Oakwood Correctional Facility, with a significant increase in forensic beds. A new, privately operated 80-bed mental health unit was also opened at the Trumbull Correctional Institution.

The 1993 Easter riot at the Southern Ohio Correctional Facility drew even more attention to the needs of mentally ill prisoners. The Dunn v. Voinovich class action lawsuit, filed in federal court, also alleged inadequate mental health care in prisons. Rather than fighting the suit, the two departments adopted a cooperative and collaborative strategy, engaging an outside group of experts to conduct a detailed audit of mental health care in state prisons.

The experts, led by Fred Cohen, Professor of Law and Criminal Justice at the State University in New York, University of Albany, had unimpeded access to the prisons and their records, with the intention that their findings would be available to the courts. By working with the expert team and the plaintiffs' attorneys, the two departments are close to a settlement agreement, saving untold dollars in litigation and at the same time, significantly improving the care of mentally ill prisoners.

A major result of the expert team's findings is the decision to turn over the care of mentally ill prisoners to the DRC, with the DMH providing oversight and aftercare linkage to the community. The departments developed a "holistic approach" to care designed by an interdepartmental team. A special "Ohio Team" attended the National Coalition on Mental and Substance Abuse Health Care in Criminal Justice Policy Design Academy in Aspen, Colorado in August 1994, and developed the following mission statement.

To develop an organized approach for the continuity of holistic, quality treatment for juveniles and adults who come into contact with the criminal justice, mental health and substance abuse systems.

A special 3-day conference was later held to integrate the service delivery system within prisons, while at the same time developing and strengthening community linkages with service providers. It is essential that alternatives be developed to divert non-violent individuals from prison, by increasing options for care in the community. The two departments will be working closely with local mental health boards, law enforcement, service providers, the courts, parole, probation, and halfway houses to reduce the number of mentally ill individuals entering state prisons. At the other end of the spectrum, local agencies will provide a continuity of care for forensic patients leaving the prison setting.

The Department of Mental Health will retain involvement in offender care in three ways: 1) they will continue to operate the acute care hospital unit at Oakwood; 2) they will develop quality oversight standards to assure that a professional mental health viewpoint is reflected in the quality of care; and, (3) they will continue to work with sister agencies on the community care and treatment of mentally ill and substance abusing offenders. The DMH will retain a core mental health staff in the prisons to coordinate "discharge planning" for released inmates. The Ohio Department of Alcohol and Drug Addiction Services will assist in providing recovery services for mentally ill prisoners who are dual diagnosed.

Within the prison system, DMH will transfer the vast majority of its mental health staff to DRC. The Department of Rehabilitation and Correction will also significantly increase staffing levels to provide a coordinated mental health program. A deputy director for mental health services has been appointed, and a board certified forensic psychiatrist has been brought on board to oversee clinical services. An "Office of Correctional Health Care" has been created to ensure an integrate approach encompassing psychiatric, psychological, medical and recovery services care for inmates. We have reorganized areas of responsibility so that a deputy warden for special services is in place to oversee medical, mental health, recovery (i.e., substance abuse, sex offender, etc.), education and religious services for each institution. Placing these services areas together will help us achieve a unified system of services.

Ten prison "clusters" are designated to operate like catchment areas in a community mental health system. Patients needed crisis or residential care will be transferred to the facility within the cluster that is designated to provide that care. The cluster team will provide a continuum of care ranging from outpatient to residential services, and will work jointly with medical, recovery services and sex offender services staff.

Staff from the cluster's core mental health team will be easily accessible, providing assessment, evaluation, prison adjustment, treatment planning, individual and group counseling, activity therapy, medical prescription and monitoring, behavior management, and crisis intervention. Mental health professionals will work with inmates in segregation on a regular basis, and ensure that no prisoner is sent to segregation or punitively transferred solely on the basis of his or her mental illness.

Inmates with mental illness should benefit from the same services that other prisoners receive. For example, certain inmates with a mental illness can and should work within the institution. A combination of sheltered workshops and supported employment options will be designed. Job coaches, as part of the mental health team, will assist inmates to function productively and work with supervisors to resolve problems on the job.

One of the cornerstones of the new system is a multi-disciplinary assessment of each prisoner's needs at the point of reception. This will help us determine risk factors and appropriate security classification, as well as to develop a plan to manage inmates with special needs.

In more practical terms, the department will increase the number of crisis/residential beds at Oakwood by 24% from 558 to 710 and decrease the more expensive in-patient beds by 25% from 160 to 120. The more we can keep inmates in the general population and increase their coping skills within their environment, the better their overall adjustment will be, and prison safety will be increased.

To accomplish these many goals, the departments have established several inter- and intra-departmental work groups involving staff at all levels to focus on recruitment, standards, quality assurance, program evaluation, the reception process, classification, training, involuntary medication issues, management information systems and hiring protocols.

We will continue to build on our strong inter-agency relationships in a way that will maximize our strengths with the goal of positioning Ohio to become a leader in the delivery of prison mental health services. Readers are welcome to call for more information.

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Old 06-16-2005, 07:58 PM
JennyMCa JennyMCa is offline
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Post Great Retrospective on Wilkinson's vision

Keeping in mind that document was written in 1995 and it is now 2005 and the mental health system in the prisons is so different from what Wilkinson held out then and holds out now, I would say that he thinks he can be just like a prosecutor:

Plan A: build up an imaginary perfect case (opps. Darn it, I meant mental health system ) and then put whatever parts of it happen to fall into place in operation.

Plan B: if plan A doesn't work, instead of trying to improve it, launch a spin doctoring campaign and rope in some new to the business documentary producers to put your vision on film. Just like people tend to believe something more if they read it, people really tend to believe if it's shown in a documentary, the big difference being that virtually everyone watches TV. Not everyone reads. Therefore the TV documentaries from the highly regarded Frontline series are likely to reach a lot of people, who will hopefully believe anything Wilkinson says.

Keep in mind that people WANT to see evidence that their tax dollars are doing some good.

I've been thinking the last few days about how incredibly IRRESPONSIBLE it was of Wilkinson and his staff to produce this video documentary with such detail about the inmates their problems and the way they are treated. Evidently inmates with TV access saw it (I know my sweetie did and he commented on how awful it all is) I have been trying to put myself in the place of a Lucasville inmate with a psychiatric disorder, seeing this on TV and realizing that as a person with a legitimate disease his status has been so lowered that he can end up in a supermax prison in Ohio for doing the sort of crime that might net someone not mentally ill a couple years in a level 2 place under still horrible but much less demeaning circumstances.(the average sentence of a mentally ill inmate/patient if I understood the stat quoted in the documentary right). I do believe my self esteem might be so low after viewing this that if I were headed in the mental direction of suicide I might feel so hopeless that I might just go ahead and end it all.

I think after we're through writing to the producers of the documentary maybe we ought to write to the members of the State Senate and make sure they've seen the Frontline episode about Lucasville.

My nerves are STILL on edge from the profile in the Frontline program of an inmate who kept being stuffed in lockdown because of his psych condition where he would become isolated, despondent and start losing touch with reality all over again. Then they would ship him to a special facility a REAL mental health inpatient program with crafts and peer activity programs and real therapy where he'd (not very mysteriously improve) when he was improved one might expect he'd go somewhere OTHER than back to lockdown at Lucasville to PRESERVE his mental health and functioning, but that isn't what happens. Doctors, whose hands are tied in thsi wonderful system are forced to return him once he maintains stability for a few weeks. Insanity is repeating the same thing over and over again and expecting different results so is it the inmate or the prison system administration who is insane? I'm just getting madder and madder and madder!

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