NEWS

February 18, 2008
Prisoner mental health care lags

Inmate Matthew Ward of Mason City got so depressed in December he tried to hang himself in a Fort Madison prison cell.

"I felt hopeless," said Ward, 21, who is serving a 30-year sentence for burglary convictions.

Ward, who has had past problems with methamphetamine and marijuana, was brought to the Oakdale state prison here to stabilize his mental health. He is among about 3,500 Iowa prisoners with psychiatric illnesses. They represent 40 percent of the state's 8,700 convicts, according to the Iowa Department of Corrections, which has struggled to address the issue.
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Providing mental health care to troubled men and women is critical to keeping them out of prison once they are released, prison officials said. But the dramatic growth of Iowa's prison population - up 201 percent over the past two decades - hasn't been matched by an increase in prison mental health services, officials said.

"As far as the mentally ill are concerned within the state system, we do have rather limited resources to try to manage and care for them. We need a lot more emphasis on funding for the care of the mentally ill," said Dr. Bruce Sieleni, a psychiatrist who is mental health services director for the Department of Corrections.

For example, Iowa's prisons need at least three or four more psychiatrists and up to four more psychologists, plus other staff, to cover work now being done by about 35 professionals, Sieleni said. But even if more money were available, it's difficult to recruit mental health professionals for prison work. A 2006 report said Iowa ranked 47th nationally in psychiatrists per resident.

Many inmates with mental illness face problems upon release from prison. Ex-convicts receive a 30-day supply of psychiatric medication, but once it runs out, they often have no money to buy more. As a result, ex-convicts often start using illegal drugs and return to prison, officials said.

Prisoner advocacy groups contend Iowa needs to do a better job of addressing mental health issues. This would keep mentally ill people out of prison and reduce the need for a $256 million construction plan being considered by the Iowa Legislature to upgrade and expand Iowa's prisons, they contend.

"The state needs to fix the mental health system. ... The whole thing is broken," said the Rev. Carlos Jayne of Des Moines, a lobbyist for the Justice Reform Consortium, a coalition concerned about Iowa's prisons.

State officials are proposing several new programs to address prison-related mental health issues:

One of Gov. Chet Culver's budget requests seeks $3 million for 10 emergency mental health programs statewide, said Allen Parks, director of mental health and disability services for the Iowa Department of Human Services. Some counties already offer such services, but most don't, and Culver's proposal would take pressure off county jails and state prisons, hospital emergency rooms and in-patient psychiatric programs.

The human services agency is also working with federal officials to establish post-release mental health services for Iowa parolees, Parks said. Ex-offenders would receive psychiatric medication and services. They would be overseen by case managers.

In addition, Culver has proposed one-stop, community re-entry programs for parolees and community resource centers for probationers with mental health and substance abuse treatment and other services. The first programs would be in Des Moines and Waterloo.

In Cedar Rapids, a community corrections mental health facility is scheduled to open this summer. It will include a 26-bed inpatient treatment unit plus outpatient services, said Gary Hinzman, director of the 6th Judicial District's Department of Correctional Services. Culver's proposed budget doesn't include $2.6 million to run the facility, but Hinzman hopes lawmakers will approve the money.

The increase of mentally ill people in Iowa's prisons has corresponded with a dramatic reduction in psychiatric patients at Iowa's four mental health institutes over the past five decades, said Dr. Bhasker Dave, superintendent of the Independence Mental Health Institute. One unfortunate side effect has been that some mentally ill people are now winding up in prisons or jails, he said.

Iowa's largest mental health facility is now at the Iowa State Penitentiary at Fort Madison, where a 200-bed Clinical Care Unit opened in 2002. The Oakdale prison has an accredited psychiatric hospital and a 170-bed special-needs unit with room for mentally ill offenders. The Mount Pleasant prison has a 100-bed special-needs unit for female inmates. In contrast, the four state mental health institutes now have a total of only 158 beds for psychiatric patients, compared with thousands of psychiatric beds decades ago.

"It is just simply wrong that we have so many people in the correctional system who frankly used to be in the general mental health system," said Margaret Stout, director of the National Alliance for the Mentally Ill of Iowa.

Troubled inmate Ward said his life improved at the Oakdale prison's mental health unit, where he was given anti-depressant medication and regularly checked by mental health professionals.

"I am stable. I understand what is going on around me," Ward said. "My goal is to continue doing well, working with counselors to get me situated. I want to go to college while I am in here and better myself, so when I get out I will have more options."

Another Oakdale inmate, Cody Dickson, 19, of Chariton, who is serving a 20-year sentence for a sex offense, said he has had a lot of depression. His father, Kevin Dickson, was murdered in 1990 near Murray in southern Iowa, although his remains weren't recovered until nine years later.

Dickson said he had a rough time adjusting to prison, getting into fights with other inmates and threatening correctional officers. He said he tried committing suicide three times in prison, slashing his wrists and trying to put staples into his veins. Mental health professionals at Oakdale have helped to stabilize him, he said.

"It is working out a lot better. I have been a lot calmer. I have been able to focus on things. Before, I couldn't sit still," Dickson said.

Outside Iowa's prisons, there have been some successes in mental health services in community corrections.

For example, the Waterloo community corrections facility has an 18-bed wing for offenders, mostly on probation, who get mental health and substance abuse treatment. The nine-year-old program has received two national awards.

Story County is one of several Iowa counties with mental health programs aimed at diverting offenders from county jails. It identifies people with nonviolent criminal records and removes them from jail to receive community services, including substance abuse and mental health treatment.

Tom Newton, director of the Iowa Department of Public Health, said jail diversion programs offer hope that some offenders won't be imprisoned.

"Let's get to those people who we know can be living out in the community without causing danger to themselves or to their neighbors, friends or families, and get them the help they need so they can be contributing members of society," Newton said.

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