Calif. Ordered to Upgrade, Expand Prison Mental Health Services

California plans the biggest upgrade to the state prison system's mental health program since a court took over the system more than a decade ago.

Gov. Arnold Schwarzenegger (R) was expected to propose more than $600 million in new mental health facilities for the state's 31,000 inmates with mental illness after U.S. District Court Judge Lawrence Karlton approved the Schwarzenegger administration's plan to add 695 beds for mentally ill inmates. The judge's action came as part of a class-action lawsuit filed 11 years ago against the state that led a court takeover of the prison system's 33-facility mental health program and appointment of a “special master” to evaluate the California Department of Corrections and Rehabilitation's (CDC) compliance with the court's order in the case, known as Coleman v. Wilson.

“This will be the biggest expenditure of funds on [inmates' mental health care] since the case began,” said Randall Hagar, director of government affairs for the California Psychiatric Association.

At least 20 percent of the state's 169,000 inmates have been diagnosed with a mental illness, according to a spokesperson for the CDC.

The governor was expected to propose specific funding levels and the details of the upgrade as part of his regular mid-May budget revision proposal.

Karlton approved a plan in April that calls for the construction of new mental health facilities to be operated by the corrections system at several prison sites, including Folsom and Vacaville. Construction costs alone are estimated at more than $600 million. Staffing costs will greatly increase the final cost to a prison system budget that has grown by more than 60 percent since 2003, when Schwarzenegger was elected governor. The judge's order requires the state to provide more bed space to inmates next year, and mental health advocates expect an additional mandate—although it has not yet been handed down—for increased salaries of psychiatrists and mental health professionals as an incentive to help increase staffing levels.

“Many of these prisons are in remote locations that don't make them hugely popular places to relocate and raise a family,” Hagar said.

California now spends more than $8 billion annually on corrections, and the judge warned that the already substantial amount may greatly increase, according to media coverage of the two-day April hearing.

Karlton also ordered corrections officials to make several short-term improvements to the prison system's mental health program, which were needed, in part, due to a population explosion in the prison system that has not been contained by the construction of 22 prisons in the last 25 years. The overcrowding has left authorities with no room to house or treat the large number of inmates who need mental health care.

The system's chronic overcrowding led another federal judge, Thelton Henderson, to take control of the prison system's other medical programs in 2004 and give a receiver the authority to set health care budgets and policies for those programs, in the case Plata v. Schwarzenegger, et al.

Robert Sillen, the receiver appointed by Henderson, told the media that it was possible that the mental health system could also be placed under his control.

The two judges have indicated that they will work together to overhaul the prison health system, with Karlton scheduling a hearing to examine ways in which reforms of the medical and mental health programs may overlap, including in the areas of nursing staff, pharmacy operations, doctors, and bed space.

In his order, Karlton blamed the current situation on California's decision in the 1960s to close its state mental hospitals, which in effect turned the prisons into mental hospitals. ▪