Wi Audit on Mental Health Care for Prisoners 2009

Wi Audit on Mental Health Care for Prisoners 2009

• Topics: Misconduct/Corruption, Corrections Audits, Mental Health

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Report 09-4
March 2009

An Evaluation

Inmate Mental
Health Care
Department of Corrections
Department of Health Services

2009-2010 Joint Legislative Audit Committee Members
Senate Members:

Assembly Members:

Kathleen Vinehout, Co-chairperson
Robert Jauch
Mark Miller
Robert Cowles
Mary Lazich

Peter Barca, Co-chairperson
Andy Jorgensen
Mark Pocan
Bill Kramer
Samantha Kerkman

LEGISLATIVE AUDIT BUREAU
The Bureau is a nonpartisan legislative service agency responsible for conducting financial and
program evaluation audits of state agencies. The Bureau’s purpose is to provide assurance to the
Legislature that financial transactions and management decisions are made effectively, efficiently, and
in compliance with state law and that state agencies carry out the policies of the Legislature and the
Governor. Audit Bureau reports typically contain reviews of financial transactions, analyses of agency
performance or public policy issues, conclusions regarding the causes of problems found, and
recommendations for improvement.
Reports are submitted to the Joint Legislative Audit Committee and made available to other
committees of the Legislature and to the public. The Audit Committee may arrange public
hearings on the issues identified in a report and may introduce legislation in response to the audit
recommendations. However, the findings, conclusions, and recommendations in the report are those
of the Legislative Audit Bureau. For more information, write the Bureau at 22 E. Mifflin Street,
Suite 500, Madison, WI 53703, call (608) 266-2818, or send e-mail to leg.audit.info@legis.wisconsin.gov.
Electronic copies of current reports are available at www.legis.wisconsin.gov/lab.

State Auditor – Janice Mueller

Audit Prepared by

Kate Wade, Director and Contact Person
Shelby McCulley
Elizabeth Drilias
Joe Fontaine
Molly Regan
Robert Sommerfeld
Timothy Steiner

Director of Publications – Jeanne Thieme
Report Design and Production – Susan Skowronski

CONTENTS
Letter of Transmittal

Report Highlights

Introduction

Mental Health Care Expenditures
Mental Health Care Organization and Staffing
Wisconsin Resource Center Staffing
Screening, Assessment, and Identification
Mental Health Classification System
Mental Health Screening and Assessment
Numbers and Characteristics of Mentally Ill Inmates
Developmentally Disabled Inmates
Monitoring and Treatment
Housing of Mentally Ill Inmates
Staffing Ratios
Psychological Services
Psychiatric Services
Inmates Prescribed Psychotropic Medications
DOC’s Formulary
Medication Delivery
Other DOC Programs
Wisconsin Resource Center
Capacity and Population
Transfers and Departures
Admissions Process
Treatment
Civil Commitments

11
12
15
19
19
21
24
29
33
33
34
37
40
42
44
46
48
51
51
53
57
59
61

Improving Safety and Discipline
Inmate Self-Harm
Inmate Suicides
Assaults on Staff
Segregation
Segregation Populations
Monitoring and Treatment of Mentally Ill Inmates in Segregation
Enhancing Information and Training
Release Planning
General Release Planning Initiatives
Release Planning for Inmates with Mental Illnesses
Release Medications
Benefits Assistance
Post-Release Treatment Appointments
Community Supervision of Inmates with Mental Illnesses
Specialized Mental Health Agents
The Conditional Release Model
Future Considerations
Recent Improvements in the Provision of Services
Changes at Taycheedah Correctional Institution
Setting Priorities for Improving Inmate Mental Health Services
Appendices
Appendix 1—Mental Health Care Expenditures by Institution
Appendix 2—Prescription Drugs with Highest DOC Expenditures
Appendix 3—Authorized Full-Time Equivalent Mental Health
Positions by Institution
Appendix 4—Limited-Term Employees Providing Mental Health Care
Appendix 5—Descriptions of Selected Mental Health Disorders
Appendix 6—Worker’s Compensation Awards Related to Assaults
by Mentally Ill Inmates
Appendix 7—DOC’s Time Line for Benefits Application Assistance
Appendix 8—Standards of Mental Health Care at Taycheedah
Correctional Institution
Responses
From the Department of Corrections
From the Department of Health Services

63
63
67
70
73
75
77
79
83
83
85
86
87
90
93
93
94
97
97
98
100

March 25, 2009
Senator Kathleen Vinehout and
Representative Peter Barca, Co-chairpersons
Joint Legislative Audit Committee
State Capitol
Madison, Wisconsin 53702
Dear Senator Vinehout and Representative Barca:
We have completed an evaluation of mental health care services in adult correctional facilities, as
requested by the Joint Legislative Audit Committee. In fiscal year (FY) 2007-08, expenditures for
inmate mental health care totaled approximately $59.8 million. In June 2008, 6,957 inmates, or
31.0 percent of all inmates incarcerated in adult correctional facilities, were identified as mentally ill,
including 299 inmates at the Wisconsin Resource Center operated by the Department of Health
Services (DHS). For the two-year period from June 2006 through June 2008, the inmate population
increased by 3.9 percent but the number of mentally ill inmates increased by 14.3 percent.
In FY 2007-08, the Department of Corrections (DOC) had 127.35 authorized full-time equivalent
positions to provide mental health services, including psychologists, crisis intervention workers, and
other mental health staff. A range of mental health services and programs is provided. Psychotropic
medications are prescribed by psychiatrists, who are typically limited-term employees. Because
most medications are delivered by correctional officers rather than health services staff, we include a
recommendation that DOC ensure all officers receive appropriate training in medication delivery.
Mentally ill inmates have a disproportionate effect on safety and discipline in adult correctional
facilities. For example, during our review period they accounted for more than 90.0 percent of
self-harm incidents, 80.0 percent of inmate suicides, and nearly 80.0 percent of assaults on staff.
Mentally ill inmates are also overrepresented in segregation. We include recommendations for better
information and training to improve safety for both inmates and staff.
DOC has taken steps to improve inmate mental health care in recent years, including at Taycheedah
Correctional Institution, where a 2008 settlement agreement with the federal Department of Justice
sets specific benchmarks for improving mental health care services. Setting priorities for future
improvements will be important as the State seeks to improve the provision of inmate mental health
services at a time of significant budget constraints.
We appreciate the courtesy and cooperation extended to us by DOC and DHS staff. Responses from
both agencies follow our report.
Respectfully submitted,

Janice Mueller
State Auditor
JM/KW/ss

Report Highlights
In FY 2007-08, expenditures
for inmate mental health
care totaled approximately
$59.8 million.
Mentally ill inmates are
screened and monitored
regularly, but treatment
programming is limited at
some institutions.
Mentally ill inmates account
for a disproportionate share
of self-harm incidents and
assaults on staff.
A September 2008
settlement agreement
requires improvements to
mental health care
services at Taycheedah
Correctional Institution.

Adult inmates in Department of Corrections (DOC) custody,
including those with mental illnesses, are housed in 20 maximum,
medium, and minimum security institutions; 16 minimum security
correctional centers; and the Wisconsin Resource Center (WRC)
operated by the Department of Health Services (DHS). In June 2008,
6,957 inmates were identified as mentally ill, including 299 housed
at WRC. Expenditures for inmate mental health care totaled
approximately $59.8 million in fiscal year (FY) 2007-08.
Concerns have been raised regarding the cost and availability of
treatment for mentally ill inmates, including the services they
receive while incarcerated and in preparation for release into the
community. Therefore, at the request of the Joint Legislative Audit
Committee, we analyzed:
staffing and expenditures for mental health services;
DOC’s process for identifying mentally ill and
developmentally disabled inmates, and their
locations and characteristics;
the monitoring and treatment of mentally ill inmates;
safety and discipline, including self-harm and
assaults by mentally ill inmates and their
placement in segregation;
placements at WRC and services provided;

R EPORT H IGHLIGHTS

planning and preparation for the release of inmates
into the community; and
DOC’s activities to improve mental health care
services, including those undertaken in response
to a recent legal settlement.

