This study was done in regards to the Mental Health Care within Michigan Department of Corrections. The report is not available on-line currently. It is 102 pages long in its entirety. We have pulled out the most pertinent recommendations of what they found needs to be fixed to share with you. We want to be certain that these recommendations are put in place as quickly as possible.
TAXPAYER COST FOR THIS STUDY: $400,000.00
REPORT TO THE LEGISLATURE
Pursuant to P.A. 114 of 2009, Section 302
Mental Health Independent Study
Recommendation 1: All state prisoners with a known history or current existence of major behavioral disorders should be housed in separate facilities that do not include any other types of inmates.
Recommendation 2: Until and unless the state was to undertake the recommendation above, behavioral health services should be completely managed and operated by one entity.
Recommendation 3: Until and unless the state was to undertake either of the recommendations above, DOC and DCH should take steps to fully integrate correctional mental health and substance abuse services.
Recommendation 4: All DOC and DCH documents related to mental health should be cleaned up for dated references and changes in law; consistency of definitions and timetables; elimination of contradictions.
Recommendation 7: Individual facility operating procedures must be regularly checked by DOC for consistency with state requirements; individual facility procedures must state how the procedures vary from statewide material.
Recommendation 9: DOC should recruit, maintain and have written roles and responsibilities for a departmental position of Chief Psychiatrist, as well as a psychiatric advisory committee of the Chief Psychiatrist’s choosing.
Recommendation 12: DOC’s medication formulary document should be revised so that it:
~Assures access to medications for attention deficit, post-traumatic stress, and substance abuse/dependence;
~Includes among its “criteria of choice” the elements of Community Viability and Abuse Potential;
~Corrects the misstatement that “preferred” and “non-preferred” products will be “therapeutically equivalent”;
~Allows someone with a history of clinical benefit from a medication to remain on or resume use of that product.
Recommendation 13: Better clarity is needed regarding procedures for a prescriber to request a medication that requires some manner of administrative approval, and the appeal process should be simplified.
Recommendation 14: DOC and DCH need to describe in operating procedure what the departments will do to enable psychotropic medication continuity for persons on such medication at the time they leave the prison system.
Recommendation 15: All prisoners with mental illness who are not in DCH’s Corrections Mental Health Program should have access to psychiatric medication as clinically warranted.
Recommendation 17: DOC and DCH policy directives and procedures must be revised to comply with an October 2008 legislative directive against administrative and punitive segregation of prisoners with mental illness.
Recommendation 19: “Temporary Segregation” should not be used with prisoners known to have serious mental illness. If the practice is continued, the maximum amount of time allowed in such segregation must be shortened.
Recommendation 20: DOC and DCH must dramatically expand policy directives and operating procedures related to adolescent inmates, as current documents say extremely little about considerations for this population.
Recommendation 21: It is critical that the legislative and executive branches maximize the prospects for initiation or reestablishment of Medicaid coverage as quickly as possible for prisoners returning to community life.
Recommendation 22: DOC must document how it will deal with self mutilation: how and under what circumstances a referral involving such behavior would be made from DOC to the Corrections Mental Health Program.
Recommendation 23: The Psychological Services Unit needs expansion in critical areas such as behavioral screening; crisis intervention; treatment of mental illness, substance abuse; and response to prisoner self-mutilation.
Recommendation 25: DOC’s operating procedure on “Managing Disruptive Prisoners” needs to incorporate the Mental Health Code Chapter 7 restraint procedures and protections for non inpatient prisoners with mental illness.
Recommendation 26: The Director of the State Office of Recipient Rights within DCH should assure investigation and determination of all recipient rights complaints filed by or prisoners in the Corrections Mental Health Program.
Recommendation 27: The use of non-therapeutic “observation rooms” for evaluating suicide risk should be ended.
Recommendation 29: The definition of “suicidal behavior” in correctional mental health documents should be revised to reflect that suicidal ideation, not solely “a decision to kill oneself,” can yield suicide attempts.
Recommendation 30: Operating procedures should establish protocols for when and under what circumstances a diagnosis that accompanied a prisoner in his/her records upon entry to the DOC system may be changed.
Recommendation 31: Operating procedure on substance abuse should be revised for more content on treatment, more specificity and inclusion of the Patient Placement Criteria of the American Society of Addiction Medicine.
Recommendation 33: There should be parallel operating procedures for reentry of youth prisoners with behavioral conditions and offenders with substance abuse problems as exist for adult offenders with mental illness.
Recommendation 34: DCH operating procedure MPRI 4.6.180-A should be revised to require the involvement of mental health professionals in initial parole decisions under the “D47” designation for MPRI mental health paroles.
Recommendation 37: DCH operating procedure MPRI 4.6.180-D should be revised so that a second (psychiatric) certification on an involuntary treatment recommendation for a discharging prisoner is automatically supplied.
Recommendation 39: DOC should have a policy directive on training of all staff (including but not limited to custody, contractual and non-behavioral medical) in behavioral health problems and issues.
Recommendation 40: DOC and DCH should have written policy or operating procedure enhancing the ability of behavioral and non-behavioral medical personnel to access prisoner health records from either domain as warranted.
Recommendation 41: The Michigan Auditor General should be asked to review and critique DOC’s practice of allowing its facilities to self-audit their compliance with correctional policies and procedures.
We hope you find this report both useful and informative. When advocating, the use of this document is most important, as well as the recommendations we've posted. They are used in our legislative work.
Citizens for Prison Reform
"Our lives begin to end the day we become silent about things that matter"
"Injustice anywhere is a threat to justice everywhere"
-Martin Luther King
