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Serious gaps in mental health care in Washington prisons, report warns

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Washington State Department of Corrections
A new report from the Office of Corrections Ombuds finds evidence of numerous shortcomings in the availability of mental health care in Washington prisons. The report says distressed prisoners often have to wait to see a mental health counselor and a lack of robust treatment options means some prisoners end up in solitary confinement.

A new report is sounding the alarm about the state of mental health care in Washington prisons. It finds numerous shortcomings that increase the risk of suicide and contribute to lengthy stays in solitary confinement. The Department of Corrections acknowledges ongoing challenges, but says it's been making improvements and plans to seek additional funds from the Legislature to increase mental health staffing.

Inadequate mental health care in Washington prisons is putting some prisoners at heightened risk of self-harm and suicide, and contributing to lengthy stays in solitary confinement, according to a new ombuds report.

The report, months in the making, sounds the alarm about numerous shortcomings, including mental health workers with hefty caseloads and distressed prisoners who have to wait to see a mental health professional.

Other issues identified by the Office of the Corrections Ombuds (OCO) include problems with how psychiatric medications are prescribed and a disciplinary process that often fails to take into account the incarcerated individual’s mental health.

“The big takeaway is that we need more mental health services for people who are incarcerated,” said Joanna Carns, the OCO director.

In response to the report, the Department of Corrections (DOC) acknowledged ongoing challenges in delivering mental health care to prisoners and pointed to the ways it’s addressing many of the issues, including by partnering with outside prison reform groups.

The ombuds report is the latest in a series of OCO investigations that focus on the state of mental health care in Washington prisons – a strategic priority of the independent office, which was created in 2018.

Previous reports have focused on prisoners who’ve died by suicide, the effects of solitary confinement and concerns related to the quarantine and isolation of prisoners due to COVID-19. Forthcoming OCO reports will examine the use of force and restraints on prisoners with mental health conditions and the wellbeing of transgender prisoners.

The latest investigation paints a picture of a prison system ill-equipped to manage the mental health needs of a complex population of roughly 15,000 prisoners spread across 12 prisons and 12 work release sites. Of particular concern to the investigators is anecdotal evidence that prisoners of color with mental health disorders experience disparate treatment. The report also calls out the unique challenges faced by LQBTQ prisoners.

The report is based on an analysis of more than 300 mental health-related complaints to the OCO between November 2018 and November 2020. In addition, investigators surveyed incarcerated individuals, reviewed mental health records and spoke with DOC staff and administrators.

Myriad issues

Among the key findings is that mental health workers who are responsible for the initial screenings of new prisoners are overwhelmed. The report said staffers have to conduct an “extremely high” number of screenings each day and sometimes the location where the screenings happen isn’t private. This is an issue the OCO has flagged before.

Another persistent problem identified by the report is a lack of access to mental health professionals. That can manifest itself in numerous ways, from delays after a prisoner sends a note requesting to see a counselor to a lack of group therapy options.

Prisoners have also complained that DOC doctors have decreased or discontinued their pre-existing psychiatric medications or prescribed drugs that were ineffective.

On the discipline front, the report finds that when prisoners violate the rules and get in trouble, the process “does not provide sufficient opportunity for the full consideration of a person’s mental health condition," according to the report.

Specifically, the report describes a cycle where an incarcerated person acts out because of their mental health condition and then receives a sanction that doesn’t address the root of the behavior. In some cases, individual prisoners rack up numerous infractions due to untreated mental illness.

One example of this was contained in the OCO’s 2020 annual report. It involved a prisoner who was engaging in self-harm. When prison staff tried to restrain the person, he lashed out and assaulted one of the staff members. As a penalty, the prisoner was placed in solitary confinement and lost some of his “good time” credit toward an earlier release.

Another major concern of the OCO is prison suicide. Beginning last year, the OCO issued a series of reports on prison suicide along with several recommendations on how to address the issue. This latest report urges DOC to adopt those earlier recommendations and warns that, in some cases, the agency failed to properly follow up with and track prisoners who had harmed themselves or been on suicide watch.

Another ongoing concern of the OCO is the use of solitary confinement, which is also called intensive management or segregation. The report notes that people with serious mental health conditions are often assigned to a solitary cell for long periods of time.

“This practice goes against years of research that has shown that time spent in solitary confinement exacerbates mental health symptoms,” the report said.

DOC has been working in recent years with the Vera Institute of Justice, a national prison reform group, to reduce the use of solitary confinement.

To address mental health shortcomings, the OCO report makes a number of recommendations, including that DOC reduce the caseloads for staff who screen incoming prisoners for mental health needs.

The report also calls on DOC to increase its mental health staffing to ensure timely treatment and expand group therapy opportunities. As part of that effort, the report notes, it’s important that the clinical staff reflect the racial and ethnic diversity of the prison population.

Regarding the discipline of prisoners with serious mental illness, the report suggests DOC come up with alternatives to the standard sanctions and seek input when appropriate from mental health staff.

The report also urges DOC to reduce the time prisoners with serious mental illness spend in solitary confinement and to research best practices on housing and treatment options that don’t involve segregated housing.

Besides hiring more mental health staff, the OCO also wants DOC to train its front line custody officers to better support the mental health needs of prisoners. This would include training on mental health awareness and on de-escalation tactics. In response, DOC said it already prioritizes de-escalation, but acknowledged opportunities exist for more specific training to people in specialized job classes.

A final recommendation urges DOC to work with the Department of Social and Health Services (DHSH) to allow for the “temporary transfer” of prisoners who need inpatient psychiatric care to Western or Eastern State Hospitals.

DOC Responds

In a lengthy, formal response to the report, DOC said it plans to ask the Legislature next year for funding for two additional psychology positions, along with funds to improve the prisoner intake process.

Meantime, by September 30, the agency hopes to have a fresh assessment of the physical space that’s available in prisons to hold group therapy sessions. But DOC cautioned that finding appropriate spaces and then staffing groups with a correctional officer to ensure safety represents an ongoing challenge. COVID-19 has been another barrier to convening groups.

Next year, DOC plans to roll out more broadly a new discipline program for people with serious mental illness that it has been piloting at two prisons. The program is modeled after a similar one at the Oregon Department of Corrections and requires the involvement of the prisoner’s primary therapist in the disciplinary process.

The department also noted that since 2012 it has reduced the use of administrative segregation by a third and reduced the median stay in isolation by 33 percent. DOC said it’s also halted the use of segregation as a form of sanction and is piloting alternatives to solitary confinement like “transition pods.”

In a statement Wednesday, DOC said it was working collaboratively with the OCO and acknowledged “known challenges associated with the provision of mental health services.”

“The department continues to work on equipping and training its staff with the knowledge and skills needed to support individuals with mental health conditions and continues to review and revise its staffing levels to achieve a reasonable caseload to maintain and provide mental health services where the greatest patient needs exist,” the statement said.

The agency also said it’s working with the University of California San Francisco’s AMEND program to bring a public health-oriented culture to the prison system. DOC is also developing intensive outpatient treatment options that would allow individuals with serious mental illness to be treated while living in the general prison population.

The current DOC secretary is Cheryl Strange who previously led DSHS and, before that, was CEO of Western State Hospital. Strange was named to the position in April. Carns, the Ombuds, said she is hopeful that Strange will prioritize the recommendations in the report given her background in mental health.

“The goal is for people who are incarcerated to leave better off than when they went in and mental health services [are] a critical component of that,” Carns said.