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Aclu Criminal Neglect Report-ne Prisoners With Disabilities 2003

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Criminal Neglect:
The failures of Nebraska’s
correctional system to care for
prisoners with disabilities
December 19, 2003

Report prepared by ACLU Nebraska
Amy Miller, Legal Director
Patti Osborn, B.S., Volunteer researcher
941 O Street, #706
Lincoln, NE 68508
(402) 476-8091

The Nebraska Department of Correctional Services cares for over
4,000 inmates. Most of these inmates are not in prison for life. It is
unknown how many additional prisoners are housed in county jails.
Whether state or county prisoners, they are released after a few weeks,
months, or years. These people will reenter society, and it is important
that they receive treatment while in prison so they can get jobs and not
cause harm to themselves or others. It's also what the law requires.
The Eighth Amendment of the U.S. Constitution mandates that our
government not inflict cruel and unusual punishment. The denial of
medical care violates this constitutional requirement. The current health
care system in Nebraska’s jails and prisons fails to provide adequate
measures to treat inmates in need of care. Inmates should not be denied
treatment and medication, be it for physical conditions such as heart
disease or for mental illness. Good medical and mental health care is
not a luxury, but a constitutional necessity.
This report is intended as a first step in seeking immediate
attention and remedial efforts by advocacy groups, correctional facilities,
and the Unicameral. The intent of this report is to provide some of the
human stories behind prison walls, both the tragedies and the nearly
fatal stories that had a successful ending upon the work of outside
The report then outlines some of the reasons why the systems are
failing to provide appropriate medical and mental health care. The
emphasis in this report is mental health care, because it appears jail and
prison officials have the least understanding of or inclination to provide
services for people with mental illness. Other forms of disabilities and
medical conditions are touched on, but the largest problem at this time
appears to be the lack of screening and treatment for prisoners with
mental illness. (See Appendix B for more information on the growing
problem of mental illness behind bars.) Finally, the report outlines some
possible courses of action that could ensure we are providing the sort of
care the law and human dignity demands.
ACLU Nebraska is not claiming that the inmate health care system
is staffed with uncaring people, or that everything about it is broken.
However, the volume of complaints we have received, and the picture
that they paint, lead us to believe that this matter is ripe for public
discussion, legislative review and action to remedy the problems we have
Background on this report.
Over the past two years, ACLU Nebraska has investigated
complaints made by over 100 prisoners with disabilities. There have
been recent news reports of inmate deaths related to untreated medical

or mental health conditions. This report sets out the information
gathered from the ACLU's advocacy work, the public record, and the
studies done by state agencies.
The picture created by this study is a grim one: prisoners with
disabilities, at both the county and state level, frequently receive no care
or inadequate treatment that threatens their lives and their ability to
return to society after serving their time. The lack of care affects both
the innocent pre-trial detainees and those adjudicated as guilty.
People who are still innocent but in jail due to their financial
inability to post bail, people who have been ordered to serve a short
sentence of weeks or days in a county jail for minor offenses, and men
and women in state prisons who are facing longer sentences all are in
need of health care. Their needs range from simple access to
prescriptions such as insulin and nitroglycerin, to mental health
medication and counseling, to accommodation of physical disabilities
such as hearing impairment or use of a wheelchair.
Stories of Punishment Through Neglect:
The stories of individuals reported here are only a fraction of the
problems reported to ACLU Nebraska. Most of the people affected must
remain anonymous, either due to their fear of stigma as a person who
was incarcerated or because they are still in custody and fear retaliation
by officials. There are not simply a few facilities failing in their obligation
to provide care for the Nebraskans in their custody--the complaints
ACLU Nebraska has handled come from all over the state, from the
smallest counties to the largest and most sophisticated state prisons.

