Pennsylvania County jails are under-resourced to deal with a growing mental health crisis, putting some of the most vulnerable incarcerated people at increased risk, according to a statewide survey by Spotlight PA. and the Pittsburgh Institute for Nonprofit Journalism.
Responses from more than 20 Pennsylvania prisons serving the majority of the state’s population described similar situations: a growing number of incarcerated people with serious mental health needs, a lack of medical personnel and a complex system to access to the few resources available from the State.
Guards, medical professionals and other prison officials have written candidly about the challenges they face providing health care to thousands of Pennsylvanians awaiting their day in court.
“We are simply not trained…or have a facility to detain those in need of mental health treatment,” Fayette County Jail deputy director of treatment Angela Kern said in response to the inquiry.
“It’s frustrating, stressful for everyone – the deteriorating individual and the staff.”
Spotlight PA and PINJ sent the survey to every prison in Pennsylvania to understand the state of mental health resources for people behind bars. The 25-question survey asked managers to describe their workforce, their ability to provide adequate health care and any additional challenges they face in caring for people with mental health needs.
The 20 officials who responded represent prisons housing approximately 13,000 people.
The survey also asked prisons to rate their ability to meet prisoners’ mental health needs on a scale of one to five, with one being not at all equipped and five being very well equipped. Only six counties — Allegheny, Center, Chester, Huntingdon, Lawrence and Philadelphia — ranked four or higher.
No more sickness
The number of Pennsylvanians with mental illnesses has increased over the past decade, but the services needed to treat them have not kept pace, wrote Washington County Correctional Facility superintendent Jeffery Fewell.
As a result, he said he saw more people with more serious mental health needs at his facility.
“This population is severely dependent and suffers from mental disorders”, he wrote. “Over 50% of our population today has a dual diagnosis of mental illness and addiction with high rates of suicidal ideation.”
District Attorney Peter Acker is chairman of the Mercer County Jail Board, where he said nearly half of those incarcerated at the local jail take psychiatric medication. But other facilities have told Spotlight PA and PINJ that they have struggled to achieve even that level of care.
“When individuals don’t take medication, we have very little success in getting them started,” writes William Schouppe, superintendent of the Beaver County Jail. “Many have been demeaning, and we don’t have the resources to take care of those people.”
Officials described a justice system that lands people in jail even when their criminal behavior may be a symptom of their mental illness.
“The prison acts as a de facto social worker”, wrote David Kratz, Bucks County Director of Corrections. “If services in the community are not easily accessible to law enforcement, prison is the easiest alternative. The police don’t have time to often spend more than 12 hours trying to get services.
Officials in nearby Chester County said they were training staff to recognize the difference between “willful disobedience and inability to follow rules due to mental state.”
“As our county and involved stakeholders continually move forward in the appropriate diversion of the seriously mentally ill, the criminalization of this population continues across the United States,” wrote Rebecca Brain, county spokeswoman.
“The demonstrations of [serious mental illness] in prison could result in disciplinary infractions, while the same behaviors in a therapeutic setting would be considered symptoms of this disease.
Others were more direct.
“We seem to be a ‘dumpster'” wrote Scott Robinson, warden of the Snyder County Jail. “It is very difficult to get inmates with serious mental health issues into a facility where they can receive proper care. Some cannot even control bodily functions and this is a heavy mental and physical burden on our staff.
Staff numbers vary considerably
Every prison that responded to the survey said it employed staff or contractors to address the mental health needs of inmates. Yet the survey found that the level of staffing and resources varies by county, creating an uneven landscape where the level of care a person receives in jail largely depends on where they are arrested.
Most metropolitan and suburban prisons reported having full-time medical staff, including psychiatrists or psychologists, registered nurses and counsellors.
The Philadelphia Department of Prisons, for example, operates four prisons housing 4,400 people and employs approximately 325 clinical staff, “one-third of whom are behavioral health clinicians,” said Bruce Herdman, chief of medical operations.
The department also operates a psychiatric hospital within the prison system and has real-time access to city records. This allows staff to consider a patient’s treatment history when determining a new plan of care.
Medium-sized counties such as Bucks, Chester, Montgomery and Westmoreland reported having dedicated internal staff who are employed by the prison or provided by PrimeCare or another company.
But many smaller counties said they only have one or two staff members, some working part-time, who handle all mental health needs, including initial screenings and follow-up. Some have doctors available through telehealth, but not in-house.
“Oh, do I wish we had a psychiatrist in the house!” wrote Kern, the Fayette County Deputy Warden.
Even facilities with access to a large network of healthcare professionals have identified staff recruitment and retention issues, a problem they say has worsened during the COVID-19 pandemic.
“Our establishment is suffering like most establishments: the staff is difficult to find and to keep”, wrote Westmoreland County Commissioner Douglas Chew, who also chairs the county prison board.
Fewell, warden of the Washington County Jail, echoed the concerns of his colleagues: “Staff is everything.”
Long wait for few resources
County jails bear additional liability if a person’s mental or intellectual state affects their ability to stand trial.
If the court finds someone “incompetent,” this person may need specialized treatment before they can participate in legal proceedings. This treatment is usually provided in two public hospitals with extremely limited beds.
Almost all prisons reported that they currently or recently housed someone in need of this treatment. About 70% of institutions scored three out of five or less on their ability to address competency issues.
In candid responses – a few hundred words – prison officials detailed the difficulties they face in trying to help their most vulnerable residents get the court-ordered treatment they need.
Officials said the process was frustrating and lengthy, often prolonging the incarceration of people who may not even understand why they were in jail. They called on the state to provide alternatives to jail or increase the number of hospital beds available to treat people with skills issues.
When asked to describe the challenges they face in helping someone deemed incompetent get treatment, Philadelphia called the process “pretty bulky.” Beaver County wrote that after waiting months for public hospital beds for two, jail officials took matters into their own hands and contracted with a company that would come to the jail to provide a treatment.
“The system is down” wrote Robinson, the Snyder County Executive. “It takes too long to get people the help they need. Prisons are not equipped to handle serious mental health issues.
This story is a collaboration between Spotlight PA and the Pittsburgh Institute for Nonprofit Journalism, published as part of a Pittsburgh Media Partnership project.