Weekly Update: April 2, 2024
Americans with Disabilities Act & DOJ Enforcement: Impacting Mental Health & Substance Use Treatment in Corrections


Highlighted Stories

Editor's Note
This week's highlighted stories concentrate on mental health and behavioral health challenges within correctional facilities. The first article delves into a story from Otter Tail County, Minnesota, where correctional officers’ response to an individual in a decompensated state of mental health was to deprive that individual of food, water, and hygiene. As monitors in jails across the country, COCHS has frequently seen incarcerated individuals in a mentally decompensated state act in ways that are perceived as disobedience rather than as a result of a mental health crisis. The behavior of the detained individual is a symptom of mental illness, not a symptom of disobedience. Often, noncompliance with commands results in an individual having their punishment ratcheted up rather than identifying the underlying unmet needs driving the behavior.

The second highlighted story is a set of policy recommendations on treating mental health in corrections from the Manhattan Institute which is generally perceived as a conservative think-tank. Despite these policy proposals coming from a perceived conservative source, almost anyone who works in the correctional environment would be likely to agree with these recommendations (e.g. "correctional mental health systems have special responsibility to the seriously mentally ill").

It is the dissonance between the first and second highlighted stories that underscores the challenge that correctional institutions will face as we move to a more regulated environment through Medicaid. Policymakers at the Manhattan Institute can generate widely accepted proposals for change, but in Otter Tail, Minnesota despite state requirements and a self-reported violation of standards, correctional officers on the ground still thought punishment somehow resolved a mental health crisis and that depriving an individual in a mental health crisis of food, water and hygiene was the appropriate action.

This depriving of care is not dissimilar to a highlighted story from Albuquerque, New Mexico, in last week’s Weekly Update. In that story, an auditor detailed the extent to which opioid use disorder can remain untreated within corrections even when mandated. As the Department of Justice increases its scrutiny on the ways jails and prisons respond to people's disabilities under the Americans with Disabilities Act, it would not be surprising to see the DOJ expand its enforcement of the ADA to these cases where an individual was clearly punished as a result of unmet mental health needs or was denied treatment for a substance use disorder.

Mental Health
MPR: Otter Tail County jail license downgraded after denying food to inmate
The Minnesota Department of Corrections has placed the Otter Tail County jail’s license on conditional status after an inmate reportedly was denied food and water. An investigation found staff at the county jail in Fergus Falls withheld six consecutive meals from an inmate over more than two days in February. It said the staff withheld the food after the inmate smeared feces in his cell and refused to clean it up. State jail regulations strictly prohibit withholding of food from inmates as punishment. Due to the “egregiousness” of the violations, the corrections department gave the jail until March 28 to create a training plan for staff on inmates’ rights and recognizing signs of mental illness.

Manhattan Institute: How to Reform Correctional Mental Health Care
Correctional mental health care now stands as one of the most important mental health care systems in the nation. Jails and prisons are legally obligated to serve the seriously mentally ill, whereas community-based systems are not. More effective community-based mental health remains an important goal to pursue. But equally important is the reform of corrections-based systems. Better correctional mental health care systems will benefit both community systems and the seriously mentally ill themselves. Seriously mentally ill Americans are incarcerated at a rate disproportionate to their share of the general population.

Lancet: Inequalities in physical and mental health among people in prison
This study reported high estimates of mental health conditions such as major depression, and a large proportion of people with comorbid mental health and substance misuse disorder. Despite the opportunity for health improvement that could be used during incarceration, there remain substantial barriers. In many countries, prison health care is underfunded and struggles with recruitment. Distrust, suspicion, and fear of stigma can prevent people from actively seeking support, exacerbated by the justice system's focus on delivering the order of the courts as opposed to the improvement of health. High turnover and poor integration with community services leads to treatment interruptions and lack of continuity of care.

Steinberg Institute: California’s criminal justice system not prioritizing behavioral health programs that would keep people out of jail and reduce costs
In policy breif the Steinberg Institute found that the vast majority of California counties allocate less than 10 percent of dedicated state criminal justice funding to behavioral health. At the same time, In 2023, 53% of county inmates had mental health needs – up from approximately 20% in 2010. A major source of funding that counties receive for their local criminal justice needs can be traced back to a major policy shift known as “2011 Public Safety Realignment”, which transferred responsibility for certain felony populations from the state to counties. Counties typically allocate a small fraction of realignment funding to behavioral health care.

