Nebraska prisons lack staff to improve mental health treatment for inmates, officials say

LINCOLN — The state prison system has the same problems hiring and retaining mental health staff as it does front-line security workers, a special legislative committee was told Wednesday.

Low wages and difficult working conditions — the same problems causing high turnover and shortages of corrections officers — are to blame, lawmakers were told.

Of the Corrections Department’s 23 slots for psychologists, only 11 are filled. Two of the department’s top psychiatrists have left in recent months, and its medical director recently retired, leaving what one official called a “lack of consistent leadership.” Thirty-five jobs in behavioral health are now unfilled.

“The majority of our clinicians who have left accepted employment elsewhere are receiving better wages and work under less stressful environments with less difficult clients,” said Dr. Alice Mitwaruciu, the acting behavior health administrator for the department.

Because of the staff shortages, the department has had to “triage” treatment, focusing on the most mentally ill inmates within the system. It has had to rely on existing staff to work overtime or on more-expensive contractors to fill the void until replacements can be hired.

The shortage of health professionals was among the top revelations during an eight-hour public hearing Wednesday by a special committee of lawmakers studying the woes, and the progress in addressing those woes, within the Nebraska Department of Correctional Services.

Among the department’s problems has been hiring and retaining corrections officers and corporals, which has forced existing security workers to work an average of 16 hours of overtime a week to maintain full staffing.

Wednesday’s hearing, part of a series to gauge the department’s reform efforts, focused on the adequacy of mental health treatment and progress in reducing the use of solitary confinement, a practice that authorities say can exacerbate inmates’ mental troubles.

The lack of mental health treatment and the long-term use of solitary confinement in Nebraska prisons have been top concerns since the case of Nikko Jenkins, who killed four people in Omaha shortly after his release from prison in 2013 after spending years in solitary confinement.

Lawmakers were told Wednesday that if corrections can fill its mental health posts and improve care for mental illness, it could avoid such future cases, could cut spending on higher-cost solitary confinement, and could improve safety within the prison and after an inmate is released.

The numbers are daunting: About 20 percent of the 5,300 state inmates suffer from serious mental illnesses, and 25 percent of male inmates and 50 percent of female inmates are taking some kind of psychotropic medication.

State Corrections Director Scott Frakes said that to address the job vacancies, he is increasing salary offers for the positions under his discretion, and is hoping to make front-line staff pay more competitive.

But there is a national shortage of nurses and psychologists, so the state prison system is not alone in this problem, according to Dr. Randy Kohl, the recently retired head of medical services for Corrections.

Kohl and others said that the department is meeting its required standard of care, but could do much better if it was fully staffed. News about increased assaults on staff have hurt recruiting in the past couple of years, he added.

Concerning solitary confinement, Frakes said that the state would have seen a decline in number of inmates confined to so-called “restrictive housing” if not for recent prison disturbances at prisons in Lincoln and Tecumseh.

Frakes said there could have been a mistaken belief among inmates that they could no longer be sent to solitary confinement for assaulting corrections staff under recently reformed standards for solitary confinement.

“Now, we have posters going out that will tell inmates what happens when you assault staff,” he said.

Currently, there are 324 inmates confined in restrictive housing, many for assaults but also many (42 percent) as a precaution because prison officials perceive they are a threat to staff or other inmates.

A year ago, the department split off inmates put into solitary for their own protection into less-restrictive “protective management units.” About 438 inmates now live in those cells.

Frakes said that his goal is to not only decrease the number of inmates in restrictive housing, but the length of stays in such higher-cost, higher-security units. Two keys to doing that are improving conditions in the general population and decreasing inmate idleness, he said.

“We’re moving in the right direction,” Frakes said.

The department, at the behest of the Legislature, enacted new rules for restrictive housing this summer aimed at reducing its use. Sometime this fall, a study of the state’s use of solitary confinement will be released by the Vera Institute of Justice, a nonprofit research group that has helped several states with prison issues.