• Evidence of the burden that mentally ill individuals have on law enforcement, corrections, state and local budgets

and 2005 indicate that among state and federal correctional facilities, the offender population increased 10%.3 That 10% translates to approximately 63,000 more offenders in state and federal systems compared to the 2000 census data on correctional facilities.4 If we assume that 15–20% conservatively would be mentally ill, then 9450–12,600 of those individuals entering the system were mentally ill. While the percentage of the mentally ill population that will be designated SMI can vary, there is some indication that between 7% and 10% of those individuals will be considered SMI. These numbers are particularly troubling since during the same period, “the number of inmates incarcerated in state and federal facilities rose nearly three times faster than the number of employees working in state and federal facilities.”3 If the number of offenders have increased and the number of staff has not increased at a rate that accounts for the offender population, then there is imbalance and that leads to deficient service delivery.

In order to guard against an ineffective mental health service delivery system, there must be effective policy and procedures in place that specify the service delivery model. An effective mental health delivery system at its basic core screens, refers, evaluates, designates, and continuously improves the quality of its service delivery at all levels. All offenders entering into the correctional system must be screened at intake for potential risk of suicide and for any indication of mental health concerns/mental illness. This process is vital because it becomes the launching platform for future service delivery within the prison system. Effective screening influences housing, security designation, mental health designation, referrals, and countless other processes. Mental health screenings are supposed to detect the potential for mental health concerns. They are not intended to diagnosis or provide in-depth assessment, as that will occur upon referral for mental health services. The screening step is one of the first steps that can flag a problem or potential problem.

The mental health evaluation is an in-depth process that takes a comprehensive look at the person. This process includes but is not limited to assessing the person’s psychological, developmental, and social histories, along with their current mental status in order to formulate a current diagnosis and establish an individualized treatment plan. The goal of a mental health evaluation is to obtain a comprehensive picture of the person so that a diagnosis and treatment course can be formulated. Mental health evaluations should continue to occur as individuals progress through treatment to ensure their needs are continuously being met. Offenders often transfer to several different facilities within a state system, making up-to-date treatment plans imperative to ensure continuity of care.

Having an effective quality assurance (QA) process in place is a must-have for any correctional mental health system. Quality assurance is designed to find ways to improve clinical processes, enhance resource allocations, improve continuing professional educational training opportunities for staff, and improve the overall offender satisfaction with mental health services. This process, above all others, allows the prison system to show evidence that their mental health service delivery system is effective. An effective QA process may be difficult to implement in some systems, since it will require staffing and resource allocation. This is a fulltime process that must be allowed to run its course. Further, there must be a commitment on the agency’s part to support the improvement recommendations that flow out of the QA process. Without such support and commitment, the QA process cannot be effective. As has been illustrated, the offender population, specifically the mental health population and its seriously mentally ill subset, has a tremendous impact on the entire correctional system.

References