Expenditures and Staffing
DOC’s expenditures for inmate mental health care totaled
approximately $27.0 million in FY 2007-08. They included
$20.6 million in staff costs and $6.1 million for psychotropic
medications. Expenditures by DHS for housing and treating inmates
at WRC totaled $32.8 million. In FY 2007-08, DOC employed
127.35 full-time equivalent (FTE) mental health care staff.

Identification, Monitoring, and Treatment
Over the past two years, DOC’s inmate population increased
3.9 percent, from 21,610 in June 2006 to 22,451 in June 2008. The
number of inmates with mental illnesses increased 14.3 percent,
from 6,084 to 6,957.
In June 2008, 20.9 percent of inmates were classified as having mental
health needs but not seriously mentally ill, and 10.1 percent were
classified as seriously mentally ill, as shown in Figure 1. Mental
illnesses were more than twice as common among female inmates.

Figure 1
Inmate Mental Health Status
June 2008
Seriously
Mentally Ill
10.1%

Mental Health
Need
20.9%

Code Missing
2.1%
Developmentally
Disabled
0.3%

No Mental Health Need
66.6%

R EPORT H IGHLIGHTS

Most DOC facilities house inmates with mental illnesses. In a
random sample, we found that 67.7 percent of inmates were
screened for mental illness within two days of entering DOC
custody. When mentally ill inmates were transferred between
institutions, their files were generally reviewed by DOC staff in a
timely manner.
Psychologists monitor mentally ill inmates on a regular basis, but
group and individual therapy is limited. Psychiatrists focus on
monitoring the approximately 3,900 inmates who are prescribed
psychotropic medications. Neither psychology nor psychiatry
staffing ratios at all DOC institutions meet national standards.
Correctional officers deliver most medications, including
psychotropic medications, to DOC inmates. In neighboring states,
inmates’ medications are delivered primarily by health care staff.

Wisconsin Resource Center
Some male inmates with serious mental illnesses are housed at
WRC, which currently has an operating capacity of 314 inmates.
Nearly three-quarters of WRC staff positions provide direct services
to inmates. Most WRC inmates participate in one or more treatment
programs and have frequent contact with mental health care staff.
In FY 2007-08, the average length of stay at WRC was 392 days.
WRC admissions are negotiated with DOC staff on a case-by-case
basis. Clearer policies, more centralized decision-making, and more
detailed record-keeping could help ensure that WRC resources are
used effectively.

Improving Safety and Discipline
Mentally ill inmates have had a disproportionate effect on safety
and discipline in DOC institutions. From FY 2005-06 through
FY 2007-08, they accounted for more than 90.0 percent of
1,231 special placements made as a result of self-harm. These
placements require monitoring by DOC personnel at least every
15 minutes.
Mentally ill inmates also accounted for nearly 80.0 percent of the
755 inmate assaults on staff in the past three fiscal years. These
assaults resulted in $874,200 in worker’s compensation awards to
DOC and DHS staff from FY 2005-06 through FY 2007-08.
Mentally ill inmates have been overrepresented in segregation. In
January 2008, 46.1 percent of inmates in segregation were mentally ill.

R EPORT H IGHLIGHTS

Release Planning
DOC has developed a standardized curriculum to help prepare all
inmates for re-entry into the community. DOC policy also directs
special services to mentally ill inmates, including a two-week supply
of medications and post-release appointments with treatment
providers. However, DOC’s implementation of policies developed
in 2004 to ensure timely application for disability and medical
benefits could be strengthened.

Improving Inmate Mental Health Services
DOC has taken steps to improve inmate mental health care services
in recent years. However, the federal Department of Justice found in
2006 that inmate mental health care at Taycheedah Correctional
Institution did not meet constitutional standards. In September 2008,
DOC reached a conditional settlement with the federal Department
of Justice that requires specific improvements by September 2012.
To improve mental health services for female inmates, a 45-bed
addition to WRC is scheduled for completion in February 2011, at
a cost of approximately $11.1 million. DOC has also requested
$7.6 million in general purpose revenue (GPR) bonding to build
additional treatment space at Taycheedah.
2009 Assembly Bill 75, the Governor’s 2009-11 biennial budget
proposal, requests a total of 149.0 FTE positions and $6.6 million in
GPR to operate the WRC addition for female inmates and to provide
additional mental health services at Taycheedah.
If the Legislature appropriates additional funding for inmate mental
health services in the future, costs in other areas may be reduced.
For example, the Wisconsin Department of Justice (DOJ) estimates
that its staffing costs to defend the State in inmate health care
litigation total approximately $1.1 million annually, a portion of
which relates specifically to inmate mental health. In addition,
settlements or judgments resulting from such litigation have totaled
$4.8 million in payments by the State over the past five years.

R EPORT H IGHLIGHTS

Recommendations
Our report includes recommendations for DOC to report to the Joint
Legislative Audit Committee by January 4, 2010, regarding:
options for improving screening for
developmental disabilities (p. 31);
its plans for providing correctional officers
with more specific information on inmates’
mental health needs and with enhanced
training (p. 81);
the allocation of designated release planning
funds and its progress in implementing a
pre-release curriculum (p. 84);
its efforts to improve both release planning for
mentally ill inmates and, after release, their
supervision in the community (pp. 90, 93, 94);
the feasibility of incorporating elements of the
Conditional Release Program model into its
supervision of released inmates (p. 96); and
progress in implementing its settlement
agreement with the federal Department of
Justice (p. 99).
In addition, we include a recommendation for DOC and DHS to:
report to the Joint Legislative Audit Committee
by January 4, 2010, regarding policies for WRC
admissions and transfers (p. 58).
Finally, we recommend that DOC:
ensure all correctional officers have been
trained in medication delivery (p. 48); and
improve its collection and management of
data related to inmate self-harm, assaults on
staff, and segregation placements (p. 80).

Mental Health Care Expenditures
Mental Health Care Organization and Staffing

Introduction
Inmates have a
constitutional right to
mental health care.

In 1976, the United States Supreme Court ruled that failure by a
correctional system to provide minimally adequate health care
violates the Eighth Amendment prohibition of cruel and unusual
punishment. Subsequent rulings have clarified that inmates’
constitutional right to health care extends to mental health care
for those with serious mental illnesses. These rulings establish
minimum standards; they also indicate inmates do not have the
right to the best care available in the community.
Wisconsin statutes and administrative code do not set specific
requirements for mental health care in correctional facilities.
However, s. 302.385, Wis. Stats., requires DOC to base its
standards for health services on those issued by a recognized
professional organization. DOC has consulted the standards of
several organizations and reports that its policies and practices are
based primarily on those published by the National Commission
on Correctional Health Care (NCCHC). DOC does not, however,
establish policies that fully meet those standards when staffing,
budgetary, or other limitations would prevent compliance.
NCCHC also offers accreditation to facilities that substantially
comply with its standards. No DOC facilities are accredited at present,
although WRC was accredited in 2006.
Recent legal action against DOC has resulted in the establishment of
more specific mental health care-related standards at two institutions.
In 2000, a lawsuit was filed on behalf of mentally ill inmates at the
Wisconsin Secure Program Facility in Boscobel, which was then
known as the Supermax Correctional Institution, alleging that the
institution’s restrictive conditions of confinement constituted cruel

I NTRODUCTION

and unusual punishment for inmates with serious mental illnesses,
because of the tendency for those conditions to worsen such inmates’
mental states. DOC reached a settlement with the plaintiffs in
January 2002 that included a provision to exclude inmates with
serious mental illnesses from residing in the institution. DOC
achieved compliance with that provision in 2003. The settlement
agreement has not been in effect since May 2008, but DOC reports
that it continues to comply with its terms.
A federal settlement
agreement requires
improvements in mental
health care at
Taycheedah.

