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County prisons across Pennsylvania lack the resources to tackle a growing mental health crisis, putting some of the most vulnerable inmates at increased risk, according to a statewide survey by Spotlight PA and the nonprofit Pittsburgh Press Institute.
Responses from more than 20 Pennsylvania prisons serving the majority of the state’s population described similar situations: a growing number of prisoners with serious mental health needs, a shortage of medical staff, and a complex system for accessing the few resources available from the state.
Prison guards, medical professionals, and other prison officials have written candidly about the challenges they face in providing health care to the thousands of Pennsylvanians awaiting their day in court.
“We are simply not trained…and we don’t have a facility to detain those who need mental health treatment,” said Angela Kern, deputy warden of treatment at the Fayette County Jail, in response to the survey.
“It’s frustrating and stressful for everyone – degraded individuals and employees.”
Spotlight PA and PINJ sent out the survey to every prison in Pennsylvania to understand the state of people’s mental health resources behind bars. The 25-question survey asked officials to describe their employment levels, their ability to provide adequate health care, and any additional challenges they face in caring for people with mental health needs.
The 20 officials who responded represent prisons of nearly 13,000 people.
The survey also asked prisons to rank their ability to meet the mental health needs of detainees on a scale of one to five, with one being under-equipped at all and five being extremely well-equipped. Only six counties—Allegheny, Center, Chester, Huntingdon, Lawrence, and Philadelphia—ranked themselves fourth or higher.
More disease, fewer resources
The population of Pennsylvania with mental illness has increased over the past decade, but the services needed to treat them haven’t kept pace, writes Jeffrey Faywell, the warden of the Washington County Correctional Facility.
As a result, he said he saw more people with more severe mental health needs in his facility.
“These residents are severely addicted and mentally ill,” he wrote. “More than 50% of our current population has a dual diagnosis of mental illness and addiction with high rates of suicidal ideation.”
County District Attorney Peter Aker serves as chair of the Mercer County Jail Board of Directors, where he said nearly half of the people incarcerated at the local jail take psychiatric medications. But other facilities told Spotlight PA and PINJ they had difficulty achieving this level of care.
“When individuals do not receive treatment, we have very little success in starting them,” wrote William Schop, warden of Beaver County Jail. “Many are humiliated, and we don’t have the resources to take care of these people.”
Officials described a justice system that sends people to prison even when their criminal behavior is a symptom of their mental illness.
“The prison functions as a de facto social worker,” wrote David Kratz, director of corrections for Bucks County. “If services in the community are not readily available to law enforcement, prison is the easiest alternative. The police often don’t have the time to spend more than 12 hours trying to get services.”
Officials in neighboring Chester County said they are training staff to recognize the difference between “willful disobedience and inability to follow rules due to mental state”.
“While our county and relevant stakeholders are taking ongoing steps to appropriately divert people with serious mental illness, the criminalization of this population continues across the United States,” wrote county spokeswoman Rebecca Breen.
“Appearances [serious mental illness] In prison this may translate to disciplinary offenses, while the same behaviors in a therapeutic setting are seen as symptoms of the disease.”
Others were more blunt.
“It appears we are a ‘waste land,’” wrote Snyder County Jail Warden Scott Robinson. “It is very difficult to transfer detainees with serious mental problems to an institution where they can receive appropriate care. Some cannot even control bodily functions and it is a dangerous drain, both mental and physical, for our employees.”
Recruitment varies widely
Every prison that responded to the survey said it employs staff or contractors to address mental health needs among inmates. However, the survey found that the level of staffing and resources vary by county, creating an uneven environment where the level of care a person receives in prison largely depends on where they are detained.
Most capital and suburban prisons said they had full-time medical staff, including psychiatrists or psychologists, nurses and certified counselors.
The Philadelphia Penitentiary Administration, for example, operates four prisons with 4,400 people and employs about 325 clinical staff, “one-third of whom are behavioral health physicians,” said Bruce Herdman, chief medical officer.
The department also operates a psychiatric hospital within the prison system and has real-time access to city records. This allows staff to consider a patient’s treatment history when determining a new course of care.
Midsize counties like Bucks, Chester, Montgomery and Westmoreland said they have assigned internal staff working for the prison or provided by PrimeCare or another company.
But many smaller counties said they have only one or two employees, some of whom work part-time, who handle all mental health needs, including initial and follow-up check-ups. Some have doctors available via telehealth, but not at home.
“Oh, I wish we had a psychiatrist in the house!” Kern, the deputy sheriff of Fayette County wrote.
Even facilities with access to a large network of healthcare professionals have identified problems with hiring and retaining staff, a problem they said has worsened during the COVID-19 pandemic.
“Our facility is suffering like most facilities: staff are hard to find and keep,” Westmoreland County Commissioner Douglas Chiu, who also chairs the county jail board, wrote.
“Employment is everything,” Feyuel, the warden of the Washington County Jail, echoed his colleagues’ concerns.
Long awaits few resources
County prisons have additional liability if a person’s mental or intellectual state affects their ability to stand trial.
If a court finds someone to be “incompetent,” that person may need professional treatment before they can participate in any legal proceedings. This treatment is usually offered in two state-run hospitals with very limited beds.
Almost every prison said it currently or recently housed someone who needed this treatment. About 70% of facilities scored in three out of five or less for their ability to address efficiency issues.
In candid answers — hundreds of words long — prison officials have detailed the difficulties of trying to help the most vulnerable residents get the court-ordered treatment they need.
Officials said the process is frustrating and lengthy, often prolonging incarceration for people who may not understand why they are in prison in the first place. They called on the state to provide alternatives to imprisonment or increase the number of hospital beds available to treat people with competence problems.
When Philadelphia was asked to describe the challenges they face in helping someone deemed incompetent to get treatment, Philadelphia described the process as “extremely stressful.” Beaver County writes that after waiting months for state hospital beds for two, prison officials took matters into their own hands and contracted a company that would come to the prison to provide treatment.
“The system is broken,” Snyder County Sheriff Robinson wrote. “It takes a long time to get the help they need. Prisons are not equipped to deal with serious mental health issues.”
This story is the product of a collaboration between Spotlight PA and the nonprofit Pittsburgh Institute of Journalism, and was published as part of the Pittsburgh Media Partnership.
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