Mental health care that goes above and beyond
Correctional setting presents many challenges
Recent comments by a Washington state senator that nurses in rural hospitals sit around playing cards was met with protests from across the nation. Nurses and organizations sent hundreds of decks of cards to the senator’s office in the form of protest. The political logic of such a statement is curious as, according to Gallup polls, nurses have consistently topped the charts as the most trusted professionals. In fact, among the professions surveyed, nurses, medical doctors and pharmacists constitute the top three spots for professionals with the most honesty and highest ethical standards. I am a medical doctor and am here to offer my own protest against criticism of my colleagues right here in Connecticut.
As a board certified psychiatrist, a portion of my current practice includes care of the youthful offenders housed at Manson Youth (Correctional) Institution, one of the state’s maximum security prisons that houses male inmates 15 to 21 years of age. As a rule, an inmate population carries a heavier disease burden compared to the general population. This is particularly true for psychiatric disease in adolescence when some conditions emerge for the first time.
Society determines whom to incarcerate and jails or prisons are not health care facilities. Yet the Supreme Court has held that inmates are constitutionally entitled to medical care. So once they arrive, an entire service that includes nurses, social workers, counselors, physicians and even correctional officers is constantly and vigilantly on the lookout to refer any patient who needs care and assistance.
The process starts with screening of all new inmates, followed by classification, which is a dynamic and multidisciplinary process, to assume proper monitoring and follow-up. This is just a sliver of the daily tasks that correctional medical and mental health staff have to carry out.
This brings me to a recent article published in Hearst Connecticut Media (April 29), which referenced a January 2019 report released by the State Office of Child Advocate. The money quote was that at MYI, “most of the male juveniles did not receive mental health screening or programing.”
This is false. To be very clear, every inmate brought to MYI is screened and assessed by a nurse followed by a licensed mental health professional. Every. Single. One.
The assessments are not just for psychiatric diagnoses or predispositions, but level of stress and ability to cope, adjustment issues, drug use and abuse, past treatment, and level of functioning. All of these factors (and more) are taken into consideration in classification and referral of an inmate for “mental health treatment.”
In the correctional setting, resources are limited, sometimes outright absent. Time is short and sick inmates — both medically and psychiatrically — are many. Furthermore, in the last few years, the state’s Correctional Health Service has undergone seismic changes in administrative and organizational leadership (This July will be one year since DOC took over inmate medical care from UConn). Our dedicated medical and mental health staff manage to assure that systematic or organizational challenges do not negatively impact care.
Regardless of the challenges, we welcome the sort of media scrutiny that creates awareness and propels the changes needed to better serve this vulnerable population. But when it comes at the expense of our professional reputations? Then we ask for a fair opportunity to showcase our performance. I am confident that at MYI, inmates receive a level of medical and mental health care that exceeds community standards.
“Mental health treatment” is a term of art. It encompasses many aspects in the state of one’s mind. Are we speaking of psychiatric disease? Psychological disorders? Character flaws? Behavioral issues?
For example, acute psychosis constitutes a medical emergency. Ditto hopelessness or suicidal thinking. On the other hand, an individual’s sociopathic character traits require more of a long-term rehabilitative goal. And yet, these are all concerns that fall under the umbrella of “mental health treatment.”
In prison, safety and health, with treatment geared toward alleviating risk and a return of baseline functioning, come first. Once they are achieved and maintained, then we can work toward rehabilitative and instructional or skill building aspects of offenders’ minds.
Beyond psychiatric diagnoses, inmates’ pasts often include violence, broken homes and communities, drugs, abuse and neglect. Some inmates are just bad apples. But all deserve to be safe, healthy, properly treated and, if possible, rehabilitated.
At some point before getting released, we hope, elements of personal accountability, resilience and proper use of societal resources and opportunities have been fostered and instilled. Unfortunately, most will return to the same broken homes, violence and deprivations that predated their incarceration. Treatable psychiatric disease notwithstanding, the battle for stabilizing environmental supports in the community cannot be won in prison. But, again, when it comes to “mental health treatment,” I believe MYI exceeds the community standard of care.
Working in a prison is difficult. The population is sick and the needs, by nature of the system and population, are large. But it is a rewarding and unique branch of medicine. Regardless of obstacles, day in and day out, the medical and mental health staff at MYI are hard at work applying their professional skills in the service of each individual inmate under their care. Nobody is playing cards. Or sitting.