PubMed: Recommended Mental Health Practices for Individuals Interacting With U.S. Police, Court, Jail, Probation, and Parole Systems
This report recommended practices for criminal legal-involved individuals with mental health problems were identified from meta-analyses, reviews, and best practice recommendations. Up to four respondents per county (i.e., jail, probation, community mental health, and community substance use treatment administrators) from 950 counties were asked whether each recommended practice was present for criminal legal-involved individuals. The study indentified supportive housing, access to Medicaid reactivation in jails, and psychosocial interventions for physical pain have high importance for recovery and implementation efforts might first target these approaches.

Black Voices News: A Hold That Won’t Let Go: A System Lacks Access to Mental Health Resources
An estimated 18% of the general population has a mental health condition, while that proportion jumps to more than 37% for those in prison according to an analysis by the California Budget and Policy Center. This is true across the full spectrum of diagnoses, including bipolar disorder. According to CDCR policy, those incarcerated may self-refer or be referred by any staff member for a review by a mental health clinician. Referrals can be made on an emergent, urgent or routine basis. In the case of emergent referrals, the patient must be under constant observation until evaluated.

Opioid Epidemic

The Hill: Addiction treatment in prison is a crucial part of solving the opioid crisis
Two decades into an opioid crisis that has claimed more than 1 million American lives, policymakers are still searching for ways to reduce overdose deaths. They would do well to focus on jails and prisons. There are 4,000 correctional facilities in the U.S., of which only a few dozen operate on-site opioid treatment programs. To break the cycle, a national effort is underway to treat opioid addiction behind bars. Research has shown that the FDA-approved medications methadone and buprenorphine decrease opioid-related deaths and all-cause mortality by more than half.


Kansas City Beacon: Missouri considers banning county jails from shackling some pregnant inmates
The Missouri House stands poised to pass a bill largely prohibiting city and county jails from shackling women in their third trimester of a pregnancy. In state prisons in Missouri and 39 other states, the practice is already banned. The legislation would extend that rule to city and county jails. The bill, sponsored by Republican Rep. Chad Perkins of Bowling Green, would create a slew of health care requirements for city and county jails to follow during the booking of a pregnant inmate. It would require pregnant women to have access to 2,500 calories a day, dietary supplements and access to mental health and substance use treatment.


The Marshall Project: Even Where Abortion Is Legal, People in Jail Face Huge Barriers
Approximately 3% of women in jail the United States in 2017 were pregnant at the time of admission. But with thousands of jails nationwide, and no central oversight, astonishingly little is known about people’s access to abortions. A new report released Tuesday offers a glimpse at how jails in Illinois provide reproductive care and found that fewer than one-third of the state’s jails have written policies on abortions. The policies that do exist are often vague and confusing and may include steep barriers, like requiring a person to make arrangements for or pay for the procedure themselves, even though they are locked up.


KSLNewsRadio: Correctional facilities strain to help aging inmates
Correctional facilities in Utah are also feeling the pinch of an aging inmate population. Prisons aren’t staffed or designed to be assisted-living centers, and balancing inmate healthcare with security is a complicated issue. Until inmates are released, there have been improvements for the state’s aging prisoners. One new prison has a geriatric housing unit, faster med delivery, and even ADA helpers. Wheelchair accessibility has gotten better too.


The Hill: Prison education saves lives — but it’s way too hard to get
Prison education programs do much more than simply educate. They improve public safety: studies show that earning a college degree strong reduces a person’s likelihood of recidivism. They are also a smart investment, with every dollar spent on post-secondary education averaging a $20 return due to the money saved by lowering future incarceration. America’s prison population consists almost entirely of people from disadvantaged communities. Giving them the opportunity to earn a degree doesn’t just improve their lives, it improves the lives of their children, disrupting the cycle of poverty and incarceration — and improving our society as a whole.

State Roundup

Axios: Watchdog group wants more oversight on hospital care for inmates
A civilian watchdog group says Denver Health must be more transparent in its treatment and care of people in city jails. The hospital's lack of openness and oversight for inmate care has been a major concern for the past two years. The Citizen Oversight Board, which provides supervision for Denver's independent monitor, raised these concerns in its recently published annual report. Over the past two years, eight inmates have died while in custody, including three related to medical emergencies, according to documents from the independent monitor's office. The hospital could improve transparency by creating a dashboard, for example, where it releases details about complaints from inmates and how it addresses them.

