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| Psychotropic complications |
| By Sarah Etter, News Reporter |
| Published: 04/09/2007 |
Psychotropic medications are one of the top three health care costs in corrections, ranking just beneath HIV and Hepatitis C treatments, according to corrections medical consultant and University of Colorado clinical professor Dr. Jeffrey Metzner. High costs for these medications can be attributed to the newer types that keep coming out, which are much more expensive and much more widely used than older ones.“There has been an increasing recognition of the high prevalence of mental illness in correctional populations,” says Metzner, “so the cost will continue to increase.” Currently, it costs about $22 a day to supply an offender with psychotropic meds., which are split into four groups; anti-depressants, anti-psychotics, sleepers', and mood stabilizers. Some medications cover two arenas, working as anti-depressants and mood stabilizers, which are the most commonly prescribed prescriptions in corrections. But there are concerns that they are too often prescribed and given to the wrong inmates. The American Psychiatrist Association recommends one therapist for every 150 medicated offenders in prison, and one per every 75 medicated inmates in jails. “Having enough psychiatrists is an issue,” says Dr. Joel Dvoskin, author of the report On the Role of Correctional Officers in Prison Mental Health . “It's hard to have someone sit down with an inmate and really talk about the reasons behind prescribing medication if you are understaffed. It takes time to talk to someone and prescribe and explain it is in their best interest. But not having someone sit down and talk to an inmate can lead to reluctance to take the medication, which is a big issue.” That and the problem of offenders not adhering to their medication plan, makes it difficult to ensure the pills are administered properly. Although nurses typically watch to ensure that inmates have swallowed their medication, officers still routinely find discarded pills in cell block checks, or that the medication has been bartered away. In addition to the cost, complexities and complications associated with these drugs, some have side effects that can cause even bigger problems if not properly monitored. “Some of these medications have heat-related risks,” Metzner says. “That affects your temperature control. If you are on some of these meds and it is 90 degrees outside, you are at risk for a heat stroke. Many systems have a heat plan in place that identifies who is on the medications. When the temperature goes above a certain temp, measures are taken; offenders are taken to increased showers, ice and water.” Some meds also cause involuntary muscle movement or weight gain, which can lead to complications like diabetes and cardiovascular disease. Metzner says it has become an increasing challenge to monitor the weight of offenders, and ensure they remain healthy, mentally and physically. “This is among the biggest difficulties in corrections,” Dvoskin adds. “Correctional officers spend the most time with inmates. They are the first line of defense against psychiatric or psychological crisis and are the first to know about it and contact mental health staff.” Metzner and Dvoskin agree that the best prescription for this problem is additional pill training for all staff. “One good practice is cross training between the medical staff and correctional staff so they understand each other's jobs,” Dvoskin says. “That prevents medical staff from being offended when correctional officers do their job. Most nurses eventually figure out procedures like inmate count, but cross training is a good idea.” Metzner says it is important to ensure that corrections officers are trained on the best ways to handle offenders with mental illness, and to provide a background of what common prescriptions might cause an offender to act out. Both doctors also agree that the best way to address psychotropic complications is to foster a great relationship between medical and security staffs. And while those relationships should flourish, the dollars and cents of the issue won't go away any time soon. “Places that have improved mental health services find it's a huge advantage to custody personnel,” Dvoskin adds. “The simple answer is that good mental health treatment is necessary for a safe, well-run facility and high quality correctional practices are necessary for good mental health and medical health provisions. These are complimentary functions that are essential to a modern, constitutionally run jail or prison. Anyone who thinks that wardens, jailers, or sheriffs are opposed to good mental health care has never talked to one of them.” |
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