Jail Inmates' Mental Health Care Neglected; State and Federal Attention Needed

GGD-81-5: Published: Nov 17, 1980. Publicly Released: Nov 17, 1980.

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Studies indicate that from 20 to 60 percent of the jail population on any given day have mental health problems. But most jails do not identify all inmates in need of help or provide for their proper care. The Law Enforcement Assistance Administration (LEAA) established the National Advisory Commission on Criminal Justice Standards and Goals to formulate national criminal justice standards and goals at the State and local levels. The Commission found a general lack of funding and program innovation at the local level, and it concluded that few local communities, especially in sparsely settled areas, have sufficient resources to resolve jails' problems and provide appropriate health and other services. The Commission recommended that the States assume the responsibility for operating and controlling local jails by 1982. If States did not assume control, it recommended alternative actions which included: (1) adoption of professional, statewide standards for jails, and State inspections to ensure compliance; (2) State supervision of and assistance for training of jail personnel; and (3) State-supervised comprehensive planning to ensure that all appropriate community services agencies were used to provide services for inmates in jails or through community-based alternatives.

States have made only limited progress in implementing the Commission's recommendations. States generally have not assumed responsibility for operating and controlling local jails. Some States are adopting mandatory professional standards for jail mental health services. However, States have done little to overcome widespread inadequacies in the training of local jail personnel. Criminal justice and health systems continue to operate separately with little interaction or cooperation. None of the States GAO visited had comprehensively assessed inmates' mental health care needs and community agencies' capacity to meet them or linked criminal justice and health systems to provide services for inmates in jails and through community-based alternatives. Although improving mental health care in locally operated jails is not primarily a Federal responsibility, financial and technical assistance programs administered by the Department of Justice and the Department of Health and Human Services (HHS) could aid the States in bringing mental health care services for inmates up to acceptable standards. The two Federal Metropolitan Correctional Centers which GAO visited did not always adequately screen incoming inmates or provide for adequate treatment for inmates having behavioral disorders. Treatment deviated from professional standards in that neither had a program for drug addiction. Correction of management shortfalls would improve services and facilitate the better use of resources.

Recommendations for Executive Action

  1. Status: Closed

    Comments: GAO has no information on the actions taken in response to this recommendation.

    Recommendation: The Attorney General should require the Administrator of LEAA to include in the Standards Implementation Program a provision for training of State personnel responsible for training local jail staff to assist States in achieving an ongoing capability to help indvidual jails meet professional standards statewide.

    Agency Affected: Department of Justice

  2. Status: Closed

    Comments: GAO has no information on the actions taken in response to this recommendation.

    Recommendation: The Attorney General should require the Director of the U.S. Marshals Service to ensure that the Service's jail inspectors are adequately trained in professional standards for jail mental health care services, as a means of assisting their implementation in local jails.

    Agency Affected: Department of Justice

  3. Status: Closed

    Comments: GAO has no information on the actions taken in response to this recommendation.

    Recommendation: The Attorney General should require that the Director of the National Institute of Corrections (NIC) instruct the NIC Jail Center to (1) make provision for training State jail inspectors in mental health services to assist in giving States an ongoing capability to evaluate jails in terms of professional standards and to help individual jails in implementing them; (2) establish a program of demonstration and training in the implementation of professional standards for mental health care services in some, and eventually all, jail Area Resource Centers; and (3) ensure that the jail Area Resource Centers, in connection with the above, draw upon the experience acquired by the American Medical Association in its LEAA assisted project to promote the implementation of jail health standards.

    Agency Affected: Department of Justice

  4. Status: Closed

    Comments: GAO has no information on the actions taken in response to this recommendation.

    Recommendation: The Secretary of HHS should require the Administrator of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) to (1) direct the National Institute of Mental Health (NIMH) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) to revise guidelines for comprehensive statewide mental health and alcoholism plans to make it clear that State agencies should assess the needs of jail inmates in the planning process; (2) direct NIMH to furnish guidelines to community mental health centers and State agencies responsible for mental health that specifically describe the ways in which centers could assist jails; (3) direct NIAAA to evaluate its program to assist States that adopt provisions of the Uniform Alcoholism and Intoxication Treatment Act and ensure that program results are made known to other States; and (4) strengthen the National Institute on Drug Abuse procedures for reviewing State drug agencies' comprehensive plans to ensure that the drug treatment needs of jail inmates are considered.

    Agency Affected: Department of Health and Human Services

  5. Status: Closed

    Comments: GAO has no information on the actions taken in response to this recommendation.

    Recommendation: The Attorney General should require the Director of the Bureau of Prisons to (1) take appropriate actions to that assure inmates' mental health problems are adequately identified during initial screening and that behavioral disorder treatment services are upgraded to meet established policies; (2) take action to assure that Metropolitan Correctional Centers (MCC) routinely identify and refer for comprehensive health appraisals inmates who will be in the MCCs at least 14 days and provide such appraisals within that period; (3) provide MCC inmates with access to adequate substance abuse treatment programs; (4) increase the time available to professional mental health personnel for professional duties by giving greater priority to providing them with full-time clerical support; (5) use staff more effectively by ensuring that appropriate ongoing psychological reinforcement training is provided to physician's assistants engaged in mental health care problem identification; and (6) require the establishment of a psychological file for each inmate identified as mentally ill and require recording of psychological diagnoses, treatment needed, treatment provided, and results.

    Agency Affected: Department of Justice

  6. Status: Closed

    Comments: GAO has no information on the actions taken in response to this recommendation.

    Recommendation: The Secretary of HHS and the Attorney General should require the Administrators of LEAA and ADAMHA and the Director of NIC to jointly (1) establish a mechanism for continuing coordination among LEAA, NIC, and HHS institutes to better assure that their efforts regarding mental health care for jail inmates are directed towards common goals and are mutually supportive; and (2) to define and agree upon the agencies' and institutes' respective responsibilities and roles in meeting inmates' needs and, as a corollary, develop a joint strategy for their assistance efforts.

    Agency Affected: Department of Health and Human Services

  7. Status: Closed

    Comments: GAO has no information on the actions taken in response to this recommendation.

    Recommendation: The Secretary of HHS and the Attorney General should require the Administrators of LEAA and ADAMHA and the Director of NIC to jointly (1) establish a mechanism for continuing coordination among LEAA, NIC, and HHS institutes to better assure that their efforts regarding mental health care for jail inmates are directed towards common goals and are mutually supportive; and (2) to define and agree upon the agencies' and institutes' respective responsibilities and roles in meeting inmates' needs and, as a corollary, develop a joint strategy for their assistance efforts.

    Agency Affected: Department of Justice

 

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