Growth of Mental Health Services in State Adult Correctional Facilities, 1988 to 2000

The two surveys that we examined were chosen because they occurred more than a decade apart, had a reasonable amount of data, and could be made comparable. Thus results from the 1988 Center for Mental Health Services survey—Inventory of Mental Health Services in State Adult Correctional Facilities—were compared with those from the 2000 Bureau of Justice Statistics survey—Census of State and Federal Adult Correctional Facilities (1,4).

The 1988 Center for Mental Health Services survey covered state adult correctional facilities in the United States and its territories operating during the month of September (1). The sample for the survey was derived from the American Correctional Association's 1988 Directory of Juvenile and Adult Correctional Departments, Institutions, Agencies, and Paroling Authorities (1). Facilities were excluded from the survey if they were identified as youthful offender facilities, prison farms, road camps, and federal prisons. A total of 799 facilities were asked to participate, and 781 responded, giving a response rate of 98 percent. For comparison purposes we excluded facilities that were in U.S. territories, leaving 757 sample facilities for our analyses.

The 1988 survey gathered specific data for each category of mental health service: availability of services, location of services, staffing of services, volume of services, and demographic and clinical characteristics of service users. Data were collected at the facility level and then aggregated. State and national findings were reported.

The comparison survey was conducted in June 2000 by the Bureau of Justice Statistics (4). The survey's universe of facilities was developed from the Department of Justice's Census of State and Federal Adult Correctional Facilities, 1995 (5). However, the report was updated with the 2000 Census of State and Federal Adult Correctional Facilities to identify new facilities and to eliminate facilities that had closed (6). The survey included adult correctional facilities, prisons and penitentiaries, boot camps, prison farms, reception centers, diagnostic centers, classification centers, road camps, forestry and conservation camps, youthful offender facilities, vocational training facilities, prison hospitals, drug and alcohol treatment facilities, and state-operated local detention facilities.

The 2000 survey asked 1,584 state facilities to participate; 1,519 responded, giving a response rate of 95.9 percent. Data were reported by type of facility, security level of the facility—maximum, medium, and minimum—and other characteristics of the facility. Data were not collected for U.S. territories.

The scope of the 2000 survey was somewhat broader than that of the 1988 survey. To make the comparison between the 1988 and 2000 data as accurate as possible, we excluded certain types of facilities from the 2000 data. Of the 1,584 state facilities that were asked to participate in 2000, a total of 1,124 were classified as confinement-based facilities and 460 were classified as community-based facilities. Facilities were defined as confinement based if less than 50 percent of inmates in the facility were regularly allowed to leave the facility unaccompanied. Facilities were classified as community based if 50 percent or more of inmates were regularly permitted to leave unaccompanied or if they were primarily involved with community corrections. We excluded all reporting community-based facilities, including halfway houses, work release facilities, prerelease facilities, study release facilities, and restitution facilities (N=422). We also examined certain confinement-based facilities, such as boot camps, prison farms, road camps, forestry and conservation camps (N=78), and youthful offender facilities for youths being tried as adults (N=35), both of which were excluded from the 1988 survey. The various camps were unlikely to offer any mental health services. Although the youth facilities were likely to offer mental health services, their number was small enough not to alter the findings appreciably. Therefore, we concluded that the reporting confinement facilities in the 2000 data set (N=1,097) closely resemble those in the 1988 data set (N=757). These two data sets are the basis for all the comparisons in our study.

Two differences existed between the surveys. The 1988 survey collected data on the number of facilities that offered medication services and specifically inquired about facilities that monitored psychotropic medication. The 2000 survey reported on facilities that distributed psychotropic medication, a slightly different type of service. Finally, the 1988 survey reported on facilities that provided psychiatric testing and assessments, whereas the 2000 survey reported on those that provided psychiatric assessments.

Between 1988 and 2000 there was a 44.9 percent increase in the number of adult state correctional facilities. At the same time there was a 114.5 percent increase in the number of adult state prisoners. The rate of growth in incarceration was more than twice the rate of facility construction.

Although the percentage increase in facilities that offered mental health services was generally below the overall rate of facility growth, we found very large increases in use of each service in question. One potential explanation for this disparity is that caseload increased in the facilities that offered services. Clearly, the growth in prison facilities and the growth in prisoner populations are outstripping the more meager growth in mental health services. These findings suggest that mental health services are becoming less available to the prison population, and service populations are becoming more concentrated in the facilities that do offer such services.

This interpretation is supported by the fact that other findings from the 2000 survey suggested that minimum- and low-security confinement facilities are less likely to offer any mental health services and that persons with mental illnesses are more likely to be confined elsewhere in the state system (4).

Another explanation for the relative decrease in mental health services could be lack of funding for mental health staff and services. Funding for mental health services has been dwindling since the 1980s and remains a significant factor in the transinstitutionalization of persons with mental illness (7). Clearly, a majority of resources for correctional facilities are not directed toward treatment, but rather security. Therefore, a lack of funding for mental health services may also be a limiting factor (8).

Overall, mental health services in state adult correctional facilities have expanded somewhat, and use has increased dramatically. However, overall availability has decreased. Our findings have important implications for mental health policy: What should be the relative balance between service expansion and diversion? Should services be introduced at lower levels of confinement? How should we transform the specialty care sector to better serve this population? Considerably more policy discussion and research are urgently needed to illuminate these pressing questions.

Dr. Manderscheid and Ms. Goldstrom are affiliated with the division of state and community systems development of the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Room 15-C-04, Rockville, Maryland 20857 (e-mail, [email protected]). Ms. Gravesande is a graduate student with the department of psychology at Towson University in Towson, Maryland.