SUMMARY OF REPORTS
ON

MENTAL HEALTH SERVICES
WITHIN THE
OHIO DEPARTMENT OF REHABILITATION AND CORRECTION

July 25, 2006

Prepared by CIIC Staff

2
Table of Contents
Page
Introduction ..……….….………………………………………………..……………….. 3
Summary of Reports on Mental Health Services in Ohio Prisons ………………………..
.
Report 1: Mental Health Care for Ohio State Prisoners: The View from the
Director’s Office ………………………………………………………….
Renaissance
Organizational Structure…………………………………………………
Table. Residential Treatment Units with Beds, Security Level and
Institutions Served………………………………………………
Table. Population, Caseload, Percent in Segregation……………………
Mental Health Staffing…………………………………………………..
Administration…………………………………………………………..
Quality Assurance
Community Reintegration
Conclusion
Report 2: Mentally Ill Offender Treatment and Crime Reduction Act of 2003
(S. 1194) ……………………………………………………………………
Save Lives
Increase Public Safety
Reduce Spending……………………………………………………
Building on Ohio’s Successes

3
4
5
7
8
9
10

11
12

Report 3: Systems in Transition ……………………………………………………… 13
Reform Through Litigation
The Problem of Funding Mental Health Services in Prison………..
14
Report 4: Prison Mental Health Care: Dispute Resolution and Monitoring in Ohio 15
Background, Expert Team, and the Report
Report Acceptance……………………………………………………… 17
Negotiating the Consent Decree
Consent Decree………………………………………………………….. 18
Monitoring Process
Recommendations……………………………………………………….. 19
Continuity………………………………………………………………… 20
Organizational and Governmental Issues
Clarity of Roles
Transition
Appendix A: Monthly Average Institutional Population (Jan - May 2006) ………………. 23
Appendix B: Institutional Population on Psychiatric Caseload (Jan – May 2006) ….……. 24
Appendix C: Institutional Population on Mental Health Caseload (Jan – May 2006)……...25
Appendix D: Mental Health Caseload in Segregation (Jan – May 2006)…………...……...26

3

Summary of Reports on Mental Health Services
within the
Ohio Department of Rehabilitation and Correction

Introduction
The concept of mental health services in a correctional system includes a matrix of
individuals, policies, operations, procedures, programs, philosophies, and goals directed
toward serving the mental health needs of incarcerated offenders while fulfilling the
missions of the departments engaged in the work of corrections, mental health, and
justice. This paper looks at mental health services within Ohio’s prison system. The
paper provides summaries of four previously published reports on mental health services
provided to inmates in Ohio’s correctional system. The four individual reports help create
a chronological history of events, conditions, and responses contributing to the evolution
and current status of mental health services in Ohio’s prison system.
Summary of Reports on Mental Health Services in Ohio Prisons:
History of Events and Evolution of Mental Health Services
Four individually authored reports provided a base from which to consider the
delivery of mental health services. These reports provide a portrayal of the evolution of
mental health services within the correctional setting in Ohio. A summary of each report
is provided in the following sections so as to help construct an understanding of the past
and a snapshot of the current state of operations. Upon reading the four summaries, some
duplication of important information will be noticed. Rather than dilute the substantive
content of any of the reports, this paper includes the key points from each, even though
minimal repetition is created as a byproduct of the comprehensive inclusion of
information.
The authorship of the four reports was provided by the former Director of the Ohio
Department of Rehabilitation and Correction, the court appointed monitor in Dunn v
Voinovich, a former Deputy Director of Mental Health Services in Ohio, and an
organization known as Human Rights Watch, which conducts research and
investigations, and publishes reports relevant to human rights issues, including issues
inside prisons within the United States.
The purpose of this paper is not to analyze or make recommendations; rather, it is the
intent of this paper to provide an overview of these four reports in one document. The
accuracy in the historical account found in these four reports is perceived to be
trustworthy and therefore, worthy of inclusion in any consideration or future development
of systems designed to serve individuals who are mentally ill and incarcerated. Further,
statistical data collected by the Correctional Institution Inspection Committee has been
inserted at appropriate places within the report narrative and as Appendices.

4
Report 1.
Mental Health Care for Ohio State Prisoners: The View from the Director’s Office.
Correctional Mental Health Report, January/February 2000. Wilkinson, Reginald
A., Ed.D., Director.
The report, Mental Health Care for Ohio State Prisoners: The View from the
Director’s Office (2000), offers a historical description and chronology of events at a
time when the services to the incarcerated mentally ill were undergoing some evolution.
For clarity, many of the headings in the summary of Report 1 are taken from that report.
As reported in Mental Health Care for Ohio State Prisoners, the long history in
addressing mental illness in prisons and the goal of providing holistic health services
became compromised by budget limitations during a time when security issues became a
commanding priority. State appropriations for mental health services, while not ignored,
were insufficient to keep pace with a growing number of incarcerants with serious mental
illnesses.
Renaissance. The Ohio Department of Rehabilitation and Correction (ODRC)
experienced two events that gave rise to a renaissance in prison mental health care: a
prison riot at the Southern Ohio Correctional Facility in 1993 in which nine inmates and
one employee were killed, and the Dunn v Voinovich lawsuit in October 1993 that
resulted in a five-year decree as a means of addressing the constitutionally inadequate
care for prisoners with serious mental illness in Ohio. The goal of the decree was to
achieve organizational change and decision-making autonomy in the area of mental
health services in Ohio’s prison operations.
Following Dunn v Voinovich, mental health care responsibilities for inmates, which
had been the responsibility of the Ohio Department of Mental Health (ODMH), became
the responsibility of the ODRC. Under ODRC authority, the state’s hospital for mentally
ill prisoners, Oakwood Forensic Center (formerly for the criminally insane), was recommissioned as the Oakwood Correctional Facility (OCF).
There was agency
commitment to creating the best possible correctional mental health system as it was
acknowledged that good mental health was also good security for the inmates and for the
community. In addition, the federal court made the treatment of the seriously mentally ill
a constitutional requirement.
In Ohio, the court appointed a monitor, Fred Cohen, who identified in his fourth
annual report (Dunn Consent Decree Monitoring Fourth Annual Report, 1999), at the
conclusion of the five- year decree, that the Ohio system had indeed developed not only
access to services, but also to refinement in the quality of care.
Comprehensive Care. In identifying the critical nature of operating a comprehensive
and sound correctional mental health service delivery system, ODRC Director Reginald
Wilkinson offered the following points in Mental Health Care for Ohio State Prisoners
(2000).

