As part of an action plan to improve services for mentally ill prisoners, the state says it will hire at least a dozen people — including psychiatrists and social workers — over the coming year to help develop and oversee mental health programs at O'ahu Community Correctional Center.

Officials said the action plan is still being reviewed by the U.S. Department of Justice, which in December reached a settlement agreement with the state after filing suit over allegations that inmates at OCCC were not getting "constitutionally adequate mental health care."

Although the state declined to release the plan, since it has not yet been approved by the federal government, officials said it details "timelines and responsibilities" for improving mental health services at OCCC and other facilities. Some of the improvements include hiring more psychologists and social workers, improving training for correctional officers on how to deal with mentally ill inmates and expanding mental health treatment programs for inmates to offer them sessions on coping skills and dealing with trauma.

IMPROVEMENT NOTED

The action plan, submitted to the Department of Justice in February, comes as advocates for the mentally ill and lawmakers say mental health services at OCCC and the state's seven other correctional facilities have gotten better — thanks in large part to the federal scrutiny. But advocates stopped short of saying there is no longer need for concern, and added that the state still has a lot of work to do.

"I know they've been trying," said Marya Grambs, Mental Health America of Hawai'i executive director.

The Department of Justice declined further comment on the case but has said the state is making improvements.

The need for improved services for mentally ill inmates is particularly important, advocates add, because more people with mental illnesses are finding themselves in the justice system. The state has seen a 10 percent increase per year since 2004 in the number of mental health "consumers with legal encumbrances," said William Gowensmith, state forensic service director for the Health Department's Adult Mental Health Division. In an e-mail, Gowensmith said the state figures follow national trends.

State Department of Public Safety figures show there were 671 mentally ill inmates at the eight prisons and jails statewide in December 2008, up about 8 percent from a year earlier, when there were 620 mentally ill inmates. In 2008, OCCC alone had 156 mentally ill inmates, state figures show.

Mark Mitchell, administrator for the mental health branch at the Department of Public Safety, said much of the emphasis this year and next of the action plan is on improving services at OCCC, which must be brought in compliance with the federal settlement.

But he said the state wants over the next five years to implement "most of the new mental health policies and procedures being developed in response to the DOJ ... to all facilities" as more staff are hired.

STATE AGREEMENT

The state has already made changes to address the biggest concerns raised by the federal government over the treatment of mentally ill inmates. Under the settlement agreement, the state agreed to end "therapeutic lockdowns" of inmates and put strict limits on when physical restraints are used.

Mitchell said that even before the settlement, the state was working to improve how it dealt with mentally ill inmates — especially at OCCC. In 2007, in response to DOJ concerns, the state started new intake procedures for inmates so that those with mental health issues could be spotted more easily.

The state also went beyond the DOJ requirements in the settlement agreement, Mitchell said, regarding the use of restraints and how inmates are watched while in seclusion, and stopped the use of "therapeutic lockdowns" months before they were forced to. Mitchell said restraints are now rarely used, and inmates put in restraints are watched constantly and taken out of the restraints every 15 minutes.

According to a report on mental health services for inmates to the Legislature, restraints weren't used at OCCC, the Women's Community Correctional Center and Halawa Correctional Facility in the first quarter of fiscal year 2009. In fiscal year 2008, restraints were used three times.

State Sen. Will Espero, D-20th ('Ewa Beach, Waipahu), the chairman of the Senate Public Safety and Military Affairs Committee, said the statistics indicate that mental health services are improving at OCCC.

FUTURE FUNDING

Espero toured the facility late last year and said he found no glaring concerns. But, he added, monitoring mental health services for inmates is "still a priority."

In response to questions about how the Department of Public Safety will fare amid the budget crunch, Espero said he doesn't think that the improvements made to mental health services will be diminished even though DPS will likely see a decrease in funding — like all other state agencies. In fact, officials indicated that the state expects to increase spending on mental health services in prisons in the coming fiscal year.

Mitchell said that by the end of the year he plans to have about 28 mental health positions at OCCC. The positions to be added, he said, include psychiatrists and psychologists, social workers, recreation specialists and administrative and support positions.

The new positions come as the state is spending more on mental health services at correctional facilities. The state said it had about $3.6 million in "mental health care costs" at prisons and jails in 2008, compared with $3.1 million in 2007.

OCCC FACILITIES

At OCCC last month, the 30-bed "mental health module" for men with acute mental illnesses had 21 inmates, while the "step down" unit for more stable inmates had 19 people and three vacant beds. There were nine vacant beds in the women's unit, which has both acute and "step down" inmates.

Once someone graduates from a "step down" unit, they join the general population.

The men's mental health units have been at OCCC since the 1980s, but the women's unit opened just two years ago. The units are small, but all of them have common areas with televisions meant for recreation or treatment. The men's "step down" unit also has a new conference room for therapy.

Each of the units has "safety watch" and suicide watch rooms. The "safety watch" rooms are designed for people to cool down and inmates can go in without closing the door behind them. The "suicide watch" rooms, which have closed-circuit cameras, consist of a concrete slab where a mat is placed, a toilet and a small window. There are metal loops on the concrete slab to hook restraints.

Mitchell said mental health inmates generally get more recreation time outside their cells than their peers in the general population, who generally get an hour each day. Recreation is considered therapy because it helps people with mental illnesses build relationships, something they are more reluctant to do than those without mental illnesses, he said. But, he added, he is working to add more substantive programs, including more one-on-one and group therapy.