U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics Special Report Mental Health Treatment in State Prisons, 2000 June 2001, NCJ 188215 ------------------------------------------------------- This file is text only without graphics and many of the tables. A Zip archive of the tables in this report in spreadsheet format (.wk1) and the full report including tables and graphics in .pdf format are available from: http://www.ojp.usdoj.gov/bjs/abstract/mhtsp00.htm ---------------------------------------------------------- By Allen J. Beck, Ph.D. and Laura M. Maruschak BJS Statisticians ---------------------------------------------------------- Highlights Nearly all State adult confinement facilities screen inmates for mental health problems or provide treatment Percent of facilities Mental Confine- Community- health policy ment based Any 95% 82% Screen at intake 78 47 Conduct psychiatric assessments 79 30 Provide 24-hour care 63 20 Provide therapy/counseling 84 35 Distribute psychotropic medications 83 49 Assist releasees 72 51 * Mental health screening and treatment services were more frequently reported by State confinement facilities (95%) than by community-based facilities (82%). * Community-based facilities, in which at least 50% of the inmates regularly depart unaccompanied, were less likely to report mental health screening (47%), assessment (30%), and therapy/counseling (35%). Percent of inmates receiving -- Facility Therapy/ Psychotropic characteristic counseling medications All 13% 10% Public 13 10 Private 10 7 Confinement 13 10 Community-based 9 5 Males only 12 9 Females only 27 22 Both 14 13 1 in 10 State inmates were receiving psychotropic medications; 1 in 8 were in mental health therapy or counseling * On June 30, 2000, an estimated 150,900 State inmates were in mental health therapy/counseling programs; 114,400 inmates were receiving psychotropic medications; and 18,900 were in 24-hour care. * In 5 States -- Maine, Montana, Nebraska, Hawaii, and Oregon -- approximately 20% of the State inmates were receiving psychotropic medications. 155 State facilities specialized in psychiatric confinement, but general confinement facilities provided a majority of treatment Mental health Other confinement functions Number of facilities 155 1,403 Number of inmates 217,420 961,387 Percent receiving -- 24-hour care 7% 0% Therapy/counseling 19 9 Psychotropic medications 17 7 * 12 facilities reported mental health/ psychiatric confinement as their primary function; 143 reported it as a specialty among other functions. * About two-thirds of all inmates receiving therapy/counseling or medications were in facilities that didn't specialize in providing mental health services in confinement. -------------------------------------------------------- On June 30, 2000, 1,394 of the Nation's 1,558 State public and private adult correctional facilities reported that they provide mental health services to their inmates.*Excluded from this report are locally operated jails and Federal confinement facilities.* Nearly 70% of facilities housing State prison inmates reported that, as a matter of policy, they screen inmates at intake; 65% conduct psychiatric assessments; 51% provide 24-hour mental health care; 71% provide therapy/counseling by trained mental health professionals; 73% distribute psychotropic medications to their inmates; and 66% help released inmates obtain community mental health services. One in every 8 State prisoners was receiving some mental health therapy or counseling services at midyear 2000. Nearly 10% were receiving psychotropic medications (including antidepressants, stimulants, sedatives, tranquilizers, or other anti-psychotic drugs). Fewer than 2% of State inmates were housed in a 24-hour mental health unit. This report is based on the 2000 Census of State and Federal Adult Correctional Facilities, an enumeration of all 84 Federal facilities, 1,320 State facilities, and 264 private facilities in operation on June 30, 2000. For the first time, the 2000 census included items related to facility policies on mental health screening and treatment. Inmates screened at admission and placed in general confinement or specialized facilities State prison systems typically screen inmates for mental disorders at a reception/diagnostic center prior to placement in a State facility. As of June 30, 2000, 161 facilities reported serving this function, including at least 1 in every State. Nearly all of these facilities (153) reported that they either screened inmates or conducted psychiatric evaluations to determine inmate mental health or emotional status. In addition, 155 facilities (in 47 States) reported mental health/psychiatric confinement as a special function. Only three States -- North Dakota, Rhode Island, and Wyoming -- lacked a special psychiatric confinement facility. In these States inmates needing special confinement separate from other inmates are placed in State hospitals, prison infirmaries, or in special needs units within