Four suicides in less than two years told officials in the Iowa they had a problem.  Since the State Penitentiary's Clinical Care Unit (CCU), designed to house mentally ill offenders, opened its doors in 2002, a handful of inmates have taken their own lives, prompting the Department of Corrections to enlist the help of a mental health consultant to come in and evaluate the situation.

"We knew there were problems with the unit and we had great concerns about what we could do to improve its operation," said Ron Welder, an executive officer at the Iowa State Penitentiary.

The DOC tapped Dr. Thomas White, a former Bureau of Prisons psychologist who now works as a consultant with Training and Consulting Services, to review the suicides and operations at the CCU.  White was asked to spend some time at the unit, take a hard look at how it functions, examine DOC policies and procedures and make some suggestions as to how CCU, as well as the Iowa's overall mental healthcare system, could be improved.

After visiting the CCU in Fort Madison, Iowa, late last year, White released his report in February, with 50 recommendations for improvements.  Last week, key DOC staff, including Burger, sat down to discuss White's report and to formulate a game plan for implementing some of his suggestions.

"I am really encouraged by the report," said Warden Ken Burger.  "I think it's giving us some good direction as to where we have to move in order to [more effectively] treat the mentally ill folks that we [have] in our system."

Burger said that some of the changes White felt were necessary could be made immediately. 

"There's a fair number here that we have already made the necessary changes in our policies, procedures or practices that have allowed us to already start improving the conditions over in CCU," said Burger. 

One of those outlined in his report suggests that "mental health staff should authorize the use of restraints for all suicidal and mental health observation offenders."

According to Burger, policy has already been changed to reflect that recommendation.

"If we have a person that we are going to be putting in restraints because of behavior [now], we always call a psychologist to get permission," Burger said. 

According to Burger, the report also recommended instituting a multi-disciplinary team concept to evaluate the day-to-day operations at the CCU.  White proposed that the team be comprised of a variety of staff members, ranging from social workers to corrections officers to vocational instructors.  That group has already been put together and is meeting weekly, Burger said. 

Another change that White advocated was moving the psychologists' offices from a central office area to the unit to make the clinicians more readily available to offenders and other staff members.  It also gives the psychologists an opportunity to see the way the offenders interact with staff and other offenders, Burger said. 

Burger also said that he has expanded the CCU inmates' recreational time as a result of White's report.  The offenders in the CCU are now allowed to go to the gym in the main prison three nights per week.

"We had talked about it and were thinking about doing it.  Then he recommended it and we did it," Burger said.

But some of the issues White addressed in the report were not as easy to fix and will take some time, Burger said.  He considers White's suggestions to increase staffing levels to be more difficult to implement.

"When you talk about staff, you talk about dollars," Burger said. 

According to Burger, the DOC did request additional money during this legislative session to add employees to the CCU and will request even more funding in the 2007 budget. 

"There are additional positions we are going to need to [add to] meet Dr. White's recommendations as to the level of staffing [on the unit]," Burger said.

In the report, White suggests that the DOC "establish a deputy warden position over the CCU to provide direct oversight of policy, operation and procedures."  He also said that the DOC should consider creating a variety of other positions, including two licensed social workers, a clinical director and a psychiatric nurse.

In addition to hiring more employees to work on the CCU, White said that the DOC should create a Director of Mental Health position at the Central Office.  This person would "provide statewide oversight of all mental health programs."

While White has many ideas about where services and practices are lacking at the CCU, he does acknowledge that the quality of mental healthcare provided to inmates by the DOC has improved since the unit was built.

"In fairness, it should be pointed out that the current living and treatment conditions at the CCU are far superior to what existed prior to its construction," White wrote in his report.  "The warden has instituted positive changes and the CCU staff have tried to develop a credible program in the face of management instability, staffing reductions, anti-treatment sentiments and physical plant limitations," he said. 

But, despite the DOC's attempt set up an effective treatment system for its mentally ill offender population in the CCU, White said the agency still has a long way to come.

"Despite these early accomplishments, the CCU and the DOC is now faced with the need to move on from its initial efforts to develop a more comprehensive treatment program that is adequate to meet the needs of their offenders," White said.

Officials in Iowa are hopeful that, armed with White's report, the agency will be able to do so.

 "I think Dr. White's report crystallized those concerns [we had about the unit] and provided a roadmap for us," said Welder.

Resources:

Iowa DOC (515) 242-5707

Mental Health Consultant Report