Inmates with mental illness neglected - page 3

They are out begging for nurses. I always wondered why none of the nurses I know would work for them. Also wondered why they needed nurses so bad with the state benefits and all. This is... Read More

  1. Visit  canoehead profile page
    6
    It sounds horrible, but given the staffing described...I don't think I'd be in a hurry to clean out a cell of urine and feces, if the inmate was mentally ill and assaultive, and especially if he consistently dirties it up again 5 minutes after you've cleaned it. If it takes 4-5 people to safely enter the cell he might get it hosed out daily (twice a day if we've got tons of staff.)

    If an inmate is going to escalate, and fire up everyone waiting in cells, once I let them out in the day room, I might find a reason to let them stay in their cell for the hour of "recreation." Especially if the other prisoners are having a calm day for once.

    I would especially be tempted if I was covering two nursing jobs, and the officers had double coverage too. We'd be lucky to complete the shift safely, without poking a few bears out of hibernation. Sounds like they didn't have much support from above, which may mean not a lot of review from above either. Even good prison nurses would need to prioritize, and the bad ones could very quickly learn to not care.

    Yes, I know it's wrong. I agree that it's wrong, but we don't live in Wonderland.
  2. Visit  SDALPN profile page
    3
    Canoehead, understandable that this is reality. But something needs to be done about this. Its hazardous for the nurses and the inmates. And once these inmates return to the streets, they'll go off their meds that they can't afford. Then society will be dealing with them again. :-(
  3. Visit  apocatastasis profile page
    0
    There is also discussion taking place about prisons as generators of mental illness. I watched a documentary a couple of nights ago, where prisoners stayed on solitary for years at a time... up until the day of release. YEARS at a TIME.

    And the prison wardens and staff were wondering why the patients were PSYCHOTIC! And why they had trouble reintegrating into society! Really!?

    Between that and the fact that we'll jail a monkey for looking funny, truly, a bunch of retards running this system we have here in the States.
  4. Visit  DoGoodThenGo profile page
    6
    Here's the deal.

    After a news expose on the Willowbrook State School on Staten Island, NY showed just how horrible conditions in "mental hospitals" were/could be there was this huge rush to move the mentally ill into community based care.

    Institutions by the scores were closed and patients were supposed to be placed into group homes and or other supportive settings where their needs could be managed with therapy and or medications in the hopes many would lead some sort of productive lives or at least were free from the horrors of a psychiatric hospital.

    It all sounded good on paper and in some places it worked for awhile. However it seems no one really planned on how much this would all cost and soon state/local governments began cutting back on services. The result is the vast population of homeless persons living on the street suffering from mental illness. Without meds and theraphy and often in stress inducing situations it is no surprise they often act out in a violent manner towards themselves and or others. When this happens they are often put through the criminal justice system and often end up incarcerated.

    Prisons and jails are *not* set up nor designed to act as mental hospitals but yet that is what they are becoming by default and the poor souls confined there often are living in conditions not that much better than the old state schools.

    The other sad thing is that contact between LE and those suffering with mental illness often does not go well for the latter. Persons not in their right mind often do not understand what is being demanded of them by LE and that is something the po-po does not take kindly to. There was a recent event in California that broke my heart. A young homeless man suffering from mental illness was beaten so badly by the local police he died of his injuries in hospital. His last words as the police were beating him down were "I'm sorry" and "Dad' (calling for his father).
  5. Visit  subee profile page
    0
    Quote from ♪♫ in my ♥
    The list of people in our society who are underserved and uncared for is long and varied; institutionalized criminals, mentally ill or not, are a fairly low priority for me given the insufficient resources available to governments at all levels.
    What is this thing spinning?
  6. Visit  Kooky Korky profile page
    3
    Quote from ♪♫ in my ♥
    The list of people in our society who are underserved and uncared for is long and varied; institutionalized criminals, mentally ill or not, are a fairly low priority for me given the insufficient resources available to governments at all levels.
    Not everyone in a jail has been convicted yet. Not everyone who is convicted is guilty. some have had terrible and ineffective assistance of counsel and been otherwise mistreated by police and prosecutors.