5
1. Judicial mandates require a quality system.
2. There is an ethical ‘right-thing-to-do’ mindset about providing such a system.
3. Seriously mentally ill inmates present a prodigious problem, representing nearly
12% of ODRC’s 47,000 inmates.
4. When mental health professionals work closely with security professionals it is
possible to more accurately discern between behavior that is “mad” versus
behavior that is “bad,” thus, enabling appropriate responses to the behavior.
5. With a mission of preventing mental deterioration and ameliorating mental health
problems, prison administration and staff remain concerned with how the methods
of operating a prison and managing inmates may help or hinder the realization of
the mission.
6. There is a constitutional duty to protect ‘weak’ or vulnerable inmates from
physical or mental assaults of stronger inmates. The duty to treat and duty to
protect are considered dual obligations.
7. Screening and evaluations are essential to inmate-appropriate housing
assignments, classification, job assignments, and individual treatment plans. Both
physical and mental limitations are identified through screening and evaluations.
8. A holistic mental health service delivery program is important to the effectiveness
of inmate treatments and to inmates’ inevitable transition back into the
community. Transitioning occurs for 95% of all prisoners.
Organizational Structure . The Ohio Department of Rehabilitation and Correction
established an Office of Correctional Healthcare (OCHC) in 1995 in order to effectively
achieve a holistic approach to correctional mental health care in Ohio. Under OCHC,
prisoner mental health care, medical and substance abuse treatment, and care for the
mentally retarded are provided. Within OCHC, the Bureau of Mental Health Services
(BOMHS) is responsible for planning, implementing, monitoring, and evaluating the
correctional mental health system and to provide oversight to day-to-day clinical care of
all mentally ill inmates within the prisons. Funding for all mental health programs and for
Oakwood Correctional Facility is provided through appropriated funds in the state’s
operating budget. Appropriated funding is used for mental health care at Oakwood
Correctional Facility and 11 “clusters” or catchment areas. Each of the state’s prisons
falls into one of the clusters, and each of the 11 clusters has a Residential Treatment Unit
(RTU) for appropriate mental health care and never for disciplinary purposes.
As presented in Mental Health Care for Ohio State Prisoners (2000), RTUs offer care,
treatment, and supervision on a graduated scale, with decreased supervision as the
inmate’s mental disability improves or stabilizes. Within the RTU, an individualized
treatment plan is developed for each inmate with the goal of returning the inmate to
general population. In 2000, there were reportedly 730 inmates housed in RTUs, with an
average population at Oakwood Correctional Facility of 95 inmates.
Historically, the concept of a Residential Treatment Unit existed before the creation
of the “clusters” per the Dunn case. It is the understanding of the Correctional Institution
Inspection Committee that the Residential Treatment Unit that formerly existed at the

6
Mansfield Correctional Institution was closed post Dunn, reportedly as a cost cutting
measure. However, the following clarification was provided by the ODRC:
Historically, under the supervision of the ODMH there had been a
Psychiatric Residential Unit (PRU) at CRC, which served the psychiatric
residential treatment needs of all the institutions. Other step down type
programs such as at CCI, were also under the supervision of the ODMH.
The design of a Residential Treatment Unit serving a cluster of institutions
was developed, but the number of inmates requiring that level of care was
less than projected and the cluster plan evolved with more than one cluster
feeding an RTU. By the end of Dunn, the system of comprehensive mental
health care including outpatient services in all institutions was established
and more inmates were maintained in the outpatient setting. The reduced
number of inmates identified as requiring the more restrictive level of care
of the RTU resulted in the closing of the RTU at Mansfield.
Aside from information taken from Mental Health Care for Ohio State Prisoners
(2000), communication from the Ohio Department of Rehabilitation and Correction’s
Deputy Director of the Office of Health Care during 2004 indicated that inmates who
need RTU services are transferred to an RTU of a similar security level when possible.
Under this arrangement, minimum security or Level One inmates are included in the
medium security or Level Two RTUs. If the RTU that normally accepts inmates from an
institution is full, another RTU of the same security classification is used. As of October
8, 2004, it was the understanding of CIIC staff that RTU patients in the Ohio correctional
system were served in institutions as shown in the following table.

7

Residential Treatment Units (RTU) – Distribution of Beds and Service Centers
Ohio Department of Rehabilitation and Correction
October 2004
INSTITUTION

SECURITY
LEVEL
2

AVAILABLE
BEDS
80

Chillicothe Correctional
Institution

2

150

Grafton Correctional Institution

2

73

Correctional Reception Center

3

106

Trumbull Correctional Institution
Warren Correctional Institution
Southern Ohio Correctional
Facility
Ohio Reformatory for Women

3
3
4

77
83
80

All security
levels

74

Allen Correctional Institution

INSTITUTIONS SERVED
Madison CI (Level 1)
London CI
Dayton CI
Montgomery CI
Toledo CI Camp
Belmont CI
Hocking CF
Noble CI
Pickaway CI
Southeastern CI
Lake Erie CI
Lorain CI
North Coast CF
Marion CI
North Central CI
Richland CI
Madison CI
Toledo CI
Ross CI
Correctional Medical Center (if medically
stable)
Pickaway CI
Mansfield CI
Lebanon CI
(Also serves Level 5 inmates excluded
from OSP due to mental illness)
Franklin PRC
Northeast PRC

In addition, recent data made available to the Correctional Institution Inspection
Committee from the Ohio Department of Rehabilitation and Correction’s Bureau of
Mental Health reveals the following averages based on calendar year 2005 (January
through December 2005). For the year, there was a monthly average of 43,565.5 total
inmates in the Ohio system and 7,066 inmates or 16.2% of the average monthly
population on the psychiatric caseload. Inmates receiving psychiatric treatment, and
therefore on the psychiatric caseload, are those with classifications of C1, and C2 within
the department. An additional monthly average of 942 inmates, classified as C3, did not
receive psychiatric services and were not on the psychiatric caseload, but were still
receiving diagnosis and therapies from the Mental Health Services. All categories
together, for the 12- month period, there was a monthly average of 8,016 inmates,
representing 18.4% of the total inmate population, receiving some form of services from
Mental Health Services. The data for the period also reveals that of the total monthly
average of 8,016 inmates receiving mental health services, a monthly average of 382.33
or 4.8% of those inmates were residing in segregation. The following table displays the
full range of data reflecting the psychiatric caseload and segregation numbers for each
adult institution as well as the statewide summarie s.

8

Ohio Department of Rehabilitation and Correction
Statewide Mental Health Services Delivered – 2005

January
February
March
April
May
June
July
August
September
October
November
December
Annual
TOTAL

43,578
43,567
43,518
43,845
43,928
44,174
44,218
44,339
44,682
44,903
41,679
40,355

Total
Psychiatric
Caseload
(C1 + C2)
7,242
7,005
7,080
7,002
7,222
7,126
7,034
7,405
7,367
7,108
6,501
6,700

522,786

84,792

11,304

96,188

4,588

4.77

Monthly
AVERAGE

43,566

7,066

942

8,016

382

4.77

Month

Institutional
Population

C3

Total
Caseload

Inmates in
Segregation

831
853
886
880
866
914
915
978
1,026
1,176
962
1,017

8,073
7,858
7,966
7,882
8,088
8,045
7,949
8,383
8,393
8,371
7,463
7,717

402
343
379
336
391
365
400
412
410
396
390
364

% of
Caseload
Inmates in
Segregation
4.98
4.36
4.76
4.26
4.83
4.54
5.03
4.91
4.89
4.73
5.23
4.72

It is the understanding of the Correctional Institution Inspection Committee that
mental health classifications are distinguished based on the presence of psychiatric care
and the degree of significant mental illness. For example, an inmate classified as C1 is
on the psychiatric caseload and has serious or severe mental illness or SMI. The criteria
used to designate SMI includes a substantial disorder of thought or mood, which
significantly impairs judgment, behavior, the capacity to recognize reality or cope with
the ordinary demands of life within the prison environment, and has manifested by the
presence of substantial pain or disability. An SMI designation requires a specific mental
health diagnosis of schizophrenia, schizoaffective, etc. and/or functional assessment that
required an RTU or inpatient hospitalization stay. According to follow-up
communication from DRC staff, it does not require prognosis, appropriate treatment by
the mental health staff, or psychiatric care. However, according to DRC policy 67-MNH11 on “Mental Health Classification,” C1 is defined as above, plus the policy states,
“Serious mental illness requires a mental health diagnosis, prognosis and treatment, as
appropriate, by mental health staff.” The policy effective April 21, 2005, fully defines
and describes C1 as follows:
C1: Psychiatric Caseload (SMI) – the inmate is on the psychiatric caseload
and meets criteria for SMI designation: a substantial disorder of thought or
mood which significantly impairs judgment, behavior, capacity to
recognize reality or cope with the ordinary demands of life within the
prison environment and which is manifested by substantial pain or
disability. Serious mental illness requires a mental health diagnosis,
prognosis and treatment, as appropriate, by mental health staff.

