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Ohio Mental Health Decree Entered

A far reaching consent decree governing the delivery of mental health care to Ohio prisoners was entered on 10 July 1995. The consent decree resulted from a §1983 suit filed in 1993 and certified as a class action on June 7, 1995. The prisoner plaintiffs were represented by Robert B. Newman and Alphonse A. Gerhardstein, both Cincinnati attorneys.

The consent decree covers all adult male and female prisoners in the state of Ohio who are incarcerated under the control of the Ohio Department of Rehabilitation and Correction (DRC). The stated objective of the consent decree is to provide "for a comprehensive system of constitutionally mandated mental health care" for Ohio prisoners. Any litigators who are involved with or contemplating an action to obtain "constitutionally mandated" mental health care within a state prison system may find a review of this consent decree to provide some useful information.

The decree mandates that mental health services "shall be provided to inmates in the least restrictive available environment and by the least intrusive measures available..." It calls for the DRC to provide mental health services "within the framework of a community health model," which among other things mandates that prisoners "with serious mental illness will be distributed relatively evenly throughout the DRC system..."

Prisoners with serious mental health illness "shall not be barred from participation in available prison programs solely because of their illness."

The court defines and describes an appropriate "constitutionally mandated" mental health services delivery system, which includes the following:

All prisoners entering the Ohio DRC "shall be the recipients of mental health screening upon admission to the prison system." The screening will be accomplished by use of a standardized form, administered by persons trained in the use of such a screening process. The screening process "shall maintain a low threshold for follow-up evaluation..." Mental health evaluations shall be performed by "appropriate mental health professionals," and may result from the initial intake screening or by later referral. Also, "Information regarding the access to mental health care shall be incorporated as part of every inmate's initial reception and orientation to... DRC institutions..."

One of the most interesting sections of the decree relates to "constitutionally mandated" mental health staffing levels. The decree directs the DRC to "hire and place in service such additional mental health staff as is required to reach a total of 246.5 mental health staff based on a total DRC prison population of 40,253 inmates." This works out to a ratio of one mental health staff per 263 prisoners. The decree mandates that those positions "shall be allocated solely to the provision of mental health services..." It also mandates the hiring of additional psychiatrists to reach a level of one psychiatrist for every 1,579 prisoners .

The mental health service delivery model encompassed by this decree sets forth a three tier level of mental health services: Inpatient hospital beds for long term care, "Residential Treatment Units" (RTUs) and "crisis beds" for short term intervention, and "Outpatient Care" for mentally ill prisoners in general population.

The DRC defendants agree to provide "not less than 120 inpatient hospital beds for male inmates and 11 inpatient hospital beds for female inmates..." which works out to one bed per 307 prisoners. They also agree to provide 710 residential beds (1 per 57 prisoners) to be allocated evenly among all DRC institutions. Allocated bed space will be adjusted up or down in proportion to changes in the DRC population.

The decree describes the delivery system for medications, including "forced medication," which "shall in all respects comply with Washington v. Harper, 494 U.S. 210 (1990)." Also defined and described are procedures for making housing assignment decisions for mentally ill prisoners, suicide prevention procedures, restrictions on the use of physical restraints and of placing mentally ill prisoners in "Control Units," procedures for conducting disciplinary hearings for mentally ill prisoners, developing a comprehensive medical records system and mental health classification system, staff training, and procedures to follow when transferring mentally ill prisoners from prison to prison.

The court appointed Professor Fred Cohen, L.L.B., of the School of Criminal Justice, The University of Albany, New York to monitor the consent decree. The decree has a five-year enforcement period. Attorney Alphonse Gerhardstein has estimated that it will cost the state of Ohio some $50 million to implement the decree in its first two years.

As stated above, those who are engaged in or contemplate litigation in the area of mental health services to prisoners would be well advised to obtain and review a copy of this decree. Copies of the consent decree can be obtained by writing the Clerk of the Court, U.S. District Court for the Southern District of Ohio, Western Division. The case is: Juan Dunn et al., vs. George V. Voinovich, et al., Case No. C1-93-0166.

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Related legal case

Dunn v. Voinovich

The consent decree is in the brief bank.