The federal Department of Justice investigated conditions at
Taycheedah Correctional Institution in 2005 and issued a findings
report in May 2006 which argued that the provision of mental
health care did not meet constitutional standards. A settlement was
reached in September 2008, under which a complaint filed by the
federal Department of Justice in September 2008 will be dropped
if DOC complies by September 2012 with a set of standards
designed to improve mental health care at Taycheedah. The
standards are more stringent than either current DOC policy or
NCCHC standards. For example, they require higher staffing
levels and specify stricter standards for the timeliness of mental
health assessments upon intake and the amount of therapeutic
programming provided.
In addition to the 2002 and 2008 settlements, there have been three
major external reviews of inmate health care, including mental
health care, provided by DOC:
our 2001 evaluation of prison health care (report 01-9);
a 2002 report conducted by NCCHC at the
direction of the federal Department of Justice
National Institute of Corrections; and
a 2006 review of eight facilities, conducted by NCCHC
under contract with DOC, to review compliance with
NCCHC standards and identify reforms needed to
qualify those facilities for accreditation.

Three recent evaluations
found shortcomings in
inmate mental health
care services.

All three reviews found shortcomings, including:
lack of central oversight and limited coordination
between psychological and psychiatric treatment;
inadequate training and knowledge among
correctional officers who deliver medications;
mental health treatment that is insufficient in type
and frequency to meet inmates’ needs; and
insufficient staffing, which was cited by NCCHC as
a primary cause of many of the other shortcomings.

I NTRODUCTION

Mental Health Care Expenditures
Wisconsin’s expenditures for inmate mental health care increased
from $46.1 million in FY 2003-04 to $59.8 million in FY 2007-08. As
shown in Table 1, most are related to staffing. Salaries and fringe
benefits represented 83.1 percent of expenditures for inmate mental
health care in FY 2007-08, and DOC’s expenditures for inmate mental
health care increased by $7.4 million, or 37.8 percent, during the fiveyear period shown, primarily because of increased staffing costs.

Table 1
Expenditures for Inmate Mental Health Care
(in millions)
Expenditure Type
Department of
Corrections
Salaries1
1

Fringe Benefits
Psychotropic
Medications

Contract Costs
3

Other

Subtotal

Department of
Health Services5
Salaries
Fringe Benefits
Psychotropic
Medications
Other3
Subtotal4
4

Total

FY 2003-04

FY 2004-05

FY 2005-06

FY 2006-07

FY 2007-08

$10.2

$12.0

$11.9

$14.4

$15.2

3.8

4.2

4.6

5.0

5.4

4.6

5.0

6.1

0.1

0.3

0.2

0.3

0.1

19.6

21.7

21.6

24.8

27.0

16.8

17.0

17.4

18.8

20.0

7.2

7.8

8.0

8.5

9.1

–6
2.5

1.1
2.9

1.0
2.7

1.0
3.0

1.2
2.5

26.6

28.8

29.1

31.4

32.8

$46.1

$50.5

$50.7

$56.2

$59.8

Includes mental health managers, psychologists, psychological services assistants, crisis intervention workers, clerical staff in the
psychological services unit, and psychiatrists. Also includes DOC correctional officers who provide security services at WRC; their costs
totaled $6.4 million in FY 2007-08.

Contracts for psychiatric services provided by temporary staffing companies and through the Forensic Psychiatry Fellowship Program at
the Medical College of Wisconsin.

Travel, training, supplies, and services other than medications.

Totals may not sum because of rounding.

Represents expenditures for services to DOC inmates at WRC, including costs for non-mental health care staff and other operating costs.

Included in Other for FY 2003-04, because detail was not available.

I NTRODUCTION

It should be noted that DOC’s expenditures shown in Table 1 include
only those specifically attributable to mental health staffing and
treatment programs for mentally ill inmates. They do not include,
for example:
the general costs of housing or supervising
inmates with mental illnesses;
the costs of treatment in programs and activities
that serve all inmates, such as education or
substance abuse treatment; or
costs related to staff who schedule psychiatric
appointments and file psychiatry reports as part of
their clerical duties, nurses who take orders for
psychotropic medications and review
psychological services requests when
psychological services staff are not on duty, nurses
or correctional officers who deliver medications,
and DOC Central Pharmacy staff who fill
prescription medication orders.
DOC’s Central Pharmacy purchases medications through a national
purchasing consortium that negotiates high-volume contracts with
pharmaceutical companies. The number of psychotropic medication
orders it filled increased by 32.6 percent from FY 2003-04 through
FY 2007-08, while expenditures for psychotropic medications
increased by only 13.0 percent. The difference suggests that DOC’s
efforts to limit costs have been successful. Appendix 1 presents
mental health care expenditures by DOC institution. Appendix 2
details DOC expenditures for the 20 prescription drugs for which
expenditures were highest in FY 2007-08.

Mental Health Care Organization
and Staffing
DOC’s Bureau of Health
Services oversees mental
health care services.

The Bureau of Health Services oversees the delivery of health care
and mental health care throughout DOC facilities. At individual
facilities, mental health care includes both psychiatry and psychology
services. Psychiatrists, who are licensed physicians, provide
psychiatric assessments of inmates and prescribe and monitor
psychotropic medications. They are primarily limited-term
employees and report directly to the psychiatry director in the
Bureau of Health Services.

I NTRODUCTION

Psychology staff are organized into psychological services units that
report to the deputy warden at each institution. Most correctional
centers send inmates to nearby adult institutions to receive mental
health treatment. Psychological services unit staff include:
masters- and doctoral-level psychologists who
administer mental health assessments, monitor the
mental health status of inmates, and provide
group and individual therapy;
psychological services assistants, who provide
support services to psychologists such as
administering and analyzing psychological tests;
crisis intervention workers, who help identify,
prevent, and manage sources of stress that may
lead to crises within an institution, primarily in
segregation units;
psychological services unit clerical staff, who
provide general office support duties, such as
maintaining inmates’ psychological services unit
files; and
psychologist interns, who are enrolled in doctorallevel psychology programs and undertake a
variety of assignments, including assisting in
psychological assessments and individual and
group therapy.
In FY 2007-08, DOC had
127.35 FTE authorized
mental health positions.

As shown in Table 2, DOC had 127.35 authorized full-time
equivalent (FTE) mental health positions in FY 2007-08, which is an
increase of 5.8 percent from FY 2003-04 staffing levels. In FY 2007-08,
69.9 percent of all FTE mental health positions were psychologists.
The number of psychologists has increased in part because DOC is
in the process of converting crisis intervention worker positions to
psychologist positions, which it believes will improve mental health
treatment. Appendix 3 shows FTE staffing by institution.

I NTRODUCTION

Table 2
Authorized FTE Mental Health Positions
Department of Corrections
Position Type

FY 2003-04

FY 2004-05

FY 2005-06

FY 2006-07

FY 2007-08

72.50

81.00

84.00

85.50

89.00

15.85

15.35

5.00

4.00

Psychology Staff
Psychologists
Psychological Services Unit
Clerical Staff
Psychological Services
Assistants
Other Mental Health Staff1
Crisis Intervention Workers

18.00

13.00

11.00

10.00

Social Workers

3.00

Treatment Specialists

2.00

Nurse Clinicians

1.00

Correctional Officers

1.00

Psychiatrists2

2.00

120.35

122.35

123.35

123.85

127.35

Total
1

1.0 FTE clinical social worker provided mental health treatment services at the Milwaukee Secure Detention Facility from FY 2003-04
through FY 2007-08. All other social work, treatment specialist, nurse clinician, and correctional officer positions were assigned to
substance abuse and mental health treatment programs at Oshkosh and Taycheedah correctional institutions.

Most psychiatrists are limited-term employees; see Table 3.

Most institution
psychiatrists are limitedterm employees.

Limited-term employees (LTEs) provide a significant proportion of
mental health services to inmates. In particular, all psychiatrists at
DOC institutions hold LTE positions because DOC reports it is
unable to recruit psychiatrists as permanent, full-time employees.
As shown in Table 3, LTE positions increased from the equivalent
of 9.84 full-time positions in FY 2003-04 to the equivalent of
21.51 full-time positions in FY 2007-08. Psychiatrists accounted
for 53.4 percent of all LTE hours in FY 2007-08, when a total of
36 individuals filled the equivalent of 11.49 full-time positions.
Appendix 4 shows LTE staffing by institution.