9

An inmate classified as C2 is on the psychiatric caseload, but does not meet the
criteria for the most severe or deemed to have a serious/severe mental illness, thus is
considered to be non-SMI. The C2 inmate receives mental health care and supportive
services, which include the prescription and monitoring of medication, and can include
the following based on identified treatment needs: individual and group counseling and
therapy, crisis intervention, and behavior management. Last, an inmate classified as C3
receives no psychiatric treatment, but based on identified treatment needs can receive
group or individual counseling, therapy, and skill building services.
The C3 inmate has a mental health diagnosis and treatment plan and is treated by the
mental health staff other than the psychiatrist.
Further, as of this writing, the most recent data submitted to the Correctional
Institution Inspection Committee from the individual adult institutions reveals the
continuation of mental health services delivered to inmates for the five- month period
January through May 2006. This data may be found in the tables in Appendices A
through F of this Summary of Reports.
As reported in Mental Health Care for Ohio State Prisoners (2000), one area that
presents a challenge to service delivery is the sometimes-blurry distinction that must be
made between behavior that is prompted by sickness or is willfully deviant in nature. An
inmate’s mental condition is taken into account at disciplinary hearings as a way to
determine their capacity to participate in the hearing and to construct a disposition
consistent with the individual inmate’s security and treatment needs.
Regarding cases where disciplinary action is warranted, Ohio State Penitentiary
(OSP) functions as a “super-max” institution and is available as a disciplinary option.
Per Ohio Department of Rehabilitation and Corrections policy, seriously mentally ill
inmates are excluded from placement at the Ohio State Penitentiary, regardless of
whether they have a security classification of level four or five.
The report continues to address key issues associated with the delivery of services to
mentally ill offenders. Among those topics of importance are mental health staffing,
administration of services, quality assurance as it applies to the department’s need to
meet the terms of the court ordered decree, and community reintegration of the exoffender who is returned to a community.
Mental Health Staffing.
Reportedly, diligent and continuous recruitment,
competitive salaries, and time-consuming training are necessary for the Ohio Department
of Rehabilitation and Correction to maintain professional mental health staff. In addition,
specialized mental health training is provided for both mental health and non- mental
health staff, such as corrections officers and clerical workers. Ongoing evaluations are
conducted to assure that staff receive training that is appropriate to the specific work
assignments.

10
Administration. The report relayed that administratively, the ODRC has instituted
employee ‘quality’ teams to improve work processes, including those processes relevant
to the delivery of quality mental health services. The staff teams were also responsible
for compliance with the terms and conditions of the Dunn court order. The ODRC
partnered with other organizations, such as the Ohio Department of Mental Health and
community me ntal health agencies and boards, to augment delivery of services to
offenders with mental disabilities. In order to aid maximum communication between the
ODRC central office and personnel in the individual correctional institutions, regularly
scheduled me etings for field administrative staff are held. The emphasis at these
meetings was on the necessary correlation between good management and good clinical
services.
Quality Assurance. Reportedly, a temporary Quality Assurance (QA) Program was
authorized in ODRC Policy 321-01 effective June 28, 1998, and a ODRC Quality
Assurance Transition Team (QATT) had the duty of preparing the agency for selfmonitoring following the termination of the court-ordered decree so that quality
improvements were continuous. In follow- up communication from DRC it was relayed
that currently, the Department continues the self- monitoring/audits within the BOMHS
through a process called mental health external reviews (MHERS) to ensure each mental
health unit within the prison is in compliance with established policies and procedures.
In the communication from DRC, it was further relayed that in addition, an integrated
healthcare Quality Assurance/Quality Improvement program was authorized in the
ODRC Policy 69-OCH-01, Quality Assurance in Correctional Healthcare effective 6-1804. The purpose of this policy is to implement the Quality Assurance Program and to
facilitate the provision of high quality medical, mental health and recovery services care
in a cost effective manner through a systematic approach of monitoring, evaluating and
resolving health care issues.
Community Reintegration. Intra-agency coordination was acknowledged as a
necessary component for effective offender/parolee transitioning into the community.
Within the Ohio Department of Rehabilitation and Correction (ODRC), the Division of
Parole and Community Services (DP&CS) is responsible for the supervision of released
offenders, including those with mental illness. The DP&CS operates the Offender
Services Netwo rk (OSN), which continues to ensure offender access to appropriate
community treatment services and mental health service providers. An inter-agency
agreement was reached in 1997 between the Ohio Department of Rehabilitation and
Correction and the Ohio Department of Mental Health such that 12 ODMH community
linkage social workers assigned to the state prisons work with ODRC mental health staff
to coordinate and link community mental health services to released prisoners.
Conclusion. According to Mental Health Care for Ohio State Prisoners (2000), the numbers
of individuals with mental illness or mental retardation who were entering the state prisons was
increasing compared to those individuals who are entering mental hospitals. Therefore, the
ODRC had to assume a role in the delivery of mental health services. At the heart of the issue,
there continues to be a fundamental need for careful study directed at the process of prescribing
the proper treatment in conjunction with the appropriate sanction for mentally ill offenders.

11
Report 2.
Mentally Ill Offender Treatment and Crime Reduction Act of 2003 (S. 1194). Oral
Testimony to The United States Senate Judiciary Committee; July 2003. Wilkinson,
Reginald A., Ph.D.
The Mentally Ill Offender Treatment and Crime Reduction Act of 2003 (S. 1194),
was expected to help the Ohio Department of Rehabilitation and Correction implement
programs and initiatives within the department into partnerships that would strengthen
the delivery of services. The four components of the Mentally Ill Offender Treatment
and Crime Reduction Act of 2003 (S. 1194) were believed to advance and benefit
corrections and included: saving lives, increasing public safety, reducing state and local
(county) government spending, and building on Ohio’s successes.
In his testimony, the Director provided a brief history of Ohio’s operations in
dealing with problems associated with the mentally ill inmate. Included in Dr.
Wilkinson’s historical review were the 1993 riot at Southern Ohio Correctional Facility
and the subsequent federal lawsuit, Dunn v Voinovich. The Dunn suit challenged the
constitutionality of the Ohio Department of Rehabilitation and Correction’s mental health
delivery system in Ohio. It was decided that rather than fight the suit, the money would
be better spent in concentrating on a five-year consent decree. Thus, it was decided in
1995 to concentrate on improving Ohio’s mental health services for the mentally ill
prisoner. Throughout the five-year consent decree period from 1995 through its
settlement in 2000, all parties, including plaintiff’s counsel, the court monitor, the state
attorney(s), correctional administrators, and health care professionals, agreed to manage
points of contention privately. The Director relayed to the Judiciary Committee in 2003
that he was proud of the mental health delivery system in Ohio and that, in his opinion, it
represented a national benchmark as it related to prison mental health care.
Save Lives. According to the report, prisons and jails house more people with
mental illnesses than do the country’s mental health institutions and therefore,
correctional administrators are de facto mental health directors. The corrections
community readily acknowledges that a correctional environment is not conducive to
recovery for a person with mental health problems, especially those with a serious mental
illness. Untreated mental illness may put an inmate at risk of committing suicide or being
victimized by predatory inmates. There is, therefore, an obligation to one of the core
missions in correctional institutions: to ensure safety and humane conditions for staff and
inmates alike through the improvement of screening procedures and in training staff to
make correct identifications of the signs for suicide.
Increase Public Safety. Because most offenders, including those with mental
illnesses, will be released to the community at some point, it is imperative to adequately
prepare those individuals for release in a manner that they do not return to prison nor
pose a threat to public safety. Recidivism among the released mentally ill offender is
over 70%, as revealed in more than one study. There is a correlation between effective
transition plans and inmate preparation and corresponding community safety.

