In October of 2016, Nebraska’s Department of Corrections had 23 psychologist positions across its state prisons. Only 11 were filled. Because of this staff shortage, the department had to ‘triage’ treatment, only focusing on the most mentally ill inmates. It also had to ask existing staff to work overtime, and rely on expensive outside contractors to compensate for its lacking staff numbers (Hammel, 2016).
Now, nine months later, Subramanyam Rajagopal is speaking out. Rajagopal was the first psychiatrist in a new mental health unit at the Lincoln Correctional Center from 2008 to 2010. He left his position “because of the stress of having 60 patients under his care” (Young 2017, p.4).
The department has had high turnover of psychiatrists since Rajagopal’s departure, and has been without one on staff altogether since mid-June, though they do have consultants. According to Rajagopal, not having a psychiatrist on staff is troubling for several reasons.
First, Rajagopal says prescriptions of specific drugs like Clozaril, given to several inmates struggling with schizophrenia, should only be written by psychiatrists, with weekly re-evaluations to monitor its side effects.
Second, Rajagopal says, “there are inmates on court-ordered medication injections that require testimony of two psychiatrists to continue the treatments when the medications are given against the will of the inmates” (Young 2017, p.9).
Finally, Rajagopal believes that the rise in violence in Nebraska prisons in the past two years can be attributed to the lack of sufficient mental health care. Examples of this violence are “a riot, [various] serious disturbances, killings of inmates, an assault in the community by an escapee, and assaults on corrections staff” (Young 2017, p.10).
Dr. Harbans Deol, the medical director of the Nebraska Department of Corrections, refutes the first and the last of the Rajagopal’s claims, saying that he knows of no guidelines for Clozaril that require it only be prescribed by a psychiatrist. He also says “there’s no correlation between mental health care and violence in the prisons” (Young 2017, p.11).
In 2015, Dr. Bruce Gage, of the Washington State Department of Corrections (DOC), conducted a review of Nebraska’s inmate mental health services. This review included the recommendations that Nebraska’s DOC “fill all of the [mental health staff] positions, [develop] a more structured treatment system, and [focus] the workers’ time on mental health services instead of programs aimed at reducing criminal behavior, such as anger management and violence reduction” (Stoddard 2015, p.21).
Deol said the DOC is working to meet psychiatric needs “with a psychiatric nurse practitioner, who can prescribe medications, the use of a contract staffing agency and tele-psychology services” (Young 2017, p.20).
He also said they are working to recruit a new staff psychiatrist, but cites pay as an obstacle, with the Department of Health and Human Services paying psychiatrists up to 100,000 more.
Nonetheless, Nebraska is working to fill the gaps its staff shortage. As Gage said in his 2015 report, “Proper mental health care is good for the prisons and the communities to which inmates return” (Young 2017, p.14).
For more on this topic please read, “Nebraska prisons not alone in struggle to find mental health staff.”
Hammel, P. (2016, October 13). Nebraska prisons lack staff to improve mental health treatment for inmates, officials say. Retrieved July 18, 2017, from http://www.omaha.com/livewellnebraska/health/nebraska-prisons-lack-staff-to-improve-mental-health-treatment-for/article_3f94d0d8-84ef-5854-899e-98a4346bb75e.html
Stoddard, M. /. (2015, August 28). Corrections Department’s mental health system doing good work but has room to improve, report says. Retrieved July 18, 2017, from http://www.omaha.com/news/nebraska/corrections-department-s-mental-health-system-doing-good-work-but/article_06754108-7100-5bf7-bf9c-cf6171fec0e0.html
Young, J. (2017, July 17). Nebraska prisons not alone in struggle to find mental health staff. Retrieved July 18, 2017, from http://journalstar.com/legislature/nebraska-prisons-not-alone-in-struggle-to-find-mental-health/article_6d7ab4ff-fd7d-524b-a29b-f1e379b5047f.html