• staffing and expenditures for mental health services;
  
  
• DOC’s process for identifying mentally ill and developmentally disabled inmates, and their locations and characteristics;
  
  
• the monitoring and treatment of mentally ill inmates;
  
  
• safety and discipline, including self-harm and assaults by mentally ill inmates and their placement in segregation;
  
  
• placements at WRC and services provided;
  
  
• planning and preparation for the release of inmates into the community; and
  
  
• DOC’s activities to improve mental health care services, including those undertaken in response to a recent legal settlement.
  
  

Expenditures and Staffing

DOC’s expenditures for inmate mental health care totaled approximately $27.0 million in FY 2007-08. They included $20.6 million in staff costs and $6.1 million for psychotropic medications. Expenditures by DHS for housing and treating inmates at WRC totaled $32.8 million.

In FY 2007-08, DOC employed 127.35 full-time equivalent (FTE) mental health care staff.

Identification, Monitoring, and Treatment

Over the past two years, DOC’s inmate population increased 3.9 percent, from 21,610 in June 2006 to 22,451 in June 2008. The number of inmates with mental illnesses increased 14.3 percent, from 6,084 to 6,957.

In June 2008, 20.9 percent of inmates were classified as having mental health needs but not seriously mentally ill, and 10.1 percent were classified as seriously mentally ill. Mental illnesses were more than twice as common among female inmates.

Most DOC facilities house inmates with mental illnesses. In a random sample, we found that 67.7 percent of inmates were screened for mental illness within two days of entering DOC custody. When mentally ill inmates were transferred between institutions, their files were generally reviewed by DOC staff in a timely manner.

Psychologists monitor mentally ill inmates on a regular basis, but group and individual therapy is limited. Psychiatrists focus on monitoring the approximately 3,900 inmates who are prescribed psychotropic medications. Neither psychology nor psychiatry staffing ratios at all DOC institutions meet national standards.

Correctional officers deliver most medications, including psychotropic medications, to DOC inmates. In neighboring states, inmates’ medications are delivered primarily by health care staff.

Wisconsin Resource Center

Some male inmates with serious mental illnesses are housed at WRC, which currently has an operating capacity of 314 inmates.

Nearly three-quarters of WRC staff positions provide direct services to inmates. Most WRC inmates participate in one or more treatment programs and have frequent contact with mental health care staff.

In FY 2007-08, the average length of stay at WRC was 392 days. WRC admissions are negotiated with DOC staff on a case-by-case basis. Clearer policies, more centralized decision-making, and more detailed record-keeping could help ensure that WRC resources are used effectively.

Improving Safety and Discipline

Mentally ill inmates have had a disproportionate effect on safety and discipline in DOC institutions. From FY 2005-06 through FY 2007-08, they accounted for more than 90.0 percent of 1,231 special placements made as a result of selfharm. These placements require monitoring by DOC personnel at least every 15 minutes.

Mentally ill inmates also accounted for nearly 80.0 percent of the 755 inmate assaults on staff in the past three fiscal years. These assaults resulted in $874,200 in worker’s compensation awards to DOC and DHS staff from FY 2005-06 through FY 2007-08.

Mentally ill inmates have been overrepresented in segregation. In January 2008, 46.1 percent of inmates in segregation were mentally ill.

Release Planning

DOC has developed a standardized curriculum to help prepare all inmates for re-entry into the community. DOC policy also directs special services to mentally ill inmates, including a two-week supply of medications and post-release appointments with treatment providers. However, DOC’s implementation of policies developed in 2004 to ensure timely application for disability and medical benefits could be strengthened.

Improving Inmate Mental Health Services

DOC has taken steps to improve inmate mental health care services in recent years. However, the federal Department of Justice found in 2006 that inmate mental health care at Taycheedah Correctional Institution did not meet constitutional standards. In September 2008, DOC reached a conditional settlement with the federal Department of Justice that requires specific improvements by September 2012.

To improve mental health services for female inmates, a 45-bed addition to WRC is scheduled for completion in February 2011, at a cost of approximately $11.1 million. DOC has also requested $7.6 million in general purpose revenue (GPR) bonding to build additional treatment space at Taycheedah.

2009 Assembly Bill 75, the Governor’s 2009-11 biennial budget proposal, requests a total of 149.0 FTE positions and $6.6 million in GPR to operate the WRC addition for female inmates and to provide additional mental health services at Taycheedah.

If the Legislature appropriates additional funding for inmate mental health services in the future, costs in other areas may be reduced. For example, the Wisconsin Department of Justice (DOJ) estimates that its staffing costs to defend the State in inmate health care litigation total approximately $1.1 million annually, a portion of which relates specifically to inmate mental health. In addition, settlements or judgments resulting from such litigation have totaled $4.8 million in payments by the State over the past five years.

Recommendations

Our report includes recommendations for DOC to report to the Joint Legislative Audit Committee by January 4, 2010, regarding:

• options for improving screening for developmental disabilities (p. 31);
  
  
• its plans for providing correctional officers with more specific information on inmates’ mental health needs and with enhanced training (p. 81);
  
  
• the allocation of designated release planning funds and its progress in implementing a pre-release curriculum (p. 84);
  
  
• its efforts to improve both release planning for mentally ill inmates and, after release, their supervision in the community (pp. 90, 93, 94);
  
  
• the feasibility of incorporating elements of the Conditional Release Program model into its supervision of released inmates (p. 96); and
  
  
• progress in implementing its settlement agreement with the federal Department of Justice (p. 99).

In addition, we include a recommendation for DOC and DHS to:

• report to the Joint Legislative Audit Committee by January 4, 2010, regarding policies for WRC admissions and transfers (p. 58).

Finally, we recommend that DOC:

• ensure all correctional officers have been trained in medication delivery (p. 48); and
  
  
• improve its collection and management of data related to inmate self-harm, assaults on staff, and segregation placements (p. 80).