Articles Posted in Mental Health

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This past Sunday’s New York Times featured a profile of the Cook County Jail (IL), “[t]he largest mental health center in America.” Writing separately, Nicholas Kristof offered “[a] few data snapshots:

• Nationwide in America, more than three times as many mentally ill people are housed in prisons and jails as in hospitals, according to a 2010 study by the National Sheriffs’ Association and the Treatment Advocacy Center.

• Mentally ill inmates are often preyed upon while incarcerated, or disciplined because of trouble following rules. They are much more likely than other prisoners, for example, to be injured in a fight in jail, the Justice Department says.

• Some 40 percent of people with serious mental illnesses have been arrested at some point in their lives.

Against this backdrop comes another compelling story from Andrew Cohen, writing for The Atlantic. Cohen gives insight into the “High Security Mental Health Step-Down Unit” at USP Atlanta, “believed to be the first federal prison program ever designed and implemented to provide substantial long-term care and treatment for high-security mentally ill inmates.”

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Just after the New Year, the Bureau of Prisons updated its formulary, from which most medications for federal prisoners are prescribed. (Part I of the formulary is here.).


As I’ve written previously, “Where a client is taking medication, counsel should also provide the prescribing physician a copy of the BOP’s national formulary to confirm that the medication is available or, if not, to facilitate a possible transition to another medication.” What this means is that where a defendant facing federal imprisonment is taking prescribed medication to manage medical or mental health issues, it is advisable that the prescribing physician review the BOP formulary to confirm whether the individual’s medication is included. If so, there is a greater likelihood that the individual will continue to receive said medication upon placement in Bureau custody (though prison doctors routinely review and modify medications upon a prisoner’s arrival at an institution, much to prisoners’ understandable consternation).

If a medication is not included in the formulary, consideration should be given to substituting formulary medications well in advance of sentencing so as to enable the prescribing physician an opportunity to assess how the individual responds to the change. Again, if successful, there is a better chance that the same medication will be prescribed once in BOP custody. If not, the doctor can and should provide counsel a letter (to be forwarded to the U.S. Probation Office for inclusion in the presentence report) confirming that the BOP’s formulary was consulted; that a substitution was attempted; and the reason both for the discontinuation of the formulary medication and the need for the medication prescribed in its place. Such a letter, a copy of which can be taken to a facility when surrendering and presented to staff during admission and orientation, increases the odds that the BOP will recognize the legitimate need for a non-formulary medication, and accommodate the individual accordingly.

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Recently, Andrew Cohen, contributing editor to The Atlantic, wrote concerning a one-page “Suicide Prevention” memorandum issued by Bureau of Prisons Director Charles E. Samuels, Jr. to all federal prisoners in the midst of ongoing litigation over conditions at ADX Florence, CO. (Memo accessible via link.). Cohen offers:
Each of you may read such things into this memo. But none of you will be able to read it and reasonably conclude that the Bureau of Prisons is planning to help solve the problem by hiring more doctors and psychiatrists. The June civil rights complaint, in the case now styled Bacote v. Federal Bureau of Prisons, alleges that there are only two mental health professionals responsible for the care of 450 prisoners at Supermax. With such a ratio, it’s ridiculous to think that even those inmates who want to accept Director Samuels’ kind invitation are going to be successful in doing so.
Nor can anyone read the July 20 memo and reasonably conclude that the Bureau of Prisons intends to modify its rules, which prohibit the use of psychotropic drugs in its “Control Units,” the most secure detention portions of its prisons. That’s the essence of the complaints in both pending cases: The Constitution requires adequate medical treatment, including mental health treatment, but often the inmates who need medicine the most are the ones who cannot by policy and practice get it.