general confinement facilities. Mental health services most commonly provided in maximum/ high security confinement facilities Facility policies relating to mental health screening, assessment, and treatment vary by type of facility and security level. Community-based facilities, in which 50% or more of their inmates are regularly permitted to depart unaccompanied, are less likely (82%) than State confinement facilities (95%) to have policies related to mental health screening and care. On each mental health policy considered, about half or fewer of the community-based facilities reported having such a policy. The most common policy for community-based facilities was providing assistance to released inmates to obtain mental health services in the community (51%). The least common was providing 24-hour mental health care to inmates (20%). Among confinement facilities, the most common forms of treatment were therapy/counseling (84%) and distribution of psychotropic medications (83%). At least three-quarters of the facilities reported screening inmates at intake and conducting psychiatric assessments. Nearly two-thirds of confinement facilities reported that 24-hour mental health care was available to inmates either on or off facility grounds. Mental health screening and treatment policies were more frequently reported by maximum/high security facilities than by minimum/low security facilities. Almost all maximum security confinement facilities (99%) reported conducting screening and providing some form of treatment. The most common (95%) was the distribution of psychotropic medications and providing mental health therapy/ counseling. Overall, 125 facilities reported that they didn't provide any mental health services to inmates. Of these facilities, 75 were community-based and 41 were minimum/low security confinement facilities. The absence of mental health policies within these facilities may reflect the confinement and treatment of mentally ill inmates elsewhere within the State systems. On June 30, 2000, fewer than 1.8% of all State inmates were held in facilities in which mental health services were not available. Based on inmate self-reports, at midyear 2000 State prisons held 191,000 mentally ill inmates In the Special Report, Mental Health Treatment of Inmates and Probationers (NCJ 174463), BJS estimated that 16.2% of State prisoners were mentally ill. Drawing from inmate surveys conducted in 1997, BJS found that 10.1% of State inmates reported a mental or emotional condition and 10.7% said they had stayed overnight in a mental hospital or program. Though these estimates depend on inmate self-reports, they provide an overall measure of the need for mental health treatment in State prisons. Assuming these percentages have not changed since the surveys were conducted, an estimated 191,000 inmates in State prisons were mentally ill as of midyear 2000. 13% of State inmates were receiving mental health therapy; 10% were receiving psychotropic medications The 2000 prison census findings reveal a great diversity in the amount and type of treatment being provided among State correctional facilities. Overall, 1.6% of all inmates (or about 10% of all those identified as mentally ill) were receiving 24-hour care in special housing or a psychiatric unit. Inmates in public facilities (1.8%) and confinement facilities (1.8%) were somewhat more likely than those in private facilities (1.1%) and community-based facilities (0.3%) to be receiving 24-hour care. Nearly 13% of State inmates (or about 79% of those mentally ill) were receiving mental health therapy or counseling services from a trained professional on a regular basis. The percent receiving therapy was the highest in female-only confinement facilities (with more than 1 in 4 female inmates receiving therapy) and in maximum/high security facilities (with nearly 1 in 6 inmates in therapy). Facilities also reported that nearly 10% of all inmates (an estimated 114,400 inmates nationwide) were receiving psychotropic medications. The use of these drugs (including antidepressants, stimulants, sedatives, and tranquil- izers) was the most common in facilities specializing in mental health confinement (45%), medical treatment facilities (22%), and female only confinement facilities (22%). General confinement facilities provided most mental health treatment The 2000 census identified 155 facilities that specialize in mental health/ psychiatric confinement. Twelve of these facilities reported that their primary function (identified by the largest number of inmates) was mental health confinement. In some States these facilities are used to house mentally ill inmates separately from the general population; in other States they are used to remove inmates in response to acute episodes for a short term. The most severely mentally ill may be transferred to outside agencies (such as State mental hospitals and secure psychiatric hospitals) for long-term treatment. Facilities with mental health confinement