Robert Pantona was an inmate at the Sarpy County Jail.
According to news reports, prior to his conviction, he was on
the medication Klonopin for an anxiety disorder. However,
upon his entry into the correctional system, Mr. Pantona was
not given his medication. A protocol for mental health
evaluations does not exist at the Sarpy County Jail, and
Robert’s requests for help were denied. On July 15, 2002,
Mr. Pantona committed suicide by hanging himself in his jail


Jamie White, Jr., was an inmate at the Nebraska State
Penitentiary. According to news reports, this 26 year old
man had severe asthma throughout his life. The prison
knew he was an asthmatic. Asthma medication must be
delivered regularly and without interruption to prevent a
killing attack, where death is tantamount to drowning and
suffocation. With proper medication and oversight, asthma


is usually a medical condition its victims can manage easily.
On September 8, 2003, Jamie White, Jr., died at the age of
26 from an asthma attack.

Lonnie Thomas, an inmate charged with writing bad checks
and other non-violent offenses, was placed in solitary
confinement for over four years due to his HIV+ status.
While in solitary, he made repeated requests for mental
health counseling to combat depression over his incurable
disease and the isolation caused by solitary confinement.
The prison refused to allow Mr. Thomas to attend group
therapy and refused to provide individual counseling as long
as he was in solitary. Mr. Thomas received a response from
the prison suggesting he deal with his mental health
problems by reading self-help books from the prison library
and by practicing yoga.


A man in a north-eastern Nebraska county jail was serving a
six month sentence for a non-violent offense. He had a
history of mental health problems and managed his
condition with anti-psychotic medications. The jail did no
mental health screening upon intake because they did not
have a protocol for such screening, and no medical staff to
perform it. Nor did the jail seek to verify whether inmates
had a prescription needed during the time in jail. After four
weeks of un-medicated incarceration, the man was
experiencing hallucinations and hearing voices that told him
to commit suicide. His wife asked the sheriff in charge of the
jail to accept the prescriptions she had or to have her
husband evaluated, but nothing was done. When ACLU
Nebraska learned of the problem, we made immediate
contact with the sheriff and outlined the need to provide care
for the inmate both for his own safety and the other inmates
and guards who had contact with him. The inmate was
given emergency treatment by a local doctor and ultimately
transferred to a state prison facility with fulltime medical
staff for the remainder of his sentence.


A man charged with crimes in Lancaster County was deaf
and able only to communicate with sign language. He
requested an interpreter as required by law so he could
attend religious services, mental health counseling, and
classes offered in the jail. The jail refused to provide an
interpreter except for at disciplinary hearings. The man


spent almost a year isolated without an interpreter since no
staff members were certified to sign. After intervention by
ACLU Nebraska, the jail agreed to provide a qualified sign
interpreter for the rehabilitative programs.

A man in a south-eastern Nebraska county jail was serving a
short sentence for non-violent offenses. He was over 50 and
had a past history of heart problems. He was taking cardiac
medications at the time of his arrest and required access to
nitroglycerin in the event of another heart attack. The jail
refused to allow him to use any of the medicines he already
had, but also refused to provide him with new medication.
The inmate waited for three months without being seen by a
doctor, during which time his sole medication was a single
aspirin each day. After intervention by the ACLU Nebraska,
the jail finally permitted a doctor's examination. The doctor
immediately prescribed appropriate medications to prevent a
fatal heart attack.


An inmate at a state prison had a history of strokes and high
blood pressure. He began to experience elevated rates of
blood pressure, and requested a re-evaluation of his
prescriptions. He was not allowed to see a doctor, though
the prison assigned a nurse to take his blood pressure daily.
The rates remained dangerously elevated at levels where a
stroke may occur for almost three weeks, but there was no
change in the inmate's medical care or prescriptions. After
intervention by ACLU Nebraska, the prison sent the inmate
to be evaluated by an outside doctor, who immediately
adjusted his prescriptions to avoid a fatal or disabling
stroke. The inmate's blood pressure remains within normal
parameters with his new regimen.


A man detained in a central Nebraska county jail noticed
symptoms of venereal disease. Concerned he may have HIV
or an STD, he requested the jail medical staff to test him.
They refused. He then contacted the Nebraska AIDS Project,
a non-profit agency that provides free medical screening for
anyone in the state, to come and test him. The Nebraska
AIDS Project agreed to do the testing free of charge to both
the man and the jail, but the county jail administrators
refused to allow the test. Medical personnel at the jail
suggested to the NAP employee that they didn't want to know
whether the man had a medical condition.