I NTRODUCTION

Table 3
Estimated LTE Mental Health Positions1
Department of Corrections
Position Type

FY 2003-04

FY 2004-05

FY 2005-06

FY 2006-07

FY 2007-08

Psychiatrists2

7.23

8.41

8.05

10.72

11.49

Psychologist
Interns

1.78

1.86

3.43

3.77

3.60

Psychological
Consultants

0.78

1.83

1.40

3.47

3.36

Psychological
Services Assistants

0.00

1.06

1.89

Psychological Services Unit
Clerical Staff

0.00

0.25

0.03

0.63

Crisis Intervention
Workers

0.05

0.18

0.20

0.70

0.54

Total

9.84

12.28

13.33

19.75

21.51

Estimates based on hours worked during the fiscal year.

Does not include contract psychiatrists.

Wisconsin Resource Center Staffing
There were 404.10 FTE
positions authorized to
provide services to
inmates at WRC in
FY 2007-08.

WRC is a DHS facility that houses some seriously mentally ill DOC
inmates, along with sexually violent persons who have been civilly
committed under s. 980.06, Wis. Stats. Most staff at WRC are DHS
employees. As shown in Table 4, the number of FTE staff providing
services to WRC inmates remained relatively stable from FY 2003-04
through FY 2007-08. Nearly one-half of those positions were filled
by psychiatric care staff, who help implement and document mental
health treatment plans and provide security on housing units. WRC
infrequently relies on LTE staff to provide mental health services.
In FY 2007-08, LTE mental health staff worked the equivalent of
0.64 full-time positions.

I NTRODUCTION

Table 4
Authorized FTE Positions at WRC1
Department of Health Services
Position Type

FY 2003-04

FY 2004-05

FY 2005-06

FY 2006-07

FY 2007-08

201.10

15.00

Mental Health Staff
Psychiatric Care Staff
Psychologists
Psychiatrists

9.00

8.50

7.50

Psychiatric Nurses

0.00

1.00

3.00

225.10

224.60

226.60

Nursing Staff

29.00

Social Services Staff

13.00

14.00

Teaching Staff

11.50

8.00

Subtotal
Other Direct Care Staff

Occupational Therapists
Recreation Leaders

4.00

Physicians

0.75

1.25

2.15

2.20

Chaplain

1.00

Dietitians

1.14

1.00

Dental Staff

1.00

Client Rights Facilitator

0.50

69.89

71.39

71.25

72.15

72.20

Administrative and
Service Staff2

110.11

108.11

104.80

105.30

Total

405.10

404.10

400.65

401.55

404.10

Subtotal

DHS positions serving DOC inmates. Does not include positions devoted to civilly-committed sexually violent persons. However,
some WRC inmate service staff provide sexually violent persons services in the event of staff shortages, while psychiatrists’ caseloads
routinely include inmates and sexually violent persons.

Includes staff assigned to the Winnebago Mental Health Institute, which is located on the same grounds as WRC, who provide
services such as food service for WRC inmates.

I NTRODUCTION

Although WRC employs psychiatrists in permanent positions,
officials noted difficulties with recruitment and retention. For
example, in FY 2006-07, 2.5 of the 7.5 authorized psychiatrist
positions were filled. In FY 2007-08, 2.0 positions remained vacant.
To address these vacancies, WRC began a pilot program in
FY 2006-07 that employed specialized nurse clinicians to assist
psychiatrists in providing services such as aiding with psychiatric
assessments. WRC officials believe the pilot program was successful.
DOC correctional staff
provide security services
at WRC.

As noted, DHS psychiatric care staff provide security services
directly on WRC’s housing units, while DOC correctional staff
provide security services elsewhere in the facility. In FY 2007-08,
there were 96.0 FTE DOC correctional staff positions at WRC, as
shown in Table 5.

Table 5
Authorized Correctional Staff Positions at WRC1
Department of Corrections
Position Type

FY 2003-04

FY 2004-05

FY 2005-06

FY 2006-07

FY 2007-08

Correctional Officers

64.0

63.0

Correctional Sergeants

26.0

7.0

8.0

7.0

97.0

98.0

97.0

96.0

Supervising Officers
Total
1

All position counts are full-time equivalent.

Mental Health Classification System
Mental Health Screening and Assessment
Numbers and Characteristics of Mentally Ill Inmates
Developmentally Disabled Inmates

Screening, Assessment, and
Identification
When inmates enter DOC custody, they are screened for mental
health problems and assigned mental health codes based on the
severity of their illnesses. We reviewed DOC’s classification system,
analyzed institutions’ compliance with DOC policies on mental health
screening and assessment, and analyzed DOC data on the number
and characteristics of mentally ill inmates. We also analyzed available
information on the number of developmentally disabled inmates.

Mental Health Classification System
At the time of our 2001 report on prison health care (report 01-9),
DOC did not maintain statistics on the number of inmates with
diagnosed mental illnesses. Therefore, that report estimated the
number of mentally ill inmates based on the number of inmates
for whom psychotropic medications were prescribed by DOC
psychiatrists, or who were receiving treatment at WRC. This
estimate likely undercounted the number of mentally ill inmates,
and the lack of a consistent classification system made it difficult for
DOC or others to assess mental health care needs in state prisons.
DOC implemented a
mental health
classification system
in 2004.

In an effort to track the number of mentally ill inmates and improve
mental health care, DOC implemented a mental health classification
system in mid-2004. As shown in Table 6, inmates are classified
based on the severity of their illnesses: a code of MH-0 identifies
inmates who do not have any mental health needs, a code of MH-1
identifies inmates who have some mental health needs but are not
seriously mentally ill, and a code of MH-2 identifies inmates who
are seriously mentally ill. The MH-1 code is used to identify inmates
whose mental health needs are short-term or do not meet the criteria

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for a formal diagnosis, as well as those with mental illnesses that
are less severe than those categorized as serious mental illnesses
(MH-2). In this report, we use the general term “mental illness” to
encompass either an MH-1 or MH-2 code. This definition is more
inclusive than some definitions of mental illness, but it serves to
include the inmates on DOC’s mental health caseload. Appendix 5
includes descriptions of selected disorders.

Table 6
Mental Health Classification Codes Used by DOC
Mid-2004 through June 2008
Code

Classification

Common Diagnoses

MH-0

No mental health need

None.

MH-1

Mental health need; not
seriously mentally ill

Anxiety disorders; adjustment disorder; impulse
control disorder; mood disorders; borderline
personality disorder (mild or moderate).

MH-2

Seriously mentally ill

Psychotic disorders; major depression; bipolar
disorder; dementia (moderate or severe); borderline
personality disorder (severe); severe dysthymia;
severe anxiety disorders; mood disorders; organic
brain syndrome.

MH-3

Mental retardation

IQ of approximately 70 or below with concurrent
impairments in adaptive functioning.

All inmates prescribed psychotropic medications are to be classified
as either MH-1 or MH-2. DOC’s definition of serious mental illness
was first established by the federal district court under the terms of
the January 2002 Supermax settlement agreement and is consistent
with definitions that resulted from litigation elsewhere in the
country. A code of MH-3 identifies inmates with mental retardation,
which DOC defines as an IQ of approximately 70 or below with
concurrent impairments in adaptive functioning. Mental health
classification codes are assigned when inmates enter DOC custody
and are to be updated as needed.
To address limitations in its mental health classification system,
DOC further refined its mental health codes in June 2008. DOC
divided the MH-2 code into two categories. A code of MH-2a
identifies inmates with disorders that include schizophrenia, bipolar
disorder, and major depressive disorder. It is also used to identify
inmates who have any diagnosed mental illness that significantly
impairs their ability to function. A code of MH-2b identifies inmates
with personality disorders that are severe and accompanied by
significant functional impairment, such as borderline personality
disorder.

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In June 2008, DOC also eliminated the MH-3 code, which it replaced
with a separate designation of developmentally disabled. The
criteria used to identify inmates who are developmentally disabled
are the same as those used for the MH-3 code. However, an inmate
could not be assigned more than one mental health code under the
old system. Under the revised system, an inmate can be classified as
both mentally ill and developmentally disabled. Because DOC
began implementing the revised codes in June 2008, we did not use
them in our data analysis or case file review.

Mental Health Screening and Assessment
Inmates are screened for
mental illnesses upon
entering DOC custody.