Idaho News: Mental health management for those in prison
Some people say there is a significant correlation between mental health issues and incarceration. The Idaho Department of Correction's Chief Psychologist, Wally Campbell, says although roughly one-third of their inmates enter the system with mental health struggles, more are diagnosed while incarcerated. Entering the stressful correctional environment is one of the reasons why it's difficult to determine how many people come in with mental health struggles, versus developing situational mental illness.

Corrections 1: Illinois DOC hosts first ‘Corrections Wellness for Families’ course
The four-hour proprietary course offers information to adult family members about how correctional work realities can impact family life with suggestions for dealing with scenarios commonly experienced by correctional families. The interactive course is designed for adult family members of seasoned correctional employees and family members of new staff. Course topics covered the impact of the corrections work environment on employees, practical suggestions for adult correctional family members to support one another, managing job stress when it intrudes on home life, and the basics of effective self-care.

News From The States: How Louisiana’s plan to lock people up longer imperils its sickest inmates
Jeff Landry, Louisiana’s new governor, defended the quality of Angola’s medical care. When he was attorney general, a post he held from 2016 until January, he argued that inmates are entitled only to “adequate” medical care, which is what they got. During the pandemic, Landry opposed releasing elderly and medically vulnerable prisoners, warning that it could result in a “crime wave” more dangerous than the “potential public-health issue." Now that Landry has moved to the governor’s mansion, the number of inmates who rely on the medical care in Louisiana’s prisons is likely to grow. The legislature passed a law that requires prisoners to serve at least 85% of their sentences before they can reduce their incarceration through good behavior. Another law ends parole for everyone but those who were sentenced to life for crimes they committed as juveniles.

New York Times: For Young Offenders in Maine, Justice Varies With Geography
Aroostook County, in Maine’s far north. Police chiefs describe their jurisdictions as sleepy, with little serious crime. But the county has sent a disproportionate number of adolescents in recent years to the state’s only youth prison. Between 2017 and 2023, there were 20 commitments to Long Creek Youth Development Center from Aroostook — nearly double the number from York County, which has more than three times as many residents at the other end of the state. York County includes wealthy coastal communities. For more than a decade, Maine has emphasized rehabilitation in its approach to juvenile justice, sending fewer teenagers to prison. But the differences between Aroostook and York Counties show that the effort has played out unevenly, resulting in justice by geography.

Rhode Island Current: Maine State Prison residents launch hunger strike over conditions they call solitary confinement
A hunger strike at the Warren correctional center is to protest conditions likened to solitary confinement. A DOC spokesperson disputed residents’ claims that their conditions are akin to solitary confinement. He added that the department is aware of the hunger strike at the prison but that it cannot share specifics about those involved because of confidentiality rules.

WHYY: Philadelphia prison chief to leave job after string of prisoner deaths and escapes
The chief of the Philadelphia Department of Prisons is leaving the job after a series of prisoner deaths and escapes. Blanche Carney, who has overseen the city’s four prisons and jails since 2016, stated in a letterthat her last day will be April 5. The city’s lockups have been dealing with surging violence and the escape of four prisoners in a span of six months last year. The Pennsylvania Prison Society interviewed nearly 50 prisoners in Philadelphia last year and issued a report that documented the “dangerous and degrading conditions in the Philadelphia prisons.”

KXXV: Falls County Sheriff Joe Lopez responds to non-compliance notice from the TX Commission on Jail Standards
Fall County jail received a letter of non-compliance from the Texas Commission on Jail Standards. The report found the following: the jail was unable to provide any records for mental disability and suicide training for staff; jail failed to notify mental health officials when inmates were suicidal one resulting in a death; five jailers working without a license;seven of the eight food handler licenses had expired; water and sewage not inspected annually, but instead two years overdue.

Los Angeles County

Los Angeles Times: Why was 2023 such a deadly year in Los Angeles County jails? It depends on whom you ask
Though the number of people in the Los Angeles County’s lockups is roughly a third less today than what it was a decade ago, the number of fatalities has risen so much that the annual death rate has more than doubled in that time frame. Suicides are slightly down after a sharp spike in 2021, but natural deaths are up, killings are up, and overdoses are way up compared to 10 years ago. After a review of thousands of pages of autopsies, lawsuits, medical records and oversight reports found a common thread stretching across all causes of death: neglect, by both guards and medical staff.