12
Reportedly, S. 1194 promoted effective reentry planning for people with mental illness
through efforts such as encouraging mental health providers to come into correctional
facilities and connect with the offender prior to release and in ensuring that an adequate
supply (more than merely a two weeks’ supply) of medications are provided to the inmate
at release. In addition, under the bill, there must be planned follow-up services.
Reduce Spending. Funds delegated to corrections have reportedly diminished
nationally. Staff and operation budgets have experienced significant reductions. Capital
budgets for building projects have also been reduced. According to the report on the
Mentally Ill Offender Treatment and Crime Reduction Act of 2003 (S.B. 1194),
correctional agencies must curb the rate of growth within the system to comply with state
legislative and executive orders to cut costs. Per the report, the mentally ill remain in the
prison system longer than other offenders and when they reenter the community, they do
not have adequate community services to avail, so they frequently violate the law and are
re-incarcerated. It is significantly more expensive to incarcerate the mentally ill offender
than other offenders due to added costs for mental health services, medications, and
additional staff. Pennsylvania, for example, estimates $80 per day for an average inmate,
but $140 per day for a mentally ill inmate. A difficult burden rests with parole boards,
which try to connect the parolee with community support. S. 1194 reportedly provides
the tools to enable the Ohio Department of Rehabilitation and Correction to facilitate the
design and implementation of risk assessment instruments, encouraging enrollment of exoffenders in federal benefit programs, and promoting aspects of programs that prove
effective in reducing recidivism.
Building on Ohio’s Successes. For departments of corrections to simply create and
expand hospitals for the mentally ill within correctional institutions is not a viable or
economically sound solution to addressing the needs of mentally ill offenders. There are both
state and local barriers to overcome, but interagency collaboration between corrections and
mental health agencies and community mental health service providers is the key to successful reentry. Reportedly, S. 1194 would help the Ohio Department of Rehabilitation and Correction
translate fledgling initiatives into strong, sustainable partnerships that have a credible evidence
base.
Based on current information from the Ohio Department of Rehabilitation and Correction
relevant to carrying out the programs and initiatives under S. 1194, the U.S. Department of
Justice’s Office of Justice Programs’ Bureau of Justice Assistance announced in April 2006 that it
was seeking applications to receive grants to fund programs under the Justice and Mental Health
Collaboration Program. The Justice and Mental Health Collaboration Program operates at the
federal level to further the Department of Justice’s mission by increasing public safety through
innovative cross-system collaboration to reach and deliver programming to individuals with
mental illness who also come into contact with the criminal or juvenile justice systems.
Insomuch as the grant request for proposals (RFP) was released in April 2006 with an application
deadline of June 2, 2006, the specific uses of the $5 million dollars that have been allocated for
the grant are unknown at this writing.
Reportedly, several county boards in Ohio intend to apply for the funding and if awarded,
will use their awarded share of the five million total grant dollars to fund appropriate programs in
Ohio. For example, the Franklin County Alcohol, Drug Addiction, and Mental Health Board
reportedly was planning to apply for some of the grant money.

13
Report 3.
Systems in Transition. Human Rights Watch: Ill Equipped: U. S. Prisons and
Offenders with Mental Illness. <http://www.hrw.org/reports/2003/usa1003/6.htm>
This researched piece establishes that there are two key forces for change in the
corrections environment applicable to offenders with mental illness, and that these two
forces often oppose each other. On the one hand, litigation has been used to induce
reform of mental health services, and on the other hand, funding pressures and cutbacks
have made implementation of reforms more difficult. A synopsis of these two dynamic
forces, as reported in Systems in Transition, is presented in the following sections.
Reform through Litigation. Litigation or the threat of it has reportedly become
the prerequisite for systemic improvements in mental health services. Litigation has
addressed the complete lack of mental health services and more recently, the need and
development of improvements in existing systems. Ohio is among many states that have
experienced class action suits and dealt with consent decrees and court orders instituting
reforms and the court appointment of masters and monitors to oversee compliance. As
reported in Systems in Transition, class action lawsuits have led to improvements in
prison mental health care in many states, but progress to date is still far from enough.
The following excerpt from Systems in Transition relays details of a lawsuit in Ohio that
made a significant impact on the operational details associated with offenders with
mental illness:
In Ohio, for example, Dr. Reginald Wilkinson, the director of the Ohio
Department of Rehabilitation and Correction, was confronted with a devastating
expert assessment of Ohio’s mental health services developed after prisoners
brought suit in 1993 claiming the services were so poor as to be unconstitutional.
After receiving this assessment, Wilkinson engaged in a remarkable collaboration
with correctional mental health experts, plaintiffs’ attorneys, and other
stakeholders to develop the blueprint for a major overhaul of the state’s prison
mental health services. The suit ended in a settlement without extensive
adversarial proceedings, and the department has remained committed to providing
quality mental health services. Within three years of the settlement, full-time
equivalent staff providing psychiatric services increased from 61 to 284; the
number of hospital beds had increased dramatically; and the percentage of
prisoners on the psychiatric outpatient caseload had increased from 7.4 percent of
the prison population to 12.2 percent.
Systems in Transition makes a point of saying that successful litigation does not
necessarily translate into actual improvement. There have been examples where directors
of corrections accepted on-paper compliance with court decrees as a substitute for real,
durable reforms. Simply, some correctional authorities have resisted putting reforms in
place. This reluctance can stem from institutional inertia, bureaucratic obstacles, failure
to understand the importance of adequate mental health services, or the lack of funding.
The article provided examples from Texas, Iowa, and Rhode Island.

14

The Problem of Funding Mental Health Services in Prisons . The extra costs
to provide adequate mental health services in prisons is an impediment to the delivery of
those services. As reported in Systems in Transition and previously mentioned in this
paper, Pennsylvania incurs costs of $80 per day to incarcerate the average prisoner, yet
$140 per day to incarcerate inmates with mental illness. The additional expenses are
incurred for medications, additional correctional and professional staff, and specific
services that mentally ill inmates receive. Cost variables from state to state include
decisions on quantity and quality of care provided and regional differences in salaries of
mental health professionals. Budget cuts in Georgia, Florida, Michigan, Iowa,
Massachusetts, and South Carolina have manifested in a variety of forms, including (a)
reduced mental health professional staffing, (b) abandoning planned openings of new
psychiatric units, (c) placing limitations/reductions on the use and type of psychotropic
medications available to inmates, (d) reductions in intensive residential treatment
programs by 25%–30%, (e) tightening criteria for outpatient eligibility, and (f) cuts in
programs for the mentally ill.