Offenders placed under DOC custody typically enter the prison
system through one of two facilities. Dodge Correctional Institution
is the intake facility for male inmates, while Taycheedah
Correctional Institution is the intake facility for female inmates.
During the intake and assessment process, which occurs over a
period of approximately one month, DOC staff conduct a variety of
screenings and assessments, including medical and mental health
screenings, to determine each inmate’s security classification and
programming needs. Inmates may also be screened or assessed
upon transfer to a new institution and at other times as needed.
DOC policy requires staff in the psychological services units at intake
facilities to perform a mental health intake screening within two
working days of an inmate’s arrival. However, inmates may be
screened immediately if they had been on suicide watch while in the
county jail, if they report having recently experienced suicidal thoughts
or behaviors or are experiencing visual or auditory hallucinations,
or if they appear to be disoriented or in psychological distress.
During the mental health screening, inmates are asked a series of
questions to assess their current mental health status and mental
health history, including whether they:
are currently or have previously taken
psychotropic medication;
have ever been hospitalized for psychological
problems;
have a history of self-harm behaviors or suicide
attempts; and
are currently experiencing any symptoms of
mental illness, including suicidality.

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The screening psychologist then assigns a provisional mental
health classification code and makes follow-up and placement
recommendations. Psychological services staff at Dodge
Correctional Institution estimated that 98 percent of inmates are
screened within 24 hours of arrival, while psychological services
staff at Taycheedah Correctional Institution reported that while they
try to screen inmates within one working day of arrival, the average
time frame in which inmates are screened is slightly over two days.
In order to evaluate the extent to which institutions comply with
DOC policies and procedures regarding inmate mental health,
as well as the types and extent of services received by mentally
ill inmates, we interviewed staff at 13 adult institutions and
4 correctional centers. We also conducted a detailed file review
of a random sample of 200 inmates who were incarcerated between
July 1, 2006, and June 30, 2008, including 100 who were assessed as
having mental health needs but not seriously mentally ill (MH-1)
and 100 who were assessed as seriously mentally ill (MH-2). Of the
200 inmates, 150 were male and 50 were female.
Most inmates in our
sample were screened
within two days of
entering DOC custody.

Intake screening data were available for 158 of the 200 inmates. As
shown in Table 7, 67.7 percent were screened within two days of
arrival, including 20 who were screened the same day. However,
20 other inmates, or 12.7 percent, were screened five or more days
after arrival.

Table 7
Time Frame for Completion of Intake Mental Health Screenings1
Male
Inmates

Female
Inmates

All
Inmates

Same day

12.7%

1 day

48.7

2 days

6.3

3 days

15.2

4 days

4.4

5 or more days

12.7

112

158

100.0%

Days after Arrival

Total
1

Percentage
of Total

For a sample of 200 inmates incarcerated between July 1, 2006, and June 30, 2008.
Intake screening data were available for 158 inmates.

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When a mentally ill inmate (MH-1 or MH-2) is transferred between
facilities, DOC policy requires that psychological services staff at the
receiving facility conduct a transfer file review within five working
days to assess the inmate’s prior mental health treatment, history of
self-harm, and suicide risk; determine his or her need for follow-up
treatment; and prioritize inmates for face-to-face interviews. Of
the ten receiving institutions we visited, four reported that they
perform the transfer file reviews for inmates with mental illnesses
as required by policy, while six reported that they exceed the
requirements of policy and perform file reviews for all inmates,
including those without identified mental illnesses, in part because
inmates may have been misclassified or have a history of mental
health problems that were not identified.
DOC staff generally
complete timely file
reviews when mentally ill
inmates are transferred
between institutions.

As shown in Table 8, 69 of the 96 transfer file reviews we analyzed,
or 71.9 percent, occurred within seven days of an inmate’s transfer.
However, 11 were completed 15 or more days following the transfer.
While the reasons for the delays are not recorded in the files, staff
noted that on occasion files may not arrive on time or may be sent to
the wrong location, and staffing shortages sometimes preclude
timely completion of the file reviews. Staff also noted that
performing file reviews reduces time spent providing direct care.

Table 8
Time Frame for Completion of Transfer File Reviews1

Days after Transfer

Male
Inmates

Female
Inmates

All
Inmates

Percentage
of Total

7 days or less

71.9%

8-14 days

16.7

15 days or more

11.4

Total

100.0%

For a sample of 200 inmates incarcerated between July 1, 2006 and June 30, 2008. Not all inmates were transferred
between institutions during this time, and some were transferred more than once.

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Numbers and Characteristics of
Mentally Ill Inmates
As of June 2008,
31.0 percent of adult
inmates were identified
as mentally ill.

As shown in Table 9, the inmate population increased from 21,610 in
June 2006 to 22,451 in June 2008, which is 3.9 percent. During that
time, the number of mentally ill inmates increased from 6,084 to
6,957, or 14.3 percent. The percentage of inmates classified as having
mental health needs but not seriously mentally ill (MH-1) increased
slightly, from 17.9 percent to 20.9 percent, while the percentage of
inmates classified as seriously mentally ill (MH-2) remained
relatively stable.

Table 9
Inmates by Mental Health Code1

Mental
Health Code

June 2006
Percentage
Inmates
of Total

MH-0

14,900

68.9%

June 2007
Percentage
Inmates
of Total
15,174

68.2%

June 2008
Percentage
Inmates
of Total
14,943

66.6%

MH-1

3,860

17.9

4,359

19.6

4,694

20.9

MH-22

2,224

10.3

2,241

10.1

2,263

10.1

MH-3
Code Missing
Total

0.3

566

2.6

399

1.8

479

2.1

21,610

100.0%

22,247

100.0%

22,451

100.0%

Excludes inmates incarcerated on certain temporary holds, as well as those at the Milwaukee Secure Detention Facility,
for whom limited mental health information was available.

Inmates with mental illnesses.

The percentage of
inmates who are
mentally ill is highest at
maximum security
institutions.

As shown in Table 10, 43.0 percent of inmates at maximum security
institutions in June 2008 were identified as mentally ill, followed
by 29.9 percent at medium security institutions and 16.6 percent
at minimum security institutions. There were 3,354 mentally ill
inmates at medium security facilities, which house one-half of
all inmates.

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Table 10
Mentally Ill Inmates by Institution1
June 2008

Institution

Mentally Ill
Inmates2

All Inmates

Percentage
of Inmates Who
Are Mentally Ill2

Maximum Security
Taycheedah3
Columbia
Waupun
Green Bay
Dodge
Wisconsin Secure Program Facility4
Subtotal

528
413
546
443
507
120
2,557

683
827
1,240
1,091
1,693
418
5,952

Medium Security
Oshkosh
Jackson
Kettle Moraine
Redgranite
Fox Lake (Medium Security)
Racine
Racine Youthful Offender
New Lisbon
Stanley
Prairie du Chien
Subtotal

722
334
390
322
313
472
126
277
316
82
3,354

2,026
959
1,192
996
1,027
1,547
431
1,010
1,536
491
11,215

35.6
34.8
32.7
32.3
30.5
30.5
29.2
27.4
20.6
16.7
29.9

Minimum Security
Wisconsin Correctional Center System5
Chippewa Valley
Sturtevant Transitional Facility
Fox Lake (Minimum Security)
Oakhill
Subtotal

447
69
16
39
88
659

2,437
437
110
298
677
3,959

18.3
15.8
14.5
13.1
13.0
16.6

Other
Wisconsin Resource Center
Other
County Jails
Out of State
Subtotal

299
10
73
5
387

311
58
826
130
1,325

96.1
17.2
8.8
3.8
29.2

6,957

22,451

31.0

Total

77.3%
49.9
44.0
40.6
29.9
28.7
43.0

Excludes inmates incarcerated on certain temporary holds, as well as those at the Milwaukee Secure Detention Facility, for
whom limited mental health information was available.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2).

Taycheedah Correctional Institution houses both maximum and medium security female inmates.

All 120 mentally ill inmates at the Wisconsin Secure Program Facility were identified as having mental health needs (MH-1).
Inmates with serious mental illnesses (MH-2) are not placed at the facility as a result of the 2002 settlement agreement.

Includes inmates at both men’s and women’s correctional centers.

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A greater percentage of
female inmates are
identified as mentally ill.

