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Ohio Considers Changes To Inmate Mental Health Treatment

The treatment of the mentally ill has been in the news a lot lately. Ohio is considering changing how it treats prison inmates with mental illness. Some health professionals say it could put inmates' lives at risk.

In 2004, a young man was found naked and urinating in a garage - it wasn't his garage. And the owner caught him. The man stole the owner's car and fled Columbus to Hamilton County. Attorney Adam Nemann said there his client mugged an elderly lady.

"Upon her demands to give her purse back, he actually turned around gave her, her purse back and apologized," Nemann said.

After a long police chase the man was arrested and charged with multiple crimes. But Nemann said his client was found not guilty by reason of insanity. Bi-polar, schizophrenia and depression along with substance abuse wreaked havoc on the college student. Nemann said his client was committed and placed under court supervision in a locked facility.

"But under proper medication they've been able to bring him back and integrate him slowly back into society. So we have step-by-step had hearings and gradually increased the amount of time he can come out of the facility and stay with his mother and get a job and go back to school," he said.

An insanity defense is used in about one percent of court cases around the country. And in only about a quarter of those cases does the insanity defense work.

In Ohio, if you're found not guilty by reason of insanity, you're placed in a behavioral health center that has varying levels of security. Department of Mental Health Medical Director Dr. Marion Sherman said it's not an easy-out for people who have broken the law. She says under Ohio law, it's very hard to prove insanity. "The system's so tightened down as you can see from those statistics that would lead you to say since human beings do commit errors that we might tend to err on the other side which is a terrible event when it occurs," Sherman said.

The Ohio Department of Rehabilitation and Corrections treats more than 4,700 inmates with serious mental illnesses like schizophrenia and bi-polar conditions. And it offers varying mental health services - psychiatrists, psychologists, different therapies - to treat inmate who have mental illnesses.

But some psychiatrists raise questions about the quality and quantity of mental health care inmates receive.

Last summer, ODRC did not renew a contract with a private company that hired and monitored most of its psychiatrists. ODRC's Chief of Mental Health Robert Hammond said the move saves money, but he said the system also uses a different treatment model.

"In an attempt to basically contain costs, but in addition to that, just looking at what kinds of services that we offered, we came to the conclusion that civil service psychiatrists would be every bit as viable," Hammond said.

ODRC will spend more than $84 million this year on mental health treatment. A 17 percent increase since 2008. Part of that treatment is with psychotropic medications written by psychiatrists and other medical professionals like nurse practitioners licensed to prescribe drugs. ODRC currently has 28 psychiatrists.

Psychiatrist Kathy Burns said that's too few. Dr. Burns once served as the prison system's mental health director and now chairs the public mental health committee for the Ohio Psychiatric Physicians Association. "The issue is around the frequency with which, or maybe the infrequency, with which a person is able to see their psychiatrist and the length of time they can spend with them. So that if there is a problem or a person has a question or is experiencing some exacerbation of their illness they can't get in in a timely way to see the doctor quickly, or as quickly as one would like them to be seen," she said.

To help with the shortage, and potentially reduce costs, State Senator Bill Seitz introduced legislation late last year to start a pilot program in prisons that would give psychologists - who are not medical doctors - the authority to write prescriptions. Seitz said the psychologists would receive additional training and have to have a Master's degree in psychopharmacology.

"We're trying to meet an under-served need within the prison," Seitz said.

But Burns said it's a bad idea. She said even with the psychologists' additional schooling, inmates' lives would be put at risk. And she called it discriminatory to test the program on inmates who already are disenfranchised.

"There is no contemplation of permitting prescriptive authority to psychologists treating children in schools or treating people in the civilian hospitals. It's only in the prison system and we have a concern that that is not appropriate treatment, Burns said.

But Seitz said the controversy is a turf war between psychiatry and psychology. He said the prison psychologists would have more training than some nurse practitioners. And he said the bill would ensure a wider supply of mental health drugs to inmates who desperately need them.

"I think it would be discriminatory to have an uneven system in which people are either delayed needed medication or denied needed medications due to unavailability of psychiatrists willing to come into the prisons," he said.

Prison mental health chief Hammond said they've always had a hard time recruiting psychiatrists, especially in rural areas.

To get around that, Hammond said ODRC has begun to heavily recruit more nurse practitioners and use tele-medicine, where doctors treat patients by phone or video conferencing.

"We're getting by just as we've always gotten by," Hammond said.

There is no hard evidence hiring psychologists with prescriptive authority will save money. Seitz said it could. Burns said it won't. And there's only one way to find out. Senator Seitz plans to re-introduce the legislation later this year after a major prison reform bill is introduced next month.