A Nebraska woman had received treatment for mental
illness, including anti-psychotic medications and antidepressants. She also had a substance addiction and upon
arrest began going through withdrawal. While in the county
jail before her conviction, no medication was provided to
ease the withdrawal, nor was she screened for mental health
care. Upon being sent to the York prison, she experienced
uncontrollable rages and suicidal urges. She attempted
suicide on several occasions. She attacked guards on
numerous occasions, and injured several during these
episodes. Whenever she was calmer, she made repeated
requests for examination and medication. Despite her
history of prescribed medication, the York prison
psychologist refused to provide care. The inmate reports the
psychologist told her during counseling sessions that the
inmate was going to hell, and that she was just bad, not
mentally ill. Then, because she was in solitary confinement
to control her behavior, counseling ceased entirely because
the psychologist refused to meet with her in person. Solitary
confinement for this woman consisted of a room without
furniture, possessions, or clothing: during visits from ACLU
Nebraska, she was only wearing panties. The inmate was
kept in these conditions for at least six months. When the
Ombudsman’s office and ACLU Nebraska separately
investigated the situation, the prison agreed to have the
woman evaluated again. She was then diagnosed as needing
medication, which the prison has now provided. She still is
not receiving supplemental counseling despite requests.
Although the prescription medication has made it possible
for the inmate to gain back many of her privileges and she
has had no serious misconduct incidents for over a year, the
period where she was not medicated left a serious impact on
her life. As a result of the assaults she committed in her unmedicated rages, she has had several decades added to her

Nebraska Jails and Prisons: A Neglected Care System
The medical and mental health care system in Nebraska jails and
prisons must be reformed. There are several important problems that
need to be addressed in order to create a system that meets the needs of
inmates. If health care is not improved, the correctional system will
continue to fail inmates and ultimately fail society.
What follows is an explanation of different medical and mental
health care issues in Nebraska jails and prisons and suggestions for how


the system can be improved.
1. Inmate Intake/Screening
The intake period in prisons and jails is a key time to find out if
people have mental illnesses or a physical disability. If detainees are
identified as having mental illnesses at the time they enter the
correctional system, the correctional staff can be aware of potential
problems, provide appropriate treatment, put inmates on suicide watch if
necessary, and place them in the type of housing that would best suit
their needs. Inmates with a medical condition or disability must be
identified in order that appropriate accommodation be made or
continuity of medicine be provided.
The need is particularly acute for individuals with mental illness,
and the recommendations of this report focus on this issue because it
appears to be the area of greatest unmet need in Nebraska at this time.
People with mental illnesses are at a greater risk for committing suicide
in correctional facilities. Most of these suicides take place within the
first twenty-four hours,1 making the intake screening process a critical
component of suicide prevention.
When people first enter correctional facilities in Nebraska, they are
given only an abbreviated form of medical screening. All county jails use
(or are supposed to use) a standardized medical questionnaire that
includes only three questions specific to mental illness. The
questionnaire asks about current treatment for mental health problems,
the presence of suicidal thoughts and depression, and whether or not the
person has ever tried to kill him or herself.
The questionnaire fails to ask if the inmates have ever been treated
for mental illness in the past, if they have ever been in a psychiatric
hospital, and whether or not the person has anxiety problems. These
questions should be added to the survey to make it less likely that
potential mental health problems will be missed. Information about past
mental health treatment is essential because even if the people are not
being treated currently, the conditions in jails and prisons could cause a
The state prisons in Nebraska do not use one standard mental
health screening form. Inmates are sent to the Diagnostic and
Evaluation Center upon conviction, but it is not clear how many
questions about mental health are asked and when the inmates are seen
by mental health counselors.
Correctional facilities in other states have developed screening
procedures that are more thorough than Nebraska’s and therefore more
effective. In the state of New York, the Commission of Correction and the

L.M. Hayes, Prison Suicide: An Overview and Guide to Prevention, National Institute of Corrections,
1995. Available at:

Office of Mental Health collaborated on and developed a standardized
mental health screening form that all jails and prisons in the state use.
This form has been tested and proven to be effective.2 Nebraska should
adopt a similar program and require that all prisons and county jails use
one form so there is uniformity across the state.
In Nebraska, inmates are given medical screening, but that
screening does not necessarily mean that a person with a mental illness
will be seen by a mental health professional for further evaluation. There
need to be procedures in place in all jails and prisons that ensure
someone with a mental illness will be seen by a counselor or psychiatrist
soon after they are booked, preferably within twenty-four hours. The jail
in Summit County, Ohio has a three-tiered screening process that could
be implemented in Nebraska. This process includes initial screening at
the time of intake, a cognitive function exam by a mental health worker
soon after intake for people identified with mental illnesses, and an
evaluation by a clinical psychologist.3
Obviously, smaller jails may have a harder time implementing a
system like the one at the Summit County Jail. Limited resources may
mean that inmates do not have immediate access to mental health
professionals because they people they employ may have to rotate to
different facilities. One possible solution would have jails make
agreements with nearby colleges and universities that would allow
medical students to intern in correctional facilities. This would give
students valuable experience while providing inmates with better, costeffective mental health care.
In some circumstances, inmates with acute mental health needs
have been transferred from a county jail to a state prison. A uniform
system should be implemented where the state and county correctional
facilities can work cooperatively in this manner to deliver the best quality
care to inmates at risk.
Inmates are also transferred from county jails to the state prisons
when their sentences are more substantial. In these situations, the jail
should be required by law to inform the prison if the inmate was
receiving mental health services or medication; this will save time in the
intake process and ensure that people who were receiving services will
continue to get them.
2. Psychiatrist and Counseling Availability
Inmate access to psychiatrists and mental health professionals is
an important part of any mental health care system. In Nebraska
correctional facilities, there are several barriers to that access.

Council of State Governments, Criminal Justice and Mental Health Consensus Project, June 2002.
Criminal Justice and Mental Health Consensus Project, Id., 103.

First, there is only one fulltime psychiatrist employed by the
Department of Corrections, meaning it is difficult for prisoners to be able
to talk to one. Also, the psychiatrist at the Department of Corrections is
not part of the Office of Mental Health, meaning that professional does
not have ultimate authority over an inmate’s mental health care. (See
Appendix A for a brief overview of the DCS mental health services.)
The prisons have other mental health staff that work in the
institutions, but the inmates do not always feel comfortable talking to
these people. Some mental health personnel have worked their way up
through the prison system and may not actually have a background in
counseling. Because of this, the staff too often have a “corrections
mentality” when dealing with inmates. They talk in threatening ways to
the prisoners and use punitive measures to “treat” them. Obviously, if
the inmates feel threatened or think that they will be punished for their
mental illnesses, they will not confide in the mental health staff and
consequently, will not get the help they need.
Additionally, even when patients are able to get counseling, it is
focused on group therapy rather than on individual treatment. Group
therapy may not be effective for someone who has a serious mental
illness, and some people may feel uncomfortable disclosing information
in those settings.
The Nebraska state prisons use the GOLF system in group therapy
sessions. The GOLF program is aimed at changing individuals’ criminal
thinking rather than treating mental illnesses. This program may help
rehabilitate some people, but it is not necessarily effective for improving
people’s mental health. The GOLF program should either be eliminated
or, at minimum, should not take the place of individualized treatment.
Inmates may have mental illnesses that were not identified in the
initial screening process or they may develop one once they have been in
the facility for awhile. These people need to see a mental health
professional, but unless personnel refer them for evaluation, the inmate
will not receive treatment. An inmate in the Nebraska penal system
cannot simply ask to be evaluated for a mental illness; that is a decision
made by the jail or prison staff. This is problematic because other staff
may miss the presence of mental illnesses, and they will go untreated.
The procedures in jails and prisons should be changed to allow inmates
to refer themselves for mental health evaluation.
3. Continuity of Care
Continuity of care is another key aspect of mental health
treatment. Once a person is diagnosed with a mental illness or a serious
medical condition, it is important that they receive consistent care.
When people enter the Nebraska correctional system, their treatment is
often disrupted because jails and prisons do not know what kinds of
treatments were being used. Additionally, inmates who were taking