AND

I DENTIFIC ATION

Table 11 shows the characteristics of mentally ill inmates as of
June 2008. Female inmates had a significantly higher incidence of
identified mental illnesses, 64.3 percent, compared to male inmates,
for whom the rate was 28.8 percent. The incidence of mental illnesses
was highest among white and American Indian inmates. In addition,
younger inmates were less-frequently diagnosed with mental
illnesses than were older inmates. We also found that mentally ill
inmates were slightly more likely to report prior military service.

Table 11
Inmate Characteristics1
June 2008
Percentage
of Inmates Who
Are Mentally Ill2

Mentally Ill Inmates2

All Inmates

877

1,364

Male

6,080

21,087

28.8

Total

6,957

22,451

31.0

3,886

9,988

Characteristic
Gender
Female

64.3%

Race/Ethnicity
White

38.9%

American Indian

270

695

38.8

Hispanic

471

1,828

25.8

2,291

9,670

23.7

Asian or Pacific Islander

192

15.1

Unknown/Other

12.8

6,957

22,451

31.0

184

19 to 24

986

3,678

26.8

25 to 34

2,149

7,593

28.3

35 to 44

2,016

5,973

33.8

45 to 54

1,292

3,696

35.0

African-American

Total
Age
18 and under

55 and older

24.5%

469

1,327

35.3

6,957

22,451

31.0

6,044

19,506

Yes

608

1,771

34.3

Unknown

305

1,174

26.0

6,957

22,451

31.0

Total
Prior Military Service

Total

31.0%

Excludes inmates incarcerated on certain temporary holds, as well as those at the Milwaukee Secure
Detention Facility, for whom limited mental health information was available.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2).

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Although reliable and comparable data are not readily available on
a national basis, research suggests that the gender and racial/ethnic
differences among DOC inmates are consistent with national trends.
DOC officials attribute these differences, in part, to gender and
cultural differences in inmates’ willingness to seek mental health
care.
Similar percentages of
mentally ill inmates and
inmates without identified
mental illnesses committed
crimes against persons.

As shown in Table 12, similar percentages of mentally ill inmates
and inmates without mental health needs committed crimes against
persons, such as battery, robbery, or homicide. Mentally ill inmates
were slightly more likely to have committed sexual offenses than
were inmates with no identified mental health needs, but they were
somewhat less likely to have committed drug offenses.

Table 12
Mental Illness Status and Criminal Offenses1
June 2008

Type of Offense

No Mental Health Needs
Inmates
Percentage
Convicted
Convicted
of Offense
of Offense

Mentally Ill2
Inmates
Percentage
Convicted
Convicted
of Offense
of Offense

Crimes Against Persons

9,357

62.6%

Drug Offense

3,319

22.2

939

13.5

Sexual Offense

2,906

19.4

1,764

25.4

Number of Inmates3

14,943

4,551

65.4%

6,957

Excludes inmates incarcerated on certain temporary holds, as well as those at the Milwaukee Secure Detention Facility,
for whom limited mental health information was available.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2).

Inmates may have committed more than one type of offense or an offense that does not fall into one of these categories.

DOC does not maintain automated data on inmates’ diagnoses.
However, as part of our file review, we noted mental illness
diagnoses for 185 of the 200 inmates in our sample. Multiple
categories were recorded for 162 inmates, including 20 inmates
with diagnoses in five or more categories. However, it was unclear
whether the diagnoses occurred simultaneously or at different
times, in part because inmates’ diagnoses were not consistently
documented or routinely updated.

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As shown in Table 13, the most common disorders with which
mentally ill inmates in our sample were diagnosed were those
related to substance abuse: 113, or 61.1 percent of the 185 inmates
for whom we were able to obtain data were diagnosed with these
disorders. However, it is important to note that inmates are not
assigned a mental health code solely because of substance abuse
problems. Personality disorders were the second most common
diagnoses, while depressive disorders were third.

Table 13
Inmates’ Mental Illness Diagnoses1

Diagnosis Category2

Female
Inmates

Percentage
of Female
Inmates with
Diagnosis

Male
Inmates

Percentage of
Male Inmates
with Diagnosis

All
Inmates

Percentage
of All Inmates
with Diagnosis

Substance Abuse Disorders3

61.2%

61.0%

Personality Disorders

32.7

51.5

46.5

Depressive Disorders

53.1

40.4

43.8

Schizophrenia/Psychotic Disorders

18.4

25.7

23.8

Other Disorders4

12.2

27.2

23.2

Anxiety Disorders

24.5

15.4

17.8

Mood Disorders

20.4

13.2

15.1

Bipolar Disorder

24.5

11.0

14.6

Post Traumatic Stress Disorder

113

61.1%

26.5

8.1

13.0

Adjustment Disorder

10.2

12.5

11.9

Attention Deficit Hyperactivity Disorder

12.2

5.9

7.6

Impulsivity/Anger Disorders

0.0

8.8

6.5

Borderline Intelligence/Mental Retardation

2.0

5.1

4.3

For 185 out of a sample of 200 inmates incarcerated between July 1, 2006, and June 30, 2008, including 49 females and 136 males.

Inmates may have been diagnosed with more than one disorder.

Inmates are not assigned a mental health code solely because of substance abuse problems.

Includes a variety of disorders, such as sleep disorders, obsessive-compulsive disorder, eating disorders, dementia, delusional disorders, and
bereavement.

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Developmentally Disabled Inmates
As noted, DOC defines developmental disability as an IQ of
approximately 70 or below with concurrent impairments in adaptive
functioning. This definition is narrower than the definition in
s. 51.01(5)(a), Wis. Stats., which includes disabilities attributable to
brain injury, cerebral palsy, epilepsy, autism, Prader-Willi
syndrome, mental retardation, or another neurologic condition
closely related to mental retardation or requiring treatment similar
to that required for individuals with mental retardation.
Not all inmates
are screened for
developmental
disabilities.

As of June 2008, DOC
identified 72 inmates as
developmentally
disabled.

Aside from the mental health intake screening, during which inmates
are asked whether they received special education services, DOC
does not routinely screen for developmental disabilities because
staffing is limited and because IQ tests—the primary method by
which developmentally disabled inmates are identified—are
time-consuming to administer and score. However, psychologists
sometimes choose to administer IQ tests to inmates they suspect are
developmentally disabled, and some inmates may be identified as
developmentally disabled based on tests administered before their
incarceration. For example, psychological services staff at Dodge
Correctional Institution reported they administer IQ tests to some
inmates they believe may be developmentally disabled and for whom
prior test results are not available. Psychological services staff at
Taycheedah Correctional Institution reported that they rarely
administer IQ tests; however, psychology interns may perform some
testing, and the institution may attempt to obtain external test results
if inmates report that they received special education services.
As of June 2008, DOC identified 72 developmentally disabled
inmates (those classified as MH-3). As shown in Table 14, Racine
Correctional Institution, which has a program for low-functioning
sex offenders, housed the largest number, 20.8 percent of the total.

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Table 14
Developmentally Disabled Inmates1
June
2006

June
2007

June
2008

Columbia

Green Bay

6.9

Waupun

4.2

Taycheedah2

1.4

Dodge

0.0

Institution

2008 Percentage
of Total

Maximum Security

Wisconsin Secure Program Facility
Subtotal

12.5%

0.0

25.0

20.8

Medium Security
Racine
Oshkosh

9.7

Stanley

8.3

Kettle Moraine

6.9

Jackson

2.8

New Lisbon

2.8

Racine Youthful Offender

2.8

Redgranite

2.8

Fox Lake (Medium Security)

1.4

Prairie du Chien

0.0

58.3

Oakhill

1.4

Wisconsin Correctional Center System3

1.4

Subtotal
Minimum Security

Chippewa Valley

0.0

Fox Lake (Minimum Security)

0.0

Sturtevant Transitional Facility

0.0

Subtotal

2.8

12.5

County Jails

1.4

Other

0.0

Other
Wisconsin Resource Center

Out of State

0.0

Subtotal

13.9

Total

100.0%

Includes inmates categorized as MH-3 (mentally retarded). This category was changed to DD (developmentally disabled)
in June 2008. Excludes inmates incarcerated on certain temporary holds, as well as those at the Milwaukee Secure
Detention Facility, for whom limited mental health information was available.