15
Report 4.
Prison Mental Health Care: Dispute Resolution and Monitoring in Ohio. (JulyAugust 1997) Criminal Law Bulletin, Volume 33, Number 4, pp 299-327. Cohen,
Fred and Aungst, Sharon.
Report 4 provides details about the resolution of the class-action lawsuit, Dunn v
Voinovich, in Ohio from the perspective of the court monitor of the decree and from the
Deputy Director of Mental Health Services in Ohio at the time of the suit and resolution
period. Fred Cohen, the monitor, and Sharon Aungst, the Deputy Director, worked
collaboratively in a unique manner so as to redesign mental health services. Rather than
follow a more typical adversarial relationship found in cases as this, the Ohio scenario
modeled affirmative collaboration in the blending of law with organizational change.
The remainder of this Summary of Reports is a presentation of the key material
found in Report 4: Prison Mental Health Care: Dispute Resolution and Monitoring in
Ohio. The headings are the same as those in the report and the content reflects the
writing of the monitor, Fred Cohen, and the Deputy Director, Sharon Aungst. The
information represents, therefore, the thoughts and insights generated by these two
individuals.
Background, Expert Team, and the Report. The Dunn suit was based on
allegations that the mental health delivery system was “deliberately indifferent” to a
degree that there was violation of the Eighth Amendment to the U.S. Constitution.
The
case delved into the language of the law and included considerations of the showing of
care. The suit held that care was delivered in a deficient manner that imposed needless
suffering and deterioration judicially associated with cruel and unusual punishment. The
suit began with the filing of a complaint on October 6, 1993 in which the plaintiffs did
not seek monetary damages, but rather systemic, injunctive relief responsive to the
allegations of systemic failure. Typically, during the deposition and discovery phase of a
case, there are adversarial dynamics, which can produce numerous costs and consume
large amounts of time. At this phase in the process, dispute resolution becomes
operative.
In the Dunn case, the discovery phase was held in a suspended state while a team
of ‘experts,’ known as the Expert Team, on correctional mental health completed eight
months of investigation. The Expert Team investigated the history of Ohio’s prisons,
interviewed large numbers of employees and others with relevant information, and
reviewed thousands of documents and records within Ohio’s correctional institutions.
With an understanding of the traditional ‘military mindset’ and suspicion of outsiders that
often exists among staff in prisons, the experts worked through the tension of the
discovery phase. During the discovery phase, institutional staff experienced inevitable
stress, yet staff dealt with media reports and inquiries, balanced fear associated with
negative scrutiny, and still maintained hope that the situation would eventually improve.

16
The Expert Team’s findings were provided in a report that was to focus on factfinding, system adequacy, and recommendations for improvement as dictated by their
findings. The Expert Team measured its findings in terms of “that which is minimally
necessary to accomplish a particular objective or perform a given task.” Applying the
“minimally adequate” standard, the Expert Team concluded that the defendants were
deficient in three basic areas of legally mandated prison mental health care: appropriate
personnel (including quantity and training), treatment/bed space (including hospital,
crisis, and chronic care beds), and access to care (ability and means available to inmates
to reach available staff and appropriate treatment). After deficiencies were found,
solutions were proposed. In addition to deficiencies in the three legally mandated
provisions named above, the following list displays eleven other basic findings, none of
which were challenged by the plaintiffs or the defendants.
1. Inadequate intake screening.
2. Inadequate referral system.
3. Paucity of residential care and crisis beds and under use of beds at the Oakwood
Correctional Facility, which was a facility designed specifically for the most
severe cases of mental illness.
4. Shortage of clinical staff coupled with conservative decision-making such that
there were obstacles created in gaining access to psychiatric care.
5. Psychiatric care that was limited to psychotropic drugs without adequate
monitoring of medications and lithium blood levels.
6. Shortage of space for mental health providers and staff, which compromised
safety, confidentiality, and appropriate care.
7. Lock-down tactics applied to some of the most severely mentally ill, affording
them no care, no activities, no opportunities to walk, exercise, or breathe fresh air.
8. Absence of staff training, especially training of security staff in the signs and
symptoms of mental illness, crippled access to mental health care due to the
ignorance of staff assigned to deal with inmates most frequently on a day-to-day
basis.
9. Deficient mental health records and an absence of treatment plans, progress
reports and notes, and comprehensible diagnoses.
10. Noncompliance in following the guidelines on basic aspects of mental health care,
which resulted in ongoing friction and role confusion between the Ohio
Department of Mental Health (providers of psychiatric care) and the Ohio
Department of Rehabilitation and Correction (providers of psychological
services).
11. Absence of remedial action in response to earlier studies that pointed to similar
problems and solutions.
The Expert Team found that while Ohio’s prison population, including a large and
growing number of seriously mentally ill inmates, had expanded, there had been a
simultaneous decline in resources, which led to the situation where minimally adequate
care for seriously mentally ill inmates was being provided. The report indicated that the
errors were of omission rather than commission, that both mental health specialists and
security staff felt frustrated by their inability to systematically recognize and provide care

17
where it was plainly indicated, and that there was no evidence of intentional infliction of
harm toward inmates. The case resolved itself into a case of systematic inability to meet
minimal conditions rather than commission of wrongful acts. The Dunn case shaped itself
into a collaborative-implementation model.
Report Acceptance. As anticipated, the report was given a favorable reception. The
rehabilitation and corrections and mental health agencies pooled executive staff to
develop a vision and Sharon Aungst of ODMH’s Office of Psychiatric Services to
Corrections developed this vision into a conceptual and operational model for service
delivery. The Expert Team advocated for the Ohio Department of Rehabilitation and
Correction to become the provider of mental health care in a unified system. In October
1994, at an Open Space Conference, Ohio’s key stakeholders in the redesigning of the
system met to design the “ideal” system. The “buy in” of all stakeholders was a
significant component in the early success of the new system. Among the accepted
system components was a “cluster” approach, which is a service delivery design whereby
a group of two to five prisons in geographic proximity to one another provide for all
mental health care (except hospital care) for their inmates. All prisons would provide
outpatient care, but only one prison in each cluster would provide crisis stabilization and
a Residential Treatment Unit. Action plans were developed following the conference in
order to implement the system and negotiate settlement of the suit. Key to the success of
the system was the timing with which the system was developed (prior to negotiations)
and that the Ohio Department of Rehabilitation and Correction had created the system
that it was to implement, rather than having a foreign system thrust upon the ODRC.
Negotiating the Consent Decree. Reportedly, in the post conference period, Fred
Cohen was asked by the defendants to take on the role of facilitator. Mr. Cohen served
simultaneously as a mediator and drafter of an agreement. Because the drafter of the
report was also the facilitator of the drafting of the consent decree, the proposed decree
aligned with the experts’ report and with all parties in line, there was an early and
amicable resolution. As reported in Prison Mental Health Care (1997), only a few points
of the decree became difficult to resolve. For example, counsel for the plaintiffs insisted
on a definition of “serious mental illness” that would include all DSM-IV, Axis I and II
diagnosis as well as “alcoholic” and “drug addict,” however, to make the definition that
inclusive could potentially mandate that mental health care be provided to a possible 80
percent of the total prison population. With agreement of the goal to dramatically
improve the quality of mental health care in Ohio’s prisons, the negotiation and drafting
of the consent decree was successful and void of many of the problems and
manipulations that commonly accompanies such an effort.
The major participants in forming the consent decree, (Governor, ODRC Director,
Attorney General, Legislature, and Counsel for the plaintiffs), worked together under the
assumption that decent mental health care plays a proportionate role in the level of safety
and security of a prison.
As the decree was undergoing fine-tuning, Fred Cohen provided monitoring and
consultation so that the fine-tuning process was efficient and consensus would be reached

