From The Oregonian, June 19, 2011

Inmates with mental problems are overrunning Oregon’s prison resources.

Year after year, the percentage of prisoners battling psychiatric demons has edged up. Now, seven in 10 of the state’s 14,000 inmates need some type of mental health care in a system never designed to provide it.

Corrections Department officials have added 525 beds for mental health care since 2005 for a total of 900 — more than in the Oregon State Hospital. They’ve created separate mental health infirmaries within prisons. They’ve even turned a “supermax” facility into a ward for the most severely ill.

It’s not enough.

Every day, officials must choose who gets a bed and more focused treatment. The choices carry stark circumstances. Sending troubled inmates back into the general prison population leaves them vulnerable to taunts and attacks. And some mentally ill inmates lose control, harming themselves, other inmates or employees.

“The corrections environment is not good for a person with serious mental health illness,” said Jana Russell, administrator of the Corrections Department’s Behavioral Health Services Division.

But with Oregon’s prison population growing and the state required to provide inmates with free health care, no easy answers are in sight.

Judges turn to prisons

In Oregon and across the country, the mix of inmates with mental illness poses an increasing challenge.

Inmates are five times as likely as the general population to suffer from mental health problems, the federal Bureau of Justice Statistics found in a 2006 study. Of those with mental issues, nine out of 10 abused drugs or alcohol. Mental illness is most pronounced among prisoners younger than 24, and women have far higher rates of mental illness than men, the report said.

“We can’t cure most people,” said Dr. Don Kern, president of the Society of Correctional Physicians. “We’re managing a chronic problem. Is it an ideal setting? No.”

The loss of mental health services in communities has turned the prison system into one of the state’s largest mental health providers. Corrections authorities say judges sometimes send an offender to state prison, convinced that’s the only place they’ll find treatment.

Mental health needs of Oregon inmates
3,988: No reported need
2,971: No need for treatment
2,503: Would benefit from treatment
1,242: Moderate need for treatment
2,400: Severe mental problems
951: Highest need for treatment
Source: Oregon Department of Corrections, May 2011

There’s good reason for that belief: By law, the state prison system must provide free full medical care to every inmate. Oregon is expected to spend more than $100 million on health care in the next year, with about $16 million going to mental health.

But health professionals say more than a mandate should drive care for mentally ill inmates. Nine out of 10 Oregon inmates will one day be released, they say, and turning them free with unresolved issues — and little community care — leaves them at higher risk for committing new crimes for lack of something as simple as daily medication.

And landing people back to prison only adds to the state’s costs.

With decent treatment, “we have a better chance of them living a better life and avoiding criminal conduct,” said Bob Joondeph, executive director of Disability Rights Oregon.

Greater suicide risk

Corrections officials are scrambling to find solutions. For starters, they are backing away from placing troubled inmates in solitary confinement, recognizing that isolation often worsens psychiatric issues and increases suicide attempts.

In 2004, a task force recommended setting up separate treatment units or even a new prison to serve as a mental hospital.

“The potential for preventing suicide attempts, preventing weaker inmates from being victimized and teaching skills to function within a highly charged environment is imperative,” the task force said.

With the Legislature’s approval, corrections officials worked for three years to design just such a building, planning to put it next to a state hospital set to be built in Junction City. The new prison would offer four levels of care, bringing under one roof the most troubled of Oregon’s inmates.

But with the state budget crisis looming, officials pulled the plug last year.

“We were devastated,” said Russell, the behavioral health administrator. “We were hanging on by the skin of our teeth.”

Now the new prison may not be available for nearly a decade. Until then, too many inmates won’t get the treatment they need, Joondeph said.

“They are not going to be ready to return to society when their time is up,” he said. “There is a greater risk of suicide among these inmates. There is a greater risk to people who are vulnerable as a result of their mental illness.”

“It’s what we have”

Prison authorities in recent years have also established mental health infirmaries at the state’s largest prisons, including Oregon State Penitentiary in Salem and Snake River Correctional Institution outside Ontario.

But that effort has faltered, too. No psychiatrists will work for a prison in eastern Oregon, so health professionals have resorted to teleconferencing with inmates.

To get around that, corrections officials elected to bring the most severely ill inmates to the Willamette Valley. But where to put them? In what Russell called the “craziest brainstorm,” eyes turned to the 145-year-old penitentiary in Salem.

Deep inside is Oregon’s version of a “supermax” — a high-security setting for the most dangerous offenders. Mental health experts decided the area, if modified, would be a safe place for mentally ill inmates. Last fall, the mental health unit opened with 187 beds, replacing the supermax unit.

No one finds it ideal. One prison official said it reminded him of scenes from “One Flew Over the Cuckoo’s Nest,” a movie filmed in the dreary reaches of Oregon State Hospital.

“This is not a great environment for doing this, but it’s what we have,” said Joondeph, who recently toured the unit.

Other prisons have managed to carve out space for mental treatment programs. Minimum-security Deer Ridge Correctional Institution in Madras, for example, uses pods that look like large dormitories. They have specially trained corrections officers and regular visits by counselors and therapists, though the inmates lack privacy, prison officials said.

But in the long run, big changes will have to wait.

In the last three budget cycles, the Corrections Department has sought money for around-the-clock mental health staffing. Now, staff has to be called in for crises on nights or weekends.

But Gov. John Kitzhaber didn’t recommend the additional funding this session. Corrections officials said in an internal report that they would manage the best they could, “understanding the inherent risks continue.”