Dr. David L. Rosen is a professor at the University of North Carolina’s School of Medicine. His research focuses on incarceration and public health. Rosen’s team conducted a survey of the availability of health care in the jails of four southern states, including North Carolina. The results have yet to be published.
Q. What were your major findings?
A. In the later months of 2020 and in the first several months of 2021, we conducted a survey of jails’ health care staffing and resources. Across North Carolina jails, we found that less than one in 10 jails routinely had a psychiatrist (or psychiatric physician assistant or nurse practitioner) onsite, and less than three in 10 had other types of mental health personnel, such as licensed counselors, onsite. Among the relatively small percentage of jails that did have onsite psychiatric personnel, hours were typically limited: For every 100 people that were incarcerated, a psychiatrist would be onsite about two-and-a-half hours in a typical week, and other mental health personnel would be onsite about 11 hours in a typical week. With jails operating 24 hours per day, 7 days a week, there is a lot of time in the week without onsite care.
Q. What kind of care do inmates receive?
A. About three-quarters of jails relied on telemedicine for providing care, but those jails only had about three hours of telemedicine every week for every 100 inmates. If you consider that more than 40% of those entering jail have a mental health problem — and around a quarter of all those entering have conditions that mental health conditions that can be very disabling –I think it’s fair to say that in most jails, there is a tremendous mismatch between the enormous mental health needs and jails’ existing resources.
Q. When is care available?
A. Among the relatively small percentage of jails that do have onsite psychiatric providers, we see that they’re typically only at the jail during business hours. Of course, people with mental health problems can be arrested and booked into a jail at all hours. Depending on when that psychiatric provider is scheduled, it could be several days until the incarcerated person may be seen by a mental health provider. Alternatively, given the relatively transient nature of jails, people in custody — including those with serious mental health problems — may be released before they can be fully evaluated.
Q. Who's providing the care? (Doctors, nurses, deputies, etc).
A. As a result of these limited hours, many of the day-to-day mental health duties fall to licensed practical nurses (LPNs) and to detention officers. Their duties include conducting initial health intake questionnaires — including asking about mental health history and medications, deciding urgency of “sick-call” complaints, documenting withdrawal symptoms, passing out medications and monitoring for suicide.
LPNs have much less training than registered nurses — typically only a year — and the certification course in NC to become a detention officer only requires about four days of health-related instruction.
Yet both LPNs and officers are often responsible for deciding the urgency of health complaints. That would never happen in the broader community.
This story is part of a collaboration with FRONTLINE, the PBS series, through its Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.