18
without unnecessary revisions. This phase lasted approximately 13 months extending
from March 1995 through April 1996. The benefits of employing consultation during
this phase included (a) the development of common understandings between the monitor
and mental health and security staff concerning the expectations and the obstacles facing
staff, (b) an increase in staff confidence due to the monitored visits being handled in a
manner that presented “no surprises” to staff, (c) much collaboration between monitor
and staff as they worked toward a common goal, and (d) a “buy- in” perspective on the
process, which was supported by some key components including ODRC’s provisions for
first-class staff, resources necessary to the process, ODRC enthusiasm, and support from
the top- most level.
Consent Decree. The Consent Decree established “substantial compliance” as the
substantive goal for ending the judicial oversight and monitoring. The Ohio experience
was notable in an absence of bitterness and contentiousness that has accompanied decrees
in other states.
Monitoring Process. There were two phases of the Dunn monitoring process:
consultative phase and oversight monitoring phase. The consultative phase took on two
parts, the first in the few months prior to the formalization of the decree, and the second
during the six months after the formalization of the decree. During the six- month period
post-decree, ODRC held itself to develop and draft 11 policies and procedures – a step
that engaged the monitor in a collaborative manner. The monitor had authority to
provide oversight of ODRC institutions by gathering empirical data, obtaining written
reports, onsite inspections, and providing oral and written reports to the parties.
Additional rights provided to the monitor included privileged communication and access
to data from internal investigations and other sensitive information. At the heart of
monitoring were monthly site visits, which began with an initial staff meeting and
included the submission of various types of institutional-specific data and statistics
pertinent to operations and services rendered to offenders. Following the executive
meeting, the monitor proceeded to hold similar sessions with other staff within the
institution. The decree described monitoring as a combination of gathering empirical
data, obtaining written reports from ODRC, on-site inspections, and providing oral and
written reports to the parties. The monitor was given access to privileged information.
ODRC prepared quarterly reports for the monitor with special emphasis on staff and on
bed or treatment space.
Prior to a site visit, the monitor was provided with a package consisting of the names
and status of inmates on the mental health caseload, the prison’s rated and current
population, names and job descriptions of relevant staff, security status information,
segregation data, and a summary of any prior findings, recommendations, or news
clippings about Ohio prisons. This information was supplied to the monitor prior to the
executive session at the onsite visit so that discussions at the executive session could be
more productive in revealing problems and prompting analysis as a result of the monitor
having time to review the data prior to the meeting.

19
Following the executive session, there were similar sessions with key mental health
staff: psychiatrists, psychologists, psychology assistants, social workers, nurses, and
activity therapists. During the site visit, inmate health charts were examined and a
session was held with Residential Treatment Unit (RTU) inmates to explore complaints.
In addition, corrections officers and segregation staff met with the monitor. A site visit
always included an attempt to sit in on a disciplinary hearing involving inmates on the
mental health caseload.
A variety of issues associated with incarceration of the mentally ill were given
consideration during the onsite visit. Some of the issues in this category included recordkeeping, policy and procedure compliance, discretionary flexibility in the system relevant
to inmate behavior, medication policy and inmate discretionary latitude, medications in
general, and staff training, among others.
The site visit as part of the monitoring process included an exit interview, which was
attended by representatives from Central Office, the warden(s), key staff, and some
mental health personnel. The comments and notes generated by the site visit were taken
seriously and staff welcomed the monitor as a partner in developing and improving their
system. It was perceived that the monitor and agency shared the same goal: to improve
the system for delivery of mental health services.
Finally, following the site visit and sessions, reports were generated to document the
observations, findings, recommendations, etc.
Recommendations. The principles that were followed and the processes used in the
implementation of the consent decree, in this case, offered some value to other
jurisdictions contemplating a similar task requiring the enforcement of a judicial remedy
within the correctional system. Fundamental principles that have been credited for the
success in the Ohio case include communication, continuity, organizational and
governmental support of “quality,” clarity of roles, and the transition process from
implementation of the components of the decree and requisite independent monitoring to
a system that operates in compliance and monitors its own performance.
Communication was identified in the Ohio case (Dunn v Voinovich), as the key to
building and maintaining the positive and productive relationships that were necessary to
the success of the venture. Communication between the monitor and the state’s Deputy
Director of Mental Health Services occurred frequently and honestly to avoid surprises.
Concerns and disagreements were discussed openly with the goal of understanding,
clarifying, and finding common ground. It was discovered that face-to- face meetings
produced more constructive and less misunderstood communication than written
“discussions.” The communication template, in this case, included the resolution of
disagreements without any threat of litigation, regular feedback sessions, and a thorough
sharing of paper documentation of the venture through reports and other written
materials.

20
Continuity. In Prison Mental Health Care (1997), continuity was identified as a
second important factor. Specifically, continuity was established by having Fred Cohen
act as the author of the Expert Team Report, continue in a role as facilitator and author of
the Consent Decree, then continue as a consultant, and finally serve as the monitor. The
multiple roles filled by Mr. Cohen did much to assure that the process did not unravel or
become misdirected during the various phases. Also, there was one consistent ODRC
staff who assumed responsibility for psychiatric services, served as the “program expert’
in negotiations, oversaw the transfer of psychiatric services from the Ohio Department of
Mental Health to the Ohio Department of Rehabilitation and Correction, and was
responsible for building a new integrated mental health system within the Ohio
Department of Rehabilitation and Corrections. The continuous service of these two key
players, the monitor and the Deputy Director, in the situation helped to prevent
misunderstandings or disagreements that might have occurred if either of the two players
had changed in the middle of the process.
Organizational and Governmental Issues.
Reportedly, the perspective or
philosophical framework held by the Ohio Department of Rehabilitation and Correction
at the time of the case included a readiness to make changes, and a desire to embrace
ownership of mental health services, thus controlling the future of those services within
the ODRC rather than relying on another agency to provide those services. The
leadership at ODRC was committed to improving service delivery and held a clear vision
in that regard. A “quality-oriented” mode of business operations was encouraged from
the executive branch such that all stakeholders in daily operations were encouraged to
participate positively and constructively, rather than act as obstacles, in the cultivation
and maintenance of operations that represented the highest quality. Staff training and
support tools were given increased emphasis in cultivating a quality approach to doing
business.
Clarity of Roles. While the attorneys were concerned with legal issues surrounding
the consent decree and in achieving and maintaining the best legal position for the state,
the program managers were concerned with providing quality services and ensuring that
legal positioning did not interfere with providing appropriate care. Roles remained clear
and distinct in the Dunn case, however, there was cross-consultation concerning both
program design and legal issues. The monitor also exercised distinction in the dual roles
of monitor and consultant so as to be able to clearly distinguish the monitoring process
separately from suggesting “best practices” to enhance services within individual
institutions.
Transition. A shift from development and implementation of the consent decree to
day-to-day performance that met and maintained standards served as a transition point in
the process of meeting the overall objective. In the Dunn case, the ODRC demonstrated
its ability to monitor its own performance by hiring a compliance monitor and developing
a quality assurance program. The role of the compliance monitor was to develop
measures to track specific requirements of the decree and develop systems for the agency
to self- monitor. The role of the quality assurance program was to monitor and evaluate
the quality and appropriateness of mental health care, the resolution of specific problems,

21
and to ensure compliance to standards, which were integrated into the agency’s operating
standards and audited annually.
Acting on their authority in the post-transition period, the ODRC reportedly instituted
a management information system to allow information to be available to staff when it
was needed. Space, staff, and access were identified as the most critical elements in
maintaining quality in the delivery of mental health services. It was identified that the
previous ODRC system for delivery of mental health services essentially was ineffective
even at reception because not all inmates were given assessments at reception. There was
not, therefore, any initial screening for any mental concerns unless the individual was
obviously symptomatic, in a crisis, or taking psychotropic medications.
Under the changes of the decree, operations were impacted. Under the decree,
inmates now receive screening at reception and mental health staff make weekly rounds
to inmates assigned to segregation and in general population. The structured and frequent
presence of mental health staff to the units enhances inmates’ access to care and
strengthens the contribution that security staff may make in the identification step.
Weekly contact with mental health staff helps to assure that inmates who may be
exhibiting signs of serious mental illness are identified, referred, and given treatment in a
timely manner. In addition, inmates are required to undergo a mental health screening
whenever they make an institutional transfer so as to verify the inmates current mental
health classification and level of care required.
In order for the credible delivery of services to occur, major initiatives were put in
place. The major initiatives for improving service delivery included improvement of the
treatment planning process, building treatment teams that include security staff,
improving recruitment and developing a credentials process applicable to the hiring
process, improving clinical skills of staff, fully implementing the involuntary medication
policy, and fully implementing the quality assurance program.
The transition of prison mental health care from the Ohio Department of Mental
Health (ODMH) to the Ohio Department of Rehabilitation and Corrections (ODRC) gave
the ODMH the primary responsibility for linking inmates with mental illnesses to
community providers of work upon inmates’ release. Twelve social workers were hired
to work within the prisons to identify those inmates with mental illnesses receive
continuity of care when they are released into the community. A primary objective of
these measures is to reduce the risk of recidivism and re- institutionalization of the inmate.
Relevant to the three criteria by which achievement may be measured: staffing,
space, and access, reportedly, Ohio succeeded in all three categories. The data revealed
that considerable achievements were made over a short period. Several hundred beds
were added system-wide for inmates needing mental health services, mental health staff
quadrupled within a few years, and mental health services were more prevalent at intake
and delivered more frequently at other points during inmate incarceration. The
accomplishments, as recognized by the monitor and the Deputy Director, were to be