medication before they were convicted may not receive it once they are in
jail or may end up having to take a different prescription. This
interruption in care will often cause an inmate’s condition to worsen,
meaning they could potentially commit suicide or act out.
As graphically demonstrated by the incident at York [page 6], when
people with mental illnesses commit infractions, it may be due to lack of
treatment for their conditions. These inmates are then punished or given
longer sentences for committing an offense that could have been
prevented with adequate care.
One major problem with ensuring that inmates receive continuous
care is that when they enter the correctional system, the jails and
prisons do not know what kind of treatment they were receiving in the
community. Other states have resolved this problem for inmates with
mental health needs; for example, some correctional facilities exchange
information with community mental health providers. The Cook County
jail in Illinois has an electronic system that transfers inmate names to
community mental health clinics. The personnel at the clinics check the
list of names to identify any people they were treating. If they see a name
on the list they recognize, the mental health clinics can then inform the
jail and treatment information can be shared.4 Another option, used by
the Montgomery County Detention Center in Maryland, has correctional
facilities post the name of detainees each day and make sure that
community mental health providers get copies of the posting.5 The more
informed the correctional facilities are about the inmates’ condition, the
more likely it is that person will get appropriate care and not act out or
become suicidal.
Another barrier to continuous care is the limited availability of
prescriptions in a correctional facility’s list of approved medications.
Prison and jail pharmacies only carry certain types of medications, often
times the older and less expensive ones. If inmates were receiving
medication before they were put in jail or prison, they might find that
their prescription is changed once they are incarcerated. This change in
medication is problematic because it may cause unexpected side effects
or may not be as effective as the original prescriptions they were on
before entering jail. Correctional facility doctors should be able to put in
special requests for any medication that is not on the existing list if they
have deemed that prescription would be the most effective in treating the
4. Solitary Confinement/Punishment
People in penal institutions sometimes commit infractions because

Criminal Justice and Mental Health Consensus Project, 106.
Criminal Justice and Mental Health Consensus Project, 106.
Criminal Justice and Mental Health Consensus Project, 136.


they are acting out as a result of a mental illness. These inmates are too
often punished but not treated for the condition that caused the
problem. Nebraska prisons use solitary confinement as a punitive
measure, but the solitary confinement environment only worsens the
person’s condition.
Writing about the use of solitary confinement in New York state
prisons, Gregory Warner states that “the extreme conditions of
disciplinary confinement can…destabilize even healthy individuals, and
drive a mentally ill person to total breakdown. Some floridly psychotic
inmates have been locked up in the segregated housing unit (SHU) for
years, suffering paranoia and hallucinations, self-mutilating, even eating
their own feces.”7
The use of solitary confinement may seem to make sense when
people with mental illnesses are being violent towards themselves or
others, but it is better to treat their illnesses than to lock them up for
twenty-three hours in a small, isolated room that will only make it more
likely that they will commit suicide. Alternatives to solitary confinement
should be explored, and prison officials should look to the standard of
care used in hospitals when attempting to bring psychotic prisoners
under control. Isolation may or may not be appropriate, but solitary
confinement should be a medical decision and not a punitive matter, and
should last only as long as is medically necessary.
An additional problem is that the Nebraska state prisons do not
allow any inmate in solitary confinement to have access to the group
therapy sessions at all. Inmates in segregation for protection or for
disciplinary reasons are not eligible for one-on-one counseling unless
they are threatening to kill themselves or harm another. Other than this
emergency intervention, an inmate in solitary--where the pressures of
untreated mental health issues may be most acute and exacerbated by
the conditions--has only periodic checkups by a mental health
professional for a few minutes at a time.
5. Inmate release from custody
Even when detainees do receive adequate medical and mental
health care in Nebraska jails and prisons, they do not necessarily get
treatment once they leave the correctional system. This is can be a
particularly acute problem for inmates with mental illness. “Individuals
with mental illnesses leaving prison without sufficient supplies of
medication, connections to mental health and other support services,
and housing are almost certain to decompensate, which in turn will
likely result in behavior that constitutes a technical violation of release
conditions or a new crime.”8 Correctional facilities need to plan for an

