Proud author of the Federal Prison Guidebook: Sentencing and Post Conviction Remedies

The Bureau of Prisons has, as with medical care, adopted mental health classifications. In addition to receiving a classification for security and health care, BOP inmates are now classified based on mental health care need. Similar to the four medical care levels, all inmates are assigned to one of four mental health levels.

1. CARE1-MH: No Significant Mental Health Care Those who show no significant level of functional impairment associated with mental illness and demonstrate no need for regular mental health interventions, and either has no history of serious functional impairment due to mental illness or, if a history of mental illness is present, have consistently demonstrated appropriate help-seeking behavior in response to any reemergence of symptoms.

2. CARE2-MH: Routine Outpatient Mental Health Care or Crisis-Oriented Mental Health Care Those requiring routine outpatient mental health care on an ongoing basis, and/or brief, crisis-oriented mental health care of significant intensity, e.g., placement on suicide watch or behavioral observation status.

3. CARE3-MH: Enhanced Outpatient Mental Health Care or Residential Mental Health Care Those requiring enhanced outpatient mental health care, such as weekly mental health interventions or residential mental health care, such as placement in a residential Psychology Treatment Program.

4. CARE4-MH: Inpatient Psychiatric Care Those who are gravely disabled and cannot function in general population in a CARE3-MH environment. In determining an appropriate mental health care level assignment, an individual’s current, recent and historical need for services is considered, along with any type of psychotropic medication required.

The BOP offers a number of formal, organized psychology treatment programs with specific target populations, admission criteria and treatment modalities. Many of these are residential programs offered only at select facilities. General psychological services and mental health crisis intervention are available throughout the BOP. Psychiatric services, including psychotropic medication, are generally coordinated through health services in conjunction with psychology services staff. Psychiatry services may be available either through contracts with a community psychiatrist, or increasingly, through telepsychiatry with a BOP psychiatrist at another location.

While it may vary from institution to institution and from mental health professional to mental health professional, generally speaking, mental health treatment in the BOP is designed to enable the inmate to function within the prison system, meaning they are not a danger to themselves, staff or other inmates.

Outside of the formal programs mentioned above, rarely will an inmate receive any meaningful treatment for underlying disorders such as post-traumatic stress disorder, major depressive disorder, bipolar disorder, and the like, because not all treatment modalities are offered. For example, eye movement desensitization and reprocessing for treatment of PTSD is not available outside of the programs.

This is regrettable. The U.S. Department of Justice estimates are that one in four inmates in this country suffers from a diagnosable mental health disorder. With the BOP’s emphasis on reducing recidivism, more attention given to the mentally ill would go a long way toward achieving this result.

The medical staffing also can vary from one federal prison to another, and offenders whose needs cannot be managed at one might be placed in another, which may mean a move further from their families. Families should be as supportive as possible under such circumstances, understanding that the health of their loved one should supersede proximity to the family. Also, the family should know that many prison facilities augment their medical care with doctors from the community, usually specialists, on a contract basis. These consulting specialists are available if BOP staff determine that a specialty consultation is required, and any recommendations made by a consulting specialist will be evaluated by a BOP physician for compliance with the agency’s scope of service.

Mental health care, or lack thereof, in the BOP is exacerbated by the fact the bureau has had a difficult time recruiting competent mental health professionals. The same holds true for medical care. One of the hardest parts for the family, I believe, is not having a choice in the health care of their loved one during confinement. But focusing on the positives of the BOP’s system can help, even if that system is more impersonal to the inmate than private medical practice. Finally, the family can be assured that each BOP region has a regional health services administrator who is usually open to knowing about serious and significant health care concerns, should an inmate believe medical needs are not being adequately addressed.