22
shared among all participants in the process because it brought substantial recognition to
Ohio.
The Conclusions published in Report 4, Prison Mental Health Care: Dispute
Resolution and Monitoring in Ohio (1997), include five concepts that the Monitor and the
Mental Health Deputy Director believed to have made an important contribution to the
quality of mental health services to inmates in Ohio.
1.
2.

3.
4.
5.

There must be support for the change at the top. It must be communicated
throughout the organization, and front-line players – those in the trenches –
must buy into the change.
The greater the contentiousness in the early stages and in the ultimate
resolution of a lawsuit seeking systemic change, the greater the difficulty in
implementing a change. Obviously, this principle implies a certain shared
view of the problems and the need for resolution. This shared view need not
exist at the initiation of litigation but must develop early in the process.
Continuity in the agents of change, whether the agents come from the
institution or from outside it, is a major factor in achieving change.
The energy of a lawsuit can be converted to a positive force for change if a
collaborative, mutually respectful posture is adopted early and consistently
maintained.
Identities of interest can be located in apparent antagonistic positions, yet
these interests may then be converted into mutual effort. Certain challenges to
prison conditions, for example, correspondence, visiting, and discipline, are
consistently viewed as threatening by prison officials. Other challenges, like
health care, are not viewed in such a threatening manner. With mutual effort,
it is relatively easy to sell the notion that decent mental health care enhances
security and the work environment generally.

As identified in the fourth report, the trust began with the Director of the Ohio
Department of Rehabilitation and Correction and was communicated and perpetuated throughout
the levels of administration and staff to the correctional officers in segregation units. This trust
was the dominant component in the success of complying with the court ordered mandate of the
Dunn case. The ODRC executive staff and legal counsel made an initial decision to suspend
discovery and look to a team of experts for an objective assessment of Ohio’s prison mental
health system. The Department continued with an open mind in beginning discussions on the
need and direction for change, followed by the acceptance of the team’s report. The Director
repeatedly supported the inquiry and exploration process, giving it legitimacy at all levels of
administration and staff and at all levels of operation. The early-established trust built upon itself
and became a pivotal factor in accommodating change.
The fourth report acknowledged that while changes in Ohio took place in response to the
Dunn case, the problems that were faced in the Dunn case would not simply disappear. It may be
that Dunn-like solutions to problems will reappear in other situations, yet there is always the
possibility that those problems will not be addressed with as much success or cooperation as
happened in the Dunn case. Ultimately, it would be preferable that future issues could be dealt
with in a similar and effective manner as the response to the Dunn case.

23
APPENDIX A
MONTHLY AVERAGE INSTITUTIONAL POPULATION

Institution

Chillicothe CI
Belmont CI
Richland CI
Noble CI
North Central CI
Ross CI
Mansfield CI
Lebanon CI
London CI
Pickaway CI
Madison CI
Ohio Reformatory for Women
Marion CI
Lorain CI
Lake Erie CI
Southeastern CI
Grafton CI
Allen CI
Trumbull CI
Southern Ohio Correctional
Facility
Warren CI
Correctional Reception Center
Toledo CI
North Coast Correctional
Treatment Center
Northeast Pre-Release Center
Ohio State Penitentiary
Hocking Correctional Facility
Dayton CI
Montgomery Education and PreRelease Center
Corrections Medical Center
Oakwood Correctional Facility
TOTAL
TOTAL (based on averaged
monthly quantities statewide)

Monthly Average Inmate Population per Institution
Ohio Department of Rehabilitation and Correction
January – May 2006
Monthly
Average
January
February
March
Institutional
2006
2006
2006
Population
(for the period)
2776
2712
2717
2788
2404
2160
2466
2470
2352
2308
2311
2385
2295
2307
2279
2291
2272
2271
2296
2249
2249
2209
2242
2247
2205*
2184
2211
2200
2163
2125
2153
2182
2150
2182
2138
2167
2003
1903
2247
1945
1985
1989
1970
1941
1951
1925
1911
1954
1777
1703
1708
1750
1706
1007
1828
1868
1457
1438
1462
1459
1447
1438
1429
1450
1399*
1401
1399*
1396
1321
1320
1315
1326
1314
1523
1248
1248

April
2006

May
2006

5-month
Total

2826
2453
2381
2313
2269
2272
2224
2174
2136
1961
1958
1987
1873
1828
1470
1454
1399*
1326
1262

2838
2470
2373
2283
2274
2277
2205*
2179
2128
1958
2067
1980
1852
1997
1457
1463
1399*
1318
1291

13,881
12,019
11,758
11,473
11,359
11,247
11,024*
10,813
10,751
10,014
9925
9757
8886
8528
7286
7234
6994*
6,605
6572

1122
1043
832
800

1091
1065
1744
784

1123
1046
1830
796

1128
1052
1878
804

1122
1034
1870
808

1146
1020
1858
810

5610
5217
9180
4002

625*
573
554
472
417

628
564
555
468
420

632
564
549
482
409

619
593
578
466
420

620
562
545
477
416

625*
582
544
468
422

3124*
2865
2771
2361
2087

334
120
110*
45,722*

328
119
107

322
121
104

332
122
118

352
124
109

337
115
110*

1671
601
548*

45,727
(variance of 5
due to
rounding)

44,469

45,807*

45,924

46,094*

46,340*

228,634*

The * indicates an institutional entry or average total derived by using a calculated average due to incomplete institutional data
available at the time of the report.

24
APPENDIX B

Institution

Oakwood
Correctional Facility
Ohio Reformatory
for Women
Franklin Pre-Release
Center
Northeast PreRelease Center
Corrections Medical
Center
Southern Ohio
Correctional Facility
Hocking Correctional
Facility
Warren CI
Allen CI
Trumbull CI
Southeastern CI
Chillicothe CI
Belmont CI
Pickaway CI
Mansfield CI
Richland CI
Correctional
Reception Center
North Central CI
Madison CI
Marion CI
Lebanon CI
Noble CI
Grafton CI
London CI
Toledo CI
Lake Erie CI
Ross CI
North Coast
Correctional
Treatment Center
Lorain CI
Ohio State
Penitentiary
Dayton CI
Montgomery
Education and PreRelease Center
TOTAL

PERCENT of MONTHLY AVERAGE INSTITUTIONAL POPULATION
on PSYCHIATRIC CASELOAD
January – May 2006
Percent
of Monthly
5 Month
Average
Jan
Feb
Mar
Apr
May
Total on
Institutional
2006
2006
2006
2006
2006
Psychiatric
Population on
Caseload
Psychiatric
Caseload
(C1 + C2)