Gregory Warner, Mentally Ill Don’t Belong in the Box, Albany Times Union, April 26, 2002.
Criminal Justice and Mental Health Consensus Project, 162.

inmate’s release to ensure that once people with disabilities return to the
community, they are able to get mental health treatment and/or needed
prescription medication.
One reason why inmates do not receive adequate medical or
mental health services once they leave prison is that they cannot afford
it. These people often qualify for SSI, SSDI, or Medicaid, but they do not
know how to apply for the programs. Jails and prisons should provide
information about these programs and help inmates apply to the services
before they are released. The processing takes a while, so if the
paperwork is not completed while an inmate is in a correctional facility,
then they will not be able to get immediate treatment once they leave jail.
Penal institutions should have pre-release agreements with local social
security offices in which the jail agrees to notify the social security offices
thirty days before detainees who qualify for services are released. This
pre-release agreement could also allow for staff from these agencies to
visit the correctional facilities and help inmates apply for federal
Many people with disabilities or mental illnesses are on Medicaid
when they are arrested, but once they have been put in jail, they can no
longer receive Medicaid benefits. The federal government requires states
to suspend Medicaid benefits during this time, but it does not require
states to terminate people from the program entirely. Unfortunately,
most states, including Nebraska, do end Medicaid eligibility once
someone is in the correctional system. This creates a problem because
instead of just having benefits restored to inmates once they are
released, they have to reapply, which takes more time and leads to a
disruption in the provision of medical or mental health care. In order to
remedy this situation, Nebraska should only suspend Medicaid eligibility
when someone is in jail, not terminate it completely.
One reason that inmates’ conditions deteriorate once they leave jail
or prison is that they are not given an adequate supply of medication to
last until they are able to make an appointment with a doctor. Nebraska
jails and prisons sometimes give inmates supplies of medications upon
release, but sometimes they do not. There is no written protocol that
stipulates every inmate should get medication upon release, and no
written protocol stipulating the amount of medication that should be
Another reason why people with mental illnesses do not get mental
health care once their sentences are over is because they do not know
where to go. This is why all jails and prisons should have contracts with
local community mental health clinics to provide treatment and to
perform mental health evaluations on inmates so when the person is
released, they already have relationships with people at the centers.

Bazelon Center for Mental Health Law, For People with Serious Mental Illnesses: Finding the key to
successful transition from jail to community, March 2001

Also, information about different counseling and treatment options could
be given to the inmates before they are released so they know where to go
to get help.
If jails and prisons do not plan adequately for inmates’ discharge,
they will be unlikely to get mental health treatment, meaning their
conditions will deteriorate once they leave the correctional system,
increasing the likelihood that they will commit another crime and be
back in the penal system again.
6. Oversight and Enforcement of Inmates' Rights
Inmates are usually isolated from being able to seek outside help if
they are experiencing a lack of medical or mental health care. Many
inmates are without the financial resources to hire a private attorney to
advocate for them, and a public defender is only able to provide criminal
representation rather than continuing assistance with all problems
associated with incarceration. Currently, ACLU Nebraska responds to
complaints made by inmates or their families, but our organization has a
very small staff and only has one office in Lincoln. Inmates in greater
Nebraska may not be aware of the ACLU as a resource, or may not be
given access to communicate their needs to ACLU.
At the state level, there is an Ombudsman office which investigates
and responds to complaints of inmates at state prisons. Their expert
staff has the qualifications and familiarity with these issues to review
medical and mental health needs and takes action when the inmate's
complaint merits intervention. The Ombudsman's office is without
enforcement powers, however; if the Ombudsman recommends action
and the prison official refuses to agree, the Ombudsman's office is
without authority to mandate change or directly enforce the inmate's
rights. Enforcement authority for the Ombudsman or another state
entity would provide the necessary "teeth" to this resource for inmates
facing a life-threatening medical situation. The Ombudsman cannot
assist inmates at county facilities at this time.
At the county level, there is a County Jail Standards Board that
reviews inmate complaints. The Board meets only four times a year, and
does not have a phone number that inmates may call. In practical
terms, this means a person held at a county jail with an emergency, such
as needing heart medication or anti-psychotic prescriptions, has no
recourse through the Board. No other agency is empowered to review the
actions of county jail officials. Without a true, responsive agency to
address emergency issues for inmates, people who are pre-trial detainees
or serving short sentences are very vulnerable.
What is Necessary to Solve this Problem?
It will take action on many different levels in order to improve

