Federal prison should improve inmates’ mental health care

THE ISSUE A medical expert says the Federal Detention Center in Honolulu fails to provide inmates the needed level of mental health care.

Jails and prisons increasingly have been turned into warehouses for the mentally ill, but they lack the medical care needed to fulfill that role. The switching of medication for a jailed federal defendant in Honolulu without a physician's approval indicates how officials have failed to recognize their obligations.

Substance abuse is obviously a contributing factor in the mental problems plaguing many of the people entering Hawaii's penal system. Recognizing but failing to treat mental illness of prisoners is tantamount to shirking the goal of rehabilitation.

Convicted bank robber James Breitenbucher had been taking the antidepressant Paxil while awaiting trial at the Federal Detention Center near the airport, under custody of the U.S. Marshals Service, on a charge of violating his parole by stealing a bottle of vodka. Because Paxil is not on the Bureau of Prisons' preferred list of drugs, detention officials gave Breitenbucher another antidepressant, Prozac, without consulting a doctor.

Breitenbucher had had previous negative reactions to Prozac so stopped taking it, according to his attorney, federal First Assistant Public Defender Alexander Silvert. Dr. Daryl Matthews, a psychiatrist, testified at a recent federal court hearing that the switch from Paxil to Prozac, although in the same family of drugs, was "below the standard of care" in medical practice. Breitenbucher's condition deteriorated, his attorney said.

Matthews said he was "stunned" to learn of the switch in medicines. Having helped evaluate mental health services at the Guantanamo Bay detention center for suspected terrorists in Cuba, Matthews said psychiatric care there is superior to that provided at the Honolulu facility.

"Jails are not designed as care facilities for those with mental disorders, but in fact many jails today are the largest inpatient mental health institutions in the United States," Wisconsin corrections consultant Martin Drapkin wrote in a 2003 book about management of inmates with mental disorders.

While only 5 percent of Americans have mental illness, the Bureau of Justice Statistics reported in 2006 that 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of local jail inmates were found to have symptoms of major depression, mania or psychotic disorders.

However, of those who had mental health problems, only one-third of state prisoners, one-fourth of federal prisoners and one-sixth of jail inmates had received mental health treatment since admission, according to the report.

Matthews says the Honolulu facility's lack of a staff psychiatrist for its more than 640 detainees -- including more than 250 state inmates awaiting trial -- is a "major problem" in need of federal review. A facility spokeswoman says the detention center is in the process of hiring a part-time psychiatrist but that seems to fall short of what is needed.