as their primary function are typically smaller than other facilities. Between July 1, 1999, and June 30, 2000, these facilities had an average daily population of 690 inmates, compared to an average of 1,460 in facilities that provide specialized care but hold other inmates as well. On June 30, 2000, these 12 facilities held more than 8,124 inmates, and, on average, were operating at about 88% of their rated capacity. The majority of inmates receiving therapy/counseling and medications were housed in facilities without a mental health specialty. Nearly 70% of all inmates receiving therapy and 65% of those receiving psychotropic medication were in general confinement or community-based facilities. In contrast, most inmates receiving 24-hour mental health care (80%) were receiving that care in a specialized confinement facility. In 5 States nearly 20% of inmates receiving pyschotropic medications Excluding States in which fewer than 90% of inmates were in facilities reporting on mental health items, the census found that the use of psychotropic medications was most common in Hawaii, Maine, Montana, Nebraska, and Oregon (with nearly 20% of all inmates) and least common in Alabama, Arkansas, and Michigan (with fewer than 5% of inmates receiving medications). In four States -- Louisiana, Nebraska, Maine, and Wyoming -- facilities reported that at least a quarter of all State inmates were receiving mental health therapy or counseling services. Among all States, only Hawaii, which operates an integrated prison and jail system, reported that fewer than 5% of their inmates were receiving mental health therapy/counseling. Among all correctional facilities, the Louisiana State Penitentiary in Baton Rouge reported the largest number of inmates in therapy (1,736), followed by the California Men's Colony in San Luis Obispo (1,721), the California Medical Facility in Vacaville (1,300), and the Indiana Wabash Valley Correctional Facility (1,021). Methodology The 2000 Census of State and Federal Adult Correctional Facilities was the sixth enumeration of State institutions sponsored by the Bureau of Justice Statistics. Earlier censuses were completed in 1974, 1979, 1984, 1990, and 1995. The facility universe was developed from the 1995 census. Each department of corrections was contacted to identify new facilities and facilities that had been closed since June 30, 1995. Data were collected from all facilities, resulting in a final response rate of 100%. Facilities were included in the census if they had separate staffs; housed primarily State or Federal prisoners; were physically, functionally, and administratively separate; and operational on June 30, 2000. Overall, the census identified 84 Federal facilities, 1,295 State facilities, 22 facilities under State and local authority, 3 facilities operated by the District of Columbia, and 264 privately-operated facilities. The census included the following types of adult correctional facilities: prisons and penitentiaries; boot camps; prison farms; reception, diagnostic, and classification centers; road camps, forestry and conservation camps; youthful offender facilities (except in California); vocational training facilities; prison hospitals; drug and alcohol treatment facilities; and State-operated local detention facilities (in Alaska, Connecticut, Delaware, Hawaii, Rhode Island, and Vermont). Facilities were classified as community based if 50% or more of their inmates were regularly permitted to leave unaccompanied or if their primary function was community corrections. Such facilities included halfway houses and restitution, prerelease, work release, and study release centers. Correctional facilities were classified as confinement facilities if fewer than 50% of the inmates are regularly permitted to leave unaccompanied. On June 30, 2000, 463 State facilities were community-based and 1,121 were confinement facilities. All Federal facilities and 26 privately- operated facilities that held at least 50% of their inmates for Federal authorities were excluded from this report. Data on policies and the numbers of inmates receiving mental health treatment within these facilities on June 30, 2000, were not available. The Bureau of Justice Statistics is the statistical agency of the U. S. Department of Justice. Lawrence A. Greenfeld is the acting director. BJS Selected Findings summarize statistics about a topic of current concern from both BJS and non-BJS data sets. Allen J. Beck and Laura Maruschak wrote this report. Paige Harrison and Erika Westry provided statistical assistance and verification. Tom Hester edited the report. Jayne Robinson administered final production. Data collection and processing for the 2000 Census of State and Federal Adult Correctional Facilities were carried out by Pam Butler and Linda Huang, with assistance from Patricia Torreyson and Bill Bryner, under the supervision of Charlene Sebold, Governments Division, U.S. Census Bureau. July 2001, NCJ 188215 End of file 07/11/01 ih