medical and mental health care in Nebraska jails and prisons. ACLU
Nebraska recommends the following steps be taken to insure that
inmates receives a constitutionally acceptable level of health care.
Prisons and Jails
1. Train jail and prison staff on how to use the medical screening
form more effectively in order to identify mental illnesses and
prescription/medical needs.
2. Use a three-tiered screening process when evaluating prisoners for
mental illness.
3. Make agreements with local colleges and universities to allow
medical/psychology students to do rotations in jails and prisons so
access to mental health care can be improved with reduced or no
4. Give individualized counseling to people with mental illnesses.
5. Give mental health evaluations to inmates who request them.
6. Communicate with local community health providers so they know
when one of their patients enters jail/prison and treatment
information can be shared.
7. Allow doctors to order medications that are not on the formulary.
8. Use solitary confinement as a treatment tool consistent with
mental health standards of care. It should not be used to punish
people who cannot control their behaviors because of untreated or
inadequately treated mental illness.
9. Work with local social welfare agencies offices to inform them of
inmates’ release dates so they can apply for federal entitlements
before they leave jail/prison.
Nebraska Unicameral
1. Pass legislation requiring prisons and jails in Nebraska to use the
same medical screening form; ensure that the form includes more
questions about mental illnesses.
2. Pass legislation requiring correctional facilities to inform each
other when a person with a mental illness is being transferred
between facilities.
3. Pass legislation stipulating that Medicaid eligibility only be
suspended while people are in jail, not terminated entirely
4. Pass legislation requiring jails and prisons to make pre-release
agreements with social security offices.
5. Pass legislation giving the Ombudsman's office or similar agency
greater powers, including authority over county jails and
enforcement powers.
6. Pass legislation with mandated uniform minimum standards of
care for county jails.

Department of Corrections/Jail Standards Board
1. Develop a medical screening form that includes more and better
questions about mental illnesses.
2. Require jails and prisons to use a three-tiered screening process.
3. Require jails and prisons to inform community mental health
providers when inmates are put in correctional facilities.
4. Require that jails and prisons comply with inmate requests for
mental health evaluations and medical evaluation/testing.
5. Require jails and prisons to use more individualized counseling.
6. Train prison and jail mental health personnel to conform to APA
(American Psychological Association) guidelines when interacting
with/treating people with mental illnesses.
7. Develop a written protocol that stipulates all inmates should
receive a certain amount of medication upon release from state or
county facilities.
The medical and mental health system in Nebraska’s correctional
facilities needs to be examined more closely and changes must be made.
It will take the cooperation of both the Legislature and Executive Branch
agencies to create these changes and insure that inmates in both jails
and prisons can receive the level of health care needed to satisfy the
constitutional requirement that punishment not include cruel and
unusual attributes.
Government officials, the Department of Corrections, the Jail
Standards Board, advocacy organizations, and correctional facilities all
need to be involved in fixing the delivery of medical and mental health
care to inmates in Nebraska. Improving mental health care in
correctional facilities will require money, but cost-effective solutions can
be implemented.
Many small steps can be taken that will make the system more
effective. Though there may be expenditures at the outset, the state will
save money in the long-term: if inmates receive better mental health
care, they are less likely to require hospitalization for mental illnesses in
state facilities or end up in jail again. Better preventative medical care
will also reduce the chance of expensive surgery.
Finally, at some point, the system may collapse under its own
inefficiencies if action is not taken. This will result in even greater tax
expenditures to defend lawsuits. The time to act is now, and not when
yet another tragic loss of life or sanity occurs.