Sentinel & Enterprise: Combined efforts helping ex-inmates from reoffending
Since it’s been established that drug dependency and lack of education constitute the main drivers of illegal behavior, the correctional system and others have come up with novel programs to address these crime-generating issues. The beneficial results of this forward-thinking approach can be seen in a recently released multi-year Massachusetts Department of Correction study that illustrates the positive impact that substance-abuse recovery and educational programming has on recidivism.

Staffing Shortages

The Hill: Why so many corrections jobs go unfilled: prison culture needs changing
Could current prison culture be a major staffing deterrent? Public welfare (police, corrections, and courts) is a state and local government budget category that exceeds those of both education and healthcare. But the leadership development resources available to wardens of correctional facilities are meager in comparison. As a result, prison culture and its environment have changed very little over the years.

Prison Contractors

Washington Post: A Va. nonprofit charges for inmate video calls. Two board members quit over it.
When Chuck Meire and Shawn Weneta gained seats on the board of directors at Assisting Families of Inmates, the men were galvanized by the Virginia nonprofit’s mission. But shortly after they joined in 2021, the unlikely duo — Meire, then a Harvard graduate student and Weneta, a recently pardoned felon — came to believe that their organization wasn’t living up to its namesake. Their problem: the cost of the Zoom-like video calls — run by AFOI and its partner ViaPath Technologies, the giant prisons communications firm. "AFOI has fallen into the same profit-seeking trap that the prison communications industry thrives on. This money is coming from disproportionately Black, Brown and poor communities," said Meire.

Quartz: Prison phone operators allegedly worked with jails to limit in-person visits
Two lawsuits filed by an activist organization allege a conspiracy between county governments in Michigan and prison phone companies (Securus, ViaPath previously GTL). This conspiracy has involved a “quid pro quo kickback scheme” that eliminated in-person visits at prisons to boost profits for the companies, the litigation claims. As part of the scheme, a portion of those profits were allegedly then shared with the county governments. These arrangements involved business relationships with the county sheriffs of St. Clair and Genesee that were predicated on the elimination of in-person prison visits. Under the new systems, visitors to the jails had to pay for phone calls with the incarcerated, and the money from those calls was then shared between the providers and the counties, the lawsuit alleges.

The Appeal: The High Costs of Free Prison Tablet Programs
In 2021 the Texas Department of Criminal Justice (TDCJ) announced a new tablet contract with Securus Technologies, a subsidiary of Aventiv Technologies (which also owns JPay). As in most free tablet contracts, Securus agrees to provide tablets for all eligible people. At first glance, free tablet programs seem like a step forward. Unfortunately, current free tablet programs rely on predatory contracts between Departments of Corrections (DOCs) and two juggernauts of prison industry, Aventiv (Securus and JPay) and Global Tel Link (GTL). These companies have long histories in prison communications, histories checkered by charges of exploitative practices.


Rand: Countering the Emerging Drone Threat to Correctional Security
Contraband trafficking in correctional institutions is highly lucrative, and drones can be an effective and relatively low-risk method of introducing large quantities in a single flight. For example, it can be challenging for a correctional institution to detect a drone entering its airspace. If a drone is detected, it can be difficult for the institution to respond quickly enough that any contraband dropped is intercepted before it reaches the incarcerated population. As drone technology and threats evolve, current detection solutions may be rendered less effective, which can deter agencies from investing in them.

Mashable: California paid millions to access a mental health app. It wasn't safe for users.
7 Cups, which operates as both a website and app, invites teens and adults to talk to someone online for free. Users give and receive emotional support, but they are discouraged from acting like a therapist. The year prior, Los Angeles County had agreed to provide 7 Cups access to residents as part of a five-year, $101 million initiative known as Tech Suite that was designed to use innovative technology to connect California residents to mental health help. But a Twitter/X user claimed that a teen friend also on the platform had been manipulated into sharing child sexual abuse content and material with an adult user outside of the United States. The incident in L.A. County factored into the abrupt termination of 7 Cups' contract with the state several months later. By the end of 7 Cups' contract, the company received an estimated $6.7 million.

