Mentally Ill Inmates

The Federal Bureau of Prisons (BOP) has a substantial number of mentally ill inmates, and not all have been diagnosed and treated--some because they have coped successfully with prison life and others because they have refused treatment, have been incompletely screened, or have lacked access to treatment resources. BOP officials, however, maintain that inmates with serious mental problems are identified and receive treatment before being released. Nevertheless, a 1990 advisory group made extensive recommendations on improving BOP's mental health care services. GAO believes that these recommendations and BOP's actions to implement these improvements signal a willingness to address resource and screening problems and to establish a framework for this understanding. Given the challenges BOP faces, it remains to be seen how thorough and effective BOP will be in implementing all of its plans.

GAO found that: (1) according to BOP officials, court officials identify mentally ill inmates before they enter the prison system and prison officials identify mentally ill inmates during screening upon the inmates' entry into prison or as a result of an observable failure to function in an open prison population; (2) about two-thirds of the 3,131 mentally ill inmates identified by officials at 65 BOP facilities were reportedly enrolled in treatment programs run by the facilities' psychology or mental health departments, while others may have been on medication or under treatment by a psychiatrist; (3) about 650 of the mentally ill offenders were located at the 4 BOP psychiatric referral centers; (4) officials from 45 of the 65 BOP facilities reported having some inmates who were suspected of being mentally ill, but who had not been diagnosed as such, mentally ill inmates who had been diagnosed, but were not enrolled in mental health treatment, and mentally ill inmates who were not receiving needed psychiatric care; (5) the major reasons prison officials gave to explain why inmates went untreated included inmate ability to cope with prison life, inmate refusal of treatment, limited treatment resources, and insufficient mental health screening; and (6) in November 1990, an advisory group made extensive recommendations to improve the treatment and identification of mentally ill inmates, but prison overcrowding, budgetary restraints, and difficulties in hiring sufficient staff hinder effective and thorough implementation of BOP plans.