    I don't like to see that you look down upon those in lock-up. You could find yourself there some day! Then what?
    I know we have budget limitations, I know we have to prioritize. Maybe I am misreading your words. If so, I'm sorry. I just don't have any easy answers except for individuals to start lobbying those in charge of prisons and jails and who are able to change the care of inmates, especially the mentally ill.
  7. Visit  PinkRocksLikeMe profile page
    2
    I am a EMT and worked for the jail system for 4 years and I had to leave as things I saw that made me mad as hell were NOT being addressed even though I brought them to my supervisor and higher up's in the system.

    There would be inmates there that had to be given pysch shots due to behavior that had to be held down to give shots, I would tell them as soon as they get their shot you HAVE to get off the inmate, as studies show people can die after getting said meds and being held down for ANY length of time.

    I have seen officers scream and be aggresive towards inmates that were "acting out" in truth these inmates were having pysch episodes. I would try to explain to the officers that in may seem as they are acting out, but they are scared, thinking people are out to harm them, etc...You coming in like the goon squad screaming and yelling will NOT help the patient calm down, you are making the situation worse!

    Speaking of Lithium levels, there was one inmate that was on this with phenobarb, he was highly combative and he was a very hard stick due to years of drug use. I would see the lab book that had dates that labs were ordered and see his name, and the days pass with no one doing the lab, I would get the guards to bring inmate down in full shackles so he could not hurt me and draw his labs, never once had a problem with him...

    A patient had a suicide attempt and bleed out very quickly, the LPN with me (I am holding direct pressure) I tell her to start IV as he has lost so much blood, she looks at me and says I don't know how.....

    These are just some of many things I saw or experienced and while i felt MOST of my complaints fell on deaf ears, it was to much for me and I got out and I am so glad I did and now I hear there are SEVERAL changes being implemented including firing the supervisor over the nursing dept and some protocals being tweeked and guards being educated on pysch patients. I hope it is better there, for the inmates sake. I feel like I let them down, honestly I do....Because I chose to leave, to get out.

    NOTE: Most guards did the right thing I will say, but the small bunch that didn't made life much harder than it had to be for the medical staff and the inmates!!
    tabbysrn and canoehead like this.
  8. Visit  makawiliwili profile page
    0
    The Dept of Justice needs to step in. That sure fixed our hospital.
  9. Visit  DoGoodThenGo profile page
    2
    Quote from SweettartRN
    I disagree. I feel that many patients use or hide behind mental illness so that they don't have to take responsibility for their actions. In fact, I have seen it first hand.
    If you're speaking of people who commit murder or even mass killings then suddenly claim they have "mental" issues then I *might* agree with you. However given how many suffering from genuine physiatric illnesses are treated in this country can't see any real benefit from gaming the system.

    The real sad thing is that many of these person in jail or prison wouldn't have come into contact with the legal system if they had access to proper treatments/meds and supportive housing. That was how things were supposed to happen when the new era of drugs came on the market allowing mental illness to be treated and thus prompting the emptying out and closure of facilities.

    Now with a shortage of treatment options along with federal, state and local governments unable or unwilling to properly fund, these persons are falling through the cracks and end up incarcerated; which by the way costs more than providing initial treatment in the first place.
    PrisonPsychRN and tabbysrn like this.
  10. Visit  Multicollinearity profile page
    2
    Quote from canoehead
    It sounds horrible, but given the staffing described...I don't think I'd be in a hurry to clean out a cell of urine and feces, if the inmate was mentally ill and assaultive, and especially if he consistently dirties it up again 5 minutes after you've cleaned it. If it takes 4-5 people to safely enter the cell he might get it hosed out daily (twice a day if we've got tons of staff.)

    If an inmate is going to escalate, and fire up everyone waiting in cells, once I let them out in the day room, I might find a reason to let them stay in their cell for the hour of "recreation." Especially if the other prisoners are having a calm day for once.

    I would especially be tempted if I was covering two nursing jobs, and the officers had double coverage too. We'd be lucky to complete the shift safely, without poking a few bears out of hibernation. Sounds like they didn't have much support from above, which may mean not a lot of review from above either. Even good prison nurses would need to prioritize, and the bad ones could very quickly learn to not care.

    Yes, I know it's wrong. I agree that it's wrong, but we don't live in Wonderland.
    Correctional nurses do not have control over the inmates' environment unless the inmate happens to physically be in the medical office or infirmary (prison med-surg type unit). Correctional nurses do not clean cells, and they do not clean body fluids out of cells. Officers do that, if it's ever done. It would be rare. The description in the article sounds like the inmates are cell-based, not in an infirmary.