Taycheedah Correctional Institution houses both maximum and medium security female inmates.

Includes inmates at both men’s and women’s correctional centers.

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Although the figures in Table 14 represent the best available data,
they underestimate the number of developmentally disabled
inmates in DOC custody. As noted, before June 2008, inmates who
were developmentally disabled and seriously mentally ill would be
classified only as seriously mentally ill. In addition, because DOC
does not routinely screen or test inmates for developmental
disabilities, DOC officials as well as interest groups believe that
some developmentally disabled inmates remain unidentified under
the current classification procedures. We attempted to assess the
prevalence of developmental disabilities among inmates; however,
institution staff and interest group representatives provided a wide
range of estimates, and the extent to which their estimates were
based on DOC’s definition of developmental disability or a broader
definition—for example, the statutory definition or one that includes
inmates with borderline intellectual functioning—was unclear.
Interest groups expressed concern that developmentally disabled
inmates who fail to be identified may not be housed separately from
the general inmate population and, as a result, may be at risk of abuse
and victimization. In addition, DOC’s current practices for screening
and identifying developmentally disabled inmates are not consistent
with NCCHC standards, which specify that mental health screenings
should include an assessment of intellectual functioning. The NCCHC
standards also specify that inmates identified as possibly “mentally
retarded” should be further evaluated using a comprehensive
instrument, such as the Wechsler Adult Intelligence Scale.
Better screening for
developmental disabilities
could help ensure proper
identification and
treatment.

DOC’s policies also differ from those of Illinois, Iowa, Michigan, and
Minnesota, which reported that inmates are to be screened for
developmental disabilities as part of the intake process. Adoption
and use of a screening tool to assess intellectual functioning could
help ensure that all developmentally disabled inmates are identified.

Recommendation
We recommend the Department of Corrections report to the Joint
Legislative Audit Committee by January 4, 2010, on its evaluation of:
options for screening tools to assess intellectual
functioning;
tests to further evaluate inmates who are
identified as potentially developmentally disabled;
and
the potential costs of implementing those tools.

Housing of Mentally Ill Inmates
Staffing Ratios
Psychological Services
Psychiatric Services
Other DOC Programs

Monitoring and Treatment
Some mentally ill inmates are housed in specialized facilities or
units, but most are housed with other inmates. Throughout DOC
facilities, psychologists respond to crises, provide individual
counseling and group therapy, and monitor inmates’ conditions.
Psychiatrists prescribe psychotropic medications and monitor their
effectiveness. We reviewed the types and frequencies of mental
health services provided to mentally ill inmates, the number of
inmates prescribed psychotropic medications, and the processes by
which psychotropic medications are prescribed and delivered.

Housing of Mentally Ill Inmates
An inmate’s mental
health classification
usually does not affect
facility assignment.

Following the intake and assessment process, DOC assigns inmates
to institutions and correctional centers based on their security
classifications, programming recommendations, and treatment
needs and the facilities’ available space. In most cases, an inmate’s
mental health classification does not affect facility assignment.
However, seriously mentally ill inmates are not placed at the
Wisconsin Secure Program Facility (formerly Supermax) under
DOC policy, as was required by the terms of the 2002 settlement
agreement, and mentally ill inmates are generally not placed at
minimum security institutions or the centers unless a psychologist
has determined they are mentally stable.
Seriously mentally ill inmates whose needs exceed the services at
DOC institutions may be placed at WRC, while other inmates who

M ONITORING

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T REATMENT

are deemed vulnerable or have difficulty functioning in the general
population because of their mental illnesses may be assigned to an
institution with a special management unit. Special management
units—which are located at Dodge, Columbia, and Taycheedah—do
not provide the same level of services as WRC. However, they have
more flexible disciplinary procedures than general population units,
and inmates are monitored more closely.
In addition to the three institutions with formal special management
units, a number of institutions have created informal special housing
units for some inmates who have difficulty in the general population
because of mental illnesses or developmental disabilities. However,
inmates are not assigned to institutions with these units specifically
because of their mental illnesses, and these units do not provide the
same level of services as special management units.
As of January 2008,
nine institutions operated
specialized units that
house some mentally
ill inmates.

As of January 2008, nine institutions operated either special
management units or other special housing units, as shown in
Table 15. However, none of the special management units were
located at medium security institutions, despite the fact that one-half
of all inmates and the largest number of mentally ill inmates are
housed there.

Staffing Ratios
Psychology staffing ratios
vary across institutions.

The American Association for Correctional Psychology recommends
1.0 FTE psychological services staff position for every 150 to
160 inmates within an institution. We found that only four
institutions met this standard as of June 2008, as shown in Table 16.
The systemwide ratio was 197 inmates per psychological services
staff position, and the considerable variation across institutions is
not explained by differences in the numbers of mentally ill inmates.
The staffing ratios at Taycheedah—57 inmates per psychologist
and 44 mentally ill inmates per psychologist—reflect recent
staffing increases that resulted from the federal Department of
Justice investigation.

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Table 15
Specialized Housing Units at DOC Institutions
January 2008

Institution

Unit Characteristics

Beds in Unit

Mentally Ill
Inmates at Institution1, 2

110

413

Special
Management Units
Columbia

Lower psychology staffing ratio than general
population units. A variety of group sessions are
offered. A phase system is used for discipline.

Dodge

Inmates have more frequent contact with
psychologists compared to general population units.
Inmates are housed in single cells and receive more
out-of-cell time.

507

Taycheedah

Mental health staff on the unit. More extensive
programming than general population units. Also
offers a dual diagnosis substance abuse and mental
health program. Staff develop a treatment plan for
each inmate.

528

Milwaukee Secure
Detention Facility3

Mental health staff on the unit. Inmates participate in
weekly groups.

–

Green Bay

Inmates have access to a teacher on the unit and
receive more out-of-cell time compared to inmates in
general population units. Social workers provide
16 hours of group therapy, 6 hours of evaluation, and
4-5 hours of individual counseling each month.

443

Oshkosh (Transitional
Program)

Mental health staff on the unit. Staff conduct inmate
reviews weekly and face-to-face evaluations every 30
days. Inmates may also attend a personal
management group.

722

Oshkosh (Mentally Ill
Chemical Abusers
Program)

A dual diagnosis program for seriously mentally ill
inmates who also have substance abuse problems.
Mental health staff are on the unit and inmates are
reviewed weekly. Inmates participate in 8 hours of
programming per day.

722

Racine

Group sessions are offered on the unit. Inmates
receive incentives for good hygiene.

472

Redgranite

A recreation leader is on the unit. Inmates may
participate in activities such as walks and book club.

250

322

Stanley

More recreation time and more flexible disciplinary
procedures than general population units.

316

Other Special
Housing Units

As of June 2008. Excludes inmates incarcerated on certain temporary holds, as well as those at the Milwaukee Secure Detention Facility,
for whom limited mental health information was available.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2).

The number of mentally ill inmates at the Milwaukee Secure Detention Facility is unknown because limited mental health information
is available.

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Table 16
Psychology Staffing Ratio1
June 2008
Mentally Ill Inmates
per Psychologist1, 3

Total Inmates per
Psychologist

121

276

Green Bay

198

Dodge

169

Columbia

138

Wisconsin Secure Program Facility

Maximum Security Ratio

138

491

Fox Lake

101

379

Oshkosh

Institution2
Maximum Security
Waupun

Taycheedah

Medium Security
Prairie du Chien
5

103

289

Kettle Moraine

265

Stanley

256

Racine6

237

New Lisbon

202

Redgranite

199

Jackson

192

Racine Youthful Offender

108

Medium Security Ratio

242

Chippewa Valley

437

Oakhill

226

Minimum Security Ratio

279

Systemwide Ratio

197

Minimum Security

Includes masters- and doctoral-level psychologists, psychological services assistants, and crisis intervention workers.

Does not include the Milwaukee Secure Detention Facility, for which limited inmate mental health information
was available, or the correctional centers, which have limited mental health staff.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously
mentally ill (MH-2).

Taycheedah Correctional Institution houses maximum and medium security female inmates.

Fox Lake Correctional Institution houses medium and minimum security inmates.