Correctional Health Care Vendors

Corizon, YesCare, Tehum Care
Bloomberg Law: Prison Medical Bankruptcy Judge to Rule Soon on Case’s Future
A bankruptcy judge said he plans to rule in the coming weeks on the validity of prison healthcare provider Tehum Care Services Inc.'s bankruptcy and on a proposed settlement with prisoners. Tehum and some of the prisoners have clashed over the settlement, worth approximately $54 million, as well as a request to dismiss the bankruptcy.

Cowboy State Daily: After 18 Years, Wyoming Prisons Drops Health Provider That’s Been Sued 1,000+ Times
The Wyoming Department of Corrections is switching health care providers after 18 years with the same company — and the longtime provider isn’t happy about it. YesCare, formerly Corizon, lost a recent bidding process to NaphCare, with which the Wyoming Department of Corrections. YesCare protested the loss of its longtime contract with the state’s prison system this month, claiming its competitor and winning bidder’s plan appears to be more expensive. Jason Begger, a representative for YesCare, told the Joint Judiciary Committee during its March 6 meeting that the new provider will cost taxpayers an additional $9 million per biennium.

WCAX: Advocates say inmates with chronic conditions not receiving adequate health care behind bars
A serious gum disease, seizures, and a PTSD diagnosis are a few of the problems suffered by an inmate after a three-year, pre-trial stay in Vermont prisons. It’s an example, advocates say, of a for-profit health care contractor overseeing chronic illnesses that can often get worse behind bars. A quick Google search shows Centurion and Vital Core, the previous contractors have been involved -- and sometimes found liable -- in dozens of lawsuits. In the past five years, the DOC has switched contractors three times before going with Wellpath, the current provider. “It’s a for-profit company and any money that they spend, it comes out of their profit,” said Leslie Thorsen with the group Vermont Just Justice.

KSBW: Monterey County Jail gets more time to fix many problems and avoid fine
The Monterey County Jail is getting more time to fix its many problems and avoid a million-dollar fine. Regardless of the extension, United States District Court Beth Labson Freeman says she is very disappointed about what is happening at the jail. We first told you about these problems in a KSBW investigation that aired earlier this month. Monterey County’s private jail health care provider, Wellpath, is out of compliance in at least 43 areas, including mental health care, clinical staffing, medical intake screenings and chronic care.

San Diego Union Tribune: Repeated failures by San Diego County jail health provider prompt sheriff to order it to fix deficiencies
Naphcare, the prime contractor delivering health care services in San Diego County jails failed to pay outside hospitals and other specialty providers, limiting the Sheriff’s Department’s ability to send sick and needy people in custody into treatment. The Alabama correctional medical giant brought in to manage treatment in the troubled county jail system, also relied on unlicensed staff, ignored requests to repair or replace equipment and failed to fill hundreds of shifts, according to the documents. Earlier this month, for example, a federal judge in Arizona presiding over a case seeking to improve conditions for the nearly 25,000 people in state prison said the medical and mental health NaphCare provides was "fundamentally lacking."

Savannah Now: Attorneys for Lee Creely claim CorrectHealth nurse lied about her actions on day he died
Attorneys for Lee Michael Creely claim that a CorrectHealth nurse working at the Chatham County Detention Center (CCDC) lied about her account of what happened on the day in September 2020 when Creely died in a Chatham County Detention Center cell, citing video surveillance and deposition testimony by a former jail worker. CorrectHealth is the private contractor that provides healthcare to the CCDC. The attorneys’ argue that the allegedly fictional account by the CorrectHealth nurse, Jackie Harned, “go to CorrectHealth’s systemic failure to deliver adequate health care to people in the jail.

Advanced Correctional Healthcare
StarTribune: RNs fired for citing inmates' poor care in many Minnesota jails, lawsuit says
Three women are claiming in a lawsuit that they were fired as contracted nurses for reporting troubling lapses in medical care for inmates in jails, including the one in Anoka County where three men fell fatally ill last year. The suit filed last week against Tennessee-based Advanced Correctional Healthcare and its subcontractor, USA Medical & Psychological Staffing, alleges the women lost their jobs as registered nurses after complaining that ACH was "putting patients in danger of serious injury or death due to their failures and refusals to properly care for those patients."