Treatment Denied: The Mental Health Crisis in Federal Prisons

The Marshall Project

By Christie Thompson and Taylor Elizabeth Eldridge

The voices in John Rudd’s head were getting louder. It was April 2017, and Rudd, an inmate at a federal prison near Hazelton, West Virginia, had stopped taking his psychiatric medication. He told staff members that he wanted to hang himself, so they moved him to a suicide-watch cell, according to records. When Rudd banged his head against the wall, trying to snap his neck, he was injected with haloperidol, an antipsychotic drug used to treat schizophrenia and prevent suicide.

Nevertheless, prison staff would conclude that Rudd wasn’t ill enough to require regular treatment. The next day, a psychologist wrote that he would be moved out of the suicide-watch cell and remain on “care level 1,” a label for those with no significant mental-health needs.

In 2014, amid mounting criticism and legal pressure, the Federal Bureau of Prisons imposed a new policy promising better care and oversight for inmates with mental-health issues. But data obtained by The Marshall Project through a Freedom of Information Act request shows that instead of expanding treatment, the bureau has lowered the number of inmates designated for higher care levels by more than 35 percent. Increasingly, prison staff are determining that prisoners—some with long histories of psychiatric problems—don’t require any routine care at all.

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