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Ask the Mental Health Expert Archives 2001-2004

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Treatment in Prison

Q. If someone is sentenced to prison for a sex offense, how would one ensure proper treatment behind bars? This person expresses a desire to get help and is also suicidal (true suicidal ideation with a plan of how to do it) out of a mixture of guilt and fear of what prison will be like...

If you know that the placement of an inmate is not likely to be beneficial, is there some way to get an inmate moved? Who would have to be involved? I have heard that most facilities do not focus on treatment until the end of the sentence towards the last year or two.

There are not many people who seem as remorseful as this person is. I think he would benefit from treatment. I fear the penal system will fail him and do more harm than good. Do you share my feeling that treatment should be started immediately?

A. The problem of providing adequate mental health services to incarcerated persons is a serious one. Clinical studies suggest that 6 to 15 percent of persons in city and county jails and 10 to 15 percent of persons in state prisons have severe mental illness.

Factors leading to mentally ill persons' being placed in the criminal justice system include: deinstitutionalization, more rigid criteria for civil commitment, lack of adequate community support for persons with mental illness, mentally ill offenders' difficulty gaining access to community treatment, and the attitudes of police officers and society (Lamb HR; Weinberger LE, Psychiatric Services 1998 Apr;49(4):483-92).

My impression is that prisons differ widely in how readily and responsibly they provide mental health care to prisoners. (Dr. Kenneth Gilbert has explored some of these issues in his series of columns in the Psychiatric Times ("Working on the Inside"), and I recommend that you look for these).

I absolutely agree that any prisoner with suicidal ideation should receive immediate assessment by a mental health professional, and may need to be on a special suicide watch. I would suggest that you try to speak with the warden of the facility immediately. Ideally, that might prompt him to request a psychiatric evaluation for the prisoner in question.

The issue of getting treatment for a sex offense is more complicated, and may depend on the nature of the underlying problem. Some penal institutions may provide therapy and/or medication for some sexual offenders, but first, a psychiatric diagnosis must be made; e.g., some sexual offenders are life-long pedophiles, while others may have acted impulsively in the course of a bout of intoxication, or during a depressive episode.

Treatment would be quite different in each case. For more information about legal options, I would suggest that you contact both the National Alliance for the Mentally Ill (NAMI; call 800-950-6264); and the Bazelon Center of Mental Health Law, a non-profit legal advocacy organization (http:www.bazelon.org/).

June 2002

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