    Correctional nurses do not have any involvement with controlling inmates' movement on prison grounds related to recreation time, etc. Officers control all of this. I suspect a lot (not all) of the problems in the article are related to officer shortages and poor training and supervision of officers.
    Last edit by Multicollinearity on Nov 18, '11
    PrisonPsychRN and VickyRN like this.
  11. Visit  Not_A_Hat_Person profile page
    1
    Quote from SDALPN
    Some meds are only name brand. I wonder how many of those had generics and how many were too new for a generic to be available.
    How many of those inmates went on generic psych meds, only to end up back on name brand meds when the generic didn't work? It happens, especially with psych meds.
    PrisonPsychRN likes this.
  12. Visit  Multicollinearity profile page
    1
    Quote from ♪♫ in my ♥
    The list of people in our society who are underserved and uncared for is long and varied; institutionalized criminals, mentally ill or not, are a fairly low priority for me given the insufficient resources available to governments at all levels.
    Our politicians who establish and vote for agency funding agree. City, county, state, and federal correctional institutions who must allocate their paltry funding pretty much agree. Inmates do not receive the same level of healthcare the general public does. They just don't. Here's an example. I have knowledge of an inmate who was raped while in custody, developed a rectal abscess, and it turned into a rectal fistula. His surgery has been rescheduled for almost a year due to various government agencies running out of money and delaying necessary surgery. His crime? He's been caught with marijuana a few times. Let's say this inmate had this condition and was uninsured and showed up in an ER without insurance: the typical under-served, uninsured patient. He'd get his surgery and get out of the hospital quickly due to lack of insurance. He cannot even get to an emergency room because he's been in various correctional facilities continuously, transferred back and forth, and he lacks control.

    I have been covered in hep C+ blood after an inmate was stabbed (due to shortage of officers to keep the environment safe) and did not have soap in the building because we ran out and the unit was out of money. These are examples of the severe short-shrift correctional healthcare facilities operate under.

    Thing is, most of these inmates WILL get out and return to society at some point. They will be next to your child in the grocery store. They might deliver your pizza and stand at your doorstep late at night. They need to have a minimum level of healthcare and be treated in the manner a civilized society treats its most desolate. Not just because it's ethically correct, but because most will walk amongst us in society post-release, and we do not want them socialized in prison to be violent animals upon release. We do not want their severe mental illnesses to become amplified without treatment, if only because they will be more likely to re-offend. Some will be violent animals anyway. But certainly not all. The US already has the highest percentage of its' population in prison of any nation in the world. We cannot afford to warehouse people like animals and perpetuate the downward spiral of our society and the resulting increase in our (expensive) dysfunctional underclass.

    Back to the original article. A monitor needs to be appointed within the prison to monitor the interface between medical and nursing staffs' special needs orders related to medical and psychiatric conditions and the officers' implementation of these orders. In correctional facilities medical and nursing staff issue forms related to special needs that the officers must implement. For example, if an inmate needs ice a few times a day related to an injury, nursing would issue a form for that, and officers would issue the ice to the inmate. If an inmate has a sz disorder, a nurse would issue a lower bunk order, and officers would implement that.

    The only way nursing or medical staff knows it's not being done is if the inmate protests to the medical department in the form of a letter. The inmates in the original article are severely mentally ill and may not be able to do this. So a monitor needs to perform this action of auditing for compliance due to the population's vulnerable state.

    Medical and nursing staff do not have any control or knowledge of inmates' daily environmental conditions or movement within the prison facility (recreation, day-room activity). Sometimes it can be as simple as having CNAs round daily or weekly, and ask the inmate if they have needs. Still, the prison must have a higher-level person who interfaces between the officers' security chain of command and the medical department to ensure compliance with medical orders.

    Correctional facilities are at risk for being sued for deliberate indifference with their treatment of inmates. The state of California's prison healthcare system is currently run by a US federal receiver because of an outrageous number of preventable inmate deaths and deliberate indifference in the treatment of inmate's medical conditions. The State of California is paying billions of dollars to remediate all of their prison healthcare facilities over many years due to being found guilty of deliberate indifference. So, besides ethical treatment being the morally right thing to do, it also saves a government institution money in the long-term as it keeps them out of class-action lawsuits with devastating financial consequences.
    Last edit by Multicollinearity on Nov 19, '11
    PrisonPsychRN likes this.


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