Monthly
Average
on
Psychiatric
Caseload

Monthly
Average
Institutional
Population

47.7

51

49

59

50

0

209

42

110*

44.0

692

697

711

749

747

4288

858

1951

42.1

208

216

211

203

204

1042

208

494

39.4

214

214

237

231

234

1130

226

573

30.8

35

39

39

38

33

184

37

120

27.9

314

320

311

308

314

1567

313

1122

22.7
21.7
21.3
20.5
18.1
18.1
16.5
16.0
15.6
14.6

107
227
284
268
257
364
406
325
339
336

107
224
278
264
269
512
397
314
342
322

107
227
281
269
265
528
399
315
348
336

108
229
280
264
258
560
383
337
344
357

104
223
286
278
260
550
395
314
343*
366

533
1130
1409
1343
1309
2514
1980
1605
1716*
1717

107
226
282
269
262
503
396
321
343*
343

472
1043
1321
1314
1447
2776
2404
2003
2205*
2352

14.2
13.5
13.4
12.8
12.6
12.2
12.1
11.8
11.6
11.4
10.6

238
298
280
210
260
292
166
273
86
163
231

267
297
275
219
275
286
169*
259
86
168
242

286
303
258
226
270
280
171
247
94
170
228

252
312
244
245
274
270
169*
247
94
169
241

257
322
272
240
281
272
169*
247
104
161
248

1300
1532
1329
1140
1360
1400
337*
1273
464
831
1190

260
306
266
228
272
280
169*
255
93
166
238

1832
2272
1985
1777
2163
2295
1399
2150
800
1457
2249

8.0

52

53

48

47

0

200

40

625*

7.8

48

136

167

158

158

667

133

1706

3.6
0

17
0

20
0

23
0

20
0

21
0

101
0

20
0

554
417

0

0

0

0

0

0

0

0

334

16.3

7041

7316*

7414

7441*

7403*

36,615*

7462*

45,722*

The * indicates an institutional entry or average total derived by using a calculated average due to incomplete institutional data available at the time
of the report.

25
APPENDIX C
PERCENT of INSTITUTIONAL POPULATION on MENTAL HEALTH CASELOAD
January – May 2006

Institution

Oakwood Correctional
Facility
Northeast Pre-Release Center
Franklin Pre-Release Center
Ohio Reformatory for
Women
Corrections Medical Center
Southern Ohio Correctional
Facility
Allen CI
Warren CI
Hocking Correctional Facility
Trumbull CI
Mansfield CI
Belmont CI
Southeastern CI
Chillicothe CI
Pickaway CI
Richland CI
Lebanon CI
Madison CI
North Coast Correctional
Treatment Center
Marion CI
Noble CI
London CI
North Central CI
Correctional Reception
Center
Ross CI
Toledo CI
Grafton CI
Lake Erie CI
Lorain CI
Ohio State Penitentiary
Dayton CI
Montgomery Education and
Pre-Release Center

TOTAL

Percent
of Institutional
Population
on Mental
Health
Caseload
(C1+C2+C3)

5-Month
Total of
Inmates on
Mental
Health
Caseload

Monthly
Average of
Inmates on
Mental
Health
Caseload

Monthly
Average
Inmate
Population

53*
278
218

266
1354
1103

53*
271
221

110*
573
494

872
38

872
33

4190
184

838
37

1951
120

326
313
239
108
301
452
477
286
559
333
379
355
319

322
311
241
109
292
439
478
278
595
346
395
356
312

322
315
236
105
315
450
496
288
590
323
410
365
331

1639
1572
1196
536
1486
2258
2396
1418
2681
1671
1924
1774
1629

328
314
239
107
297
452
479
284
536
334
385
355
326

1122
1321
1043
472
1314
2205*
2404
1447
2776
2003
2352
2163
1985

109
269
354
315
335

91
278
353
317
333

92
300
341
332
341

100*
300
333
330
358

500
1403
1745
1629
1703

100*
281
349
326
341

625*
1777
2295
2150
2272

251
314
107
189
182
60
25
0

281
337
112
193*
186
169
29
0

299
328
121
197
189
226
31
0

267
341
122
193*
188
223
28
4

269
346
130
193*
183
276
30
4

1367
1666
592
965
928
954
143
8

273
333
118
193*
186
191
29
2

1832
2249
800
1399
1457
1706
554
417

0

0

0

4

4

3

11

2

334

18.8*

8199

8496*

8644

8697*

8855*

42,891*

8580*

45,722*

Jan
2006

Feb
2006

Mar
2006

Apr
2006

May
2006

48.2*
47.3
44.7

52
264
221

50
264
226

60
279
221

51
269
217

43.0
30.8

803
35

812
39

831
39

29.2
23.8
22.9
22.7
22.6
20.5*
19.9
19.6
19.3
16.7
16.4
16.4
16.4

331
320
243
107
288
461
482
273
395
343
378
342
334

338
313
237
107
290
456
463
293
542
326
362
356
333

16.0*
15.8
15.2
15.2
15.0

108
256
364
335
336

14.9
14.8
14.8
13.8*
12.8
11.2
5.2
0

The * indicates an institutional entry or average total derived by using a calculated average due to incomplete institutional data available at
the time of the report.

26
APPENDIX D

MONTHLY AVERAGE of MENTAL HEALTH CASELOAD INMATES in SEGREGATION
January - May 2006
Monthly Average
of Mental Health
Caseload in
Segregation

Jan
2006

Feb
2006

Mar
2006

Apr
2006

May
2006

5-Month
Total in
Segregation

Monthly
Average
Total Mental
Health
Caseload

Ohio Reformatory for Women
Lebanon CI
Ross CI
Chillicothe CI
Southern Ohio Correctional
Facility
Southeastern CI
Warren CI
North Central CI
Mansfield CI
Noble CI
Lake Erie CI
London CI
Allen CI
Marion CI
Trumbull CI
Pickaway CI
Richland CI
Belmont CI
Toledo CI
Correctional Reception Center
North Coast Correctional
Treatment Center
Grafton CI
Lorain CI
Northeast Pre-Release Center
Madison CI
Hocking Correctional Facility
Franklin Pre-Release Center
Corrections Medical Center
Dayton CI
Montgomery Education and
Pre-Release Center
Oakwood Correctional Facility
Ohio State Penitentiary

54
34
33
26

42
37
29
26

60
30
31
28

71
28
30
23

47
30
35
23

52
44
42
30

272
169
167
130

838
355
333
536

Percent of
Monthly
Average Mental
Health
Caseload in
Segregation
6.4
9.6
10.0
4.9

26
24
23
21
16
15
14
13
12
12
12
11
11
10
9
6

18
23
21
17
19
23
11
0
11
13
11
12
15
16
8
6

22
23
20
11
21
11
18
20
19
9
14
15
9
14
9
4

32
24
27
6
17
14
18
11
13
9
12
9
7
6
8
5

28
28
22
71
21
16
14
18
4
18
9
15
8
9
10
13

29
22
23
0
0
10
10
18
11
13
13
6
16
7
11
4

129
120
113
105
78
74
71
67
58
62
59
57
55
52
46
32

328
284
239
341
452
349
186
326
314
281
297
334
385
479
118
273

7.9
8.5
9.6
6.2
3.5
4.3
7.5
4.0
3.8
4.3
4.0
3.3
2.9
2.1
7.6
2.2

4
4
4
4
4
2
2
0
0

4
12
1
3
0
2
5
0
0

6
0
7
6
0
2
3
0
0

7
9
2
4
0
3
0
0
0

3
0
3
5
7
1
0
0
0

0
0
9
0
14
3
3
0
1

20
21
22
18
21
11
11
0
1

100*
193*
191
271
326
107
221
37
2

4.0
2.1
2.1
1.5
1.2
1.9
1.0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

2
53*
29

0
0
0

TOTAL

406

385

412

395

458

391

2,041

8580*

4.7

Institution

The * indicates an institutional monthly entry or monthly total derived by using the calculated monthly average for select months in certain institutions due
to incomplete institutional data available at the time of the report.