Appendix A: Outline of mental health services in the Nebraska state
prison system
Most county jails have no staff with mental health staff. Currently the
makeup of the mental health department of Nebraska Department of
Corrections for state prisons is as follows:
y 7 psychologists, 25 masters level practitioners, and 6 clerical support
staff serve 10 Nebraska institutions
y Mental health staff serve 60% of institution’s inmates per month
y Services available to inmates approved upon request, via staff referral,
or because of personalized plans
I. Services Available at all State Prison Institutions
A. Generic Out-Patient Levels Format (GOLF)
y Encourages inmates to identify and change basic components of their
anti-social thinking and behavior
y 4 levels that encourage inmates to use corrective strategies, develop
self-monitoring skills, and includes intervention strategies
y Levels 1, 2, 3: 12 two-hour sessions
y Level 4: Ongoing, for those interested
B. Psychiatric Services
y All adult institutions have access to the on-staff psychiatrist or to
consulting psychiatrists who can prescribe and manage medications
y Inmates with frequent psychiatric needs are transferred to an
institution that provides more services
C. Psychological Services
y Psychological evaluations are scheduled only at the request of the
Parole Board or Housing Unit staff for consideration of custody
promotions and parole. Evaluations AREN’T made upon inmate
y Mental status evaluations are conducted within the first thirty days in
segregated confinement status and each ninety days thereafter.
II. Specialized programs only available at certain institutions
Lincoln Correctional Center (LCC)
y In-Patient Mental Health Program (IMHP) and Socially and
Developmentally Impaired Program (SDI)
y Provide services to people with chronic mental health issues
y Program goals: learning to understand and manage mental illness,
criminal thinking/behavior, improving coping and/or social skills;
goal is often integration into regular prison population


Appendix B: The growing problem of mental illness in correctional
The prevalence of mental illness is a growing problem across the
US, and is especially profound in the jail and prison population.
According to a Bureau of Justice report, 16% of state prisoners are
classified as having a mental illness.10 Upon booking, seven percent of
jail detainees have serious mental illnesses and 50% are diagnosed with
other mental health problems, including anxiety and antisocial
personality disorders.11
Proportionately, there are more people with mental illnesses in jails
and prisons than in the population at large. In many cases, these people
are serving sentences for crimes committed during a mental illness
episode. “Often the event precipitating their arrest is directly linked to
both their lack of income and their unmet need for services, such as
mental health and addiction treatment, and supports, such as housing
and employment that are essential if they are to maintain themselves in
the community.”12
Once people with mental illnesses enter the penal system, their
illnesses are exacerbated by the conditions in jails and prisons. The
close quarters and overcrowding, lack of effective mental health care, and
disciplinary measures all contribute to the increasing problems with
mental illness in the inmate population. Inmates with mental illnesses
have a higher risk for suicide, and also have the potential to be violent
towards others.
A majority of the people who are in the correctional system will
reenter society at some point; many of them have served short sentences
or are out early on parole.13 It is essential that inmates receive quality
mental health care in prisons and jails so that they are able to function
once they are released. Inadequate mental health programs have a
harmful effect on inmates with mental illnesses and society as a whole.
The stories related at the beginning of this report include a story the
ACLU Nebraska hears all too often: a Nebraskan sentenced to a short
period in jail (between 30 days and 6 months) frequently faces an underfunded county system with no screening for mental health issues.
County officials often resist providing prescription medication, even if it's

Paula M. Ditton, Mental Health Treatment of Inmates and Probationers, Bureau of Justice Statistics,
U.S. Department of Justice, July 1999.
The Gains Center for Policy Research, Inc., The Prevalence of Co-Occurring Mental and Substance
Abuse Disorders in the Criminal Justice System, 1997. Available at:
Bazelon Center for Mental Health Law, For People with Serious Mental Illnesses: Finding the key to
successful transition from jail to community, March 2001.
According to the Nebraska Department of Corrections website, the average stay of a state prisoner is only
25 months. County prisoners' time in custody is generally much shorter.


already prescribed through outside doctors.
Without mental health care during incarceration and without a
system to provide transitional prescriptions upon release, people with
mental illnesses are likely to leave the correctional system, only to return
after committing another crime while unmedicated. As described in the
stories above, untreated mental health problems may also result in
additional crimes in prison and lead to longer sentences. This is a
danger to our public employees in jails and prisons. The danger of an
inmate killing themselves, a guard, or another inmate is imminent.
Screening and care is necessary to avoid tragedies such as Robert