Includes Sturtevant Transitional Facility, with which Racine Correctional Institution shares mental health staff.

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DOC institutions do not
meet recommended
psychiatry staffing ratios.

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Because psychotropic medications prescribed by psychiatrists can
have serious side effects and reactions to medications can change
over time, the American Psychiatric Association recommends a
minimum of 1.0 FTE psychiatrist for every 150 inmates on
psychotropic medications. We compared the estimated number of
psychiatrist positions based on hours worked during FY 2007-08
to the number of inmates on psychotropic medication and found
that DOC’s systemwide ratio of 345 inmates per psychiatrist was
more than two times the American Psychiatric Association’s
recommendation. DOC records do not allow for complete and
accurate identification of psychiatrist hours worked by institution,
but they indicate that:
no institution met the American Psychiatric
Association’s recommendation;
maximum security institutions had the fewest
inmates on medication per psychiatrist, while
medium security institutions had the most; and
Taycheedah had a significantly lower psychiatry
staffing ratio than the institutions for male
inmates.

Psychological Services
Psychological services staff, including psychologists, psychological
assistants, crisis intervention workers, and psychologist interns,
provide a range of mental health services. In 2008, DOC listed crisis
intervention as the most important priority for psychological
services staff. Although DOC policy does not specify a time frame
for crisis intervention services, DOC officials indicated that it is
good clinical practice to provide these services on the same day
the need is identified, and all of the 13 institutions we visited
reported doing so.
Individual counseling on an ongoing basis is offered at some
institutions, although usually only on a limited basis to a small
number of inmates. Of the 13 institutions we visited:
2 reported that they do not offer any individual
therapy on an ongoing basis;
8 reported that individual therapy is provided
to a small number of inmates, usually between
10 and 30, on a regular basis;

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2 reported that psychologists routinely provide
inmates with short-term individual therapy,
which usually consists of two to three sessions;
and
1 reported that psychologists spend the majority
of their time providing individual therapy and
estimated that around 100 inmates receive weekly
or monthly therapy.
The availability of both
group and individual
therapy is limited.

The availability of group therapy is also limited. Of the 13 institutions
we visited, 4 do not offer any group therapy, 4 offer one group each,
and 5 offer multiple groups. Group topics vary. For example, some
groups have a specific focus, such as anxiety, depression, or trauma
and abuse, while others are general psychotherapy groups.
Groups generally meet one to two hours per week for between
6 and 16 weeks and can accommodate 12 to 20 inmates. Of the nine
institutions that provide group therapy, seven reported that there
are not enough groups to meet the inmates’ therapeutic needs.
Psychologists are also responsible for monitoring the mental status
of inmates on their caseloads. DOC policy does not specify the
frequency with which mentally ill inmates should be seen by a
psychologist for monitoring. However, DOC officials indicated they
would like seriously mentally ill (MH-2) inmates to be seen at least
once every three months, and inmates with less serious mental
health needs (MH-1) at least once every six months. DOC expects
these standards to be incorporated into policy early in 2009.
Staff at some institutions reported that they attempt to meet these
time frames. At other institutions, psychologists reported that
staffing ratios make it difficult to see inmates on a regular basis. For
example, staff at Columbia Correctional Institution estimated that
they meet the three-month standard for seriously mentally ill
inmates about 80 percent of the time but said they are unable to see
inmates with less serious mental health needs at six-month intervals.
Staff at Taycheedah Correctional Institution reported that
psychologists are not able to monitor inmates at the requested
intervals because they are too busy with crisis intervention and
other tasks.

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Psychologists document their contacts with inmates—including
crisis intervention, individual therapy, and others—on a form that
includes the date and reason for contact, a summary of the inmate’s
mental status, the inmate’s diagnosis and mental health code, and
treatment or follow-up plans. We reviewed psychology contacts
between July 1, 2006, and June 30, 2008, for the 200 inmates in our
sample and calculated their frequency, adjusting for the time each
inmate was incarcerated. As shown in Table 17, the median for
inmates with mental health needs was 2.5 psychology contacts
annually, which is approximately every 4.8 months. For seriously
mentally ill inmates, the median was 3.1, which is approximately
every 3.9 months. Eighteen of the 200 inmates in our sample did not
have any documented psychology contacts within our two-year
review period. However, six of these inmates were incarcerated at
WRC, which does not document psychology contacts on the
DOC form.

Table 17
Annual Psychology Contacts1

Gender

Mental Heath Needs (MH-1)
Inmates
Median Contacts

Seriously Mentally Ill (MH-2)
Inmates
Median Contacts

Inmates

Total
Median Contacts

Female

2.7

5.3

3.9

Male

2.5

3.0

135

2.5

Total

2.5

3.1

182

2.8

For a sample of 200 inmates incarcerated between July 1, 2006, and June 30, 3008, excluding 18 who did not have any documented
psychology contacts.

Psychologists most
frequently meet with
inmates to monitor their
mental health status.

As shown in Table 18, monitoring was the most commonly recorded
reason for contact, followed by inmate requests. We found that
female inmates were more likely than male inmates to receive
individual therapy and group therapy.

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Table 18
Reasons for Psychology Contacts1

Contacts

Percentage
of Total

Monitoring

313

25.0%

Inmate Request

305

24.3

Individual Therapy

133

10.6

Segregation Review

110

8.8

Reason

Referral

7.8

Group Therapy

5.7

Other

4.0

New Admission

3.8

Minimum Security Evaluation

3.0

Not Indicated

2.7

Observation Follow-up

2.4

Testing/Assessment

1.9

Total
1

1,254

100.0%

For a sample of 200 inmates incarcerated between July 1, 2006, and June 30, 3008,
excluding 18 who did not have any documented psychology contacts.

Psychiatric Services
Psychiatrists monitor
inmates who are
prescribed psychotropic
medications.

All inmates who are prescribed psychotropic medication when they
enter DOC custody are evaluated by a psychiatrist at either Dodge
or Taycheedah Correctional Institution. DOC officials indicated that
the time frame in which new inmates are seen by a psychiatrist
varies with staffing levels and has ranged from two to three weeks
after arrival when institutions are fully staffed to eight weeks when
positions are vacant. However, under the terms of the federal
Department of Justice settlement agreement, inmates at Taycheedah
must now be seen within ten days of arrival. Inmates may also be
seen by a psychiatrist for an initial evaluation if they are psychotic,
suicidal, or unable to control their behavior or if they are referred by
psychology or other staff.

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DOC policy does not specify the frequency with which inmates on
psychotropic medications should be seen by a psychiatrist, in part
because the intervals at which follow-up appointments should occur
can vary based on an inmate’s stability, medication type, and
whether the medication needs to be adjusted. Psychiatrists indicated
that inmates who are stable can be seen every three to four months,
while inmates who are unstable may need to be seen on a weekly or
monthly basis.
As shown in Table 19, the median number of psychiatry
appointments for inmates with mental health needs (MH-1) was
4.4 annually, which is approximately every 2.7 months, while the
median for seriously mentally ill inmates (MH-2) was slightly
higher, at 5.2 annually, which is approximately every 2.3 months.

Table 19
Annual Psychiatry Appointments1

Gender

Mental Health Needs (MH-1)
Median
Inmates
Appointments

Seriously Mentally Ill (MH-2)
Median
Inmates
Appointments

Total
Inmates

Median
Appointments

Female

5.2

7.0

5.5

Male

4.1

5.0

122

4.4

Total

4.4

5.2

169

4.8

For a sample of 200 inmates incarcerated between July 1, 2006, and June 30, 3008, excluding 31 who did not have any
documented psychiatry appointments.

As shown in Table 20, 888 of 1,090 follow-up psychiatry
appointments, or 81.5 percent, occurred within two weeks of the
date ordered by the psychiatrist. However, 202 appointments,
or 18.5 percent, occurred more than two weeks after ordered
follow-up, including 46 that occurred ten weeks or more after
ordered follow-up.

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Table 20
Time Frames for Follow-Up Psychiatry Appointments1
Time Frame

Appointments

Within 2 Weeks of Ordered
Follow-Up

Percentage of Total

888

81.5%

More than 2 Weeks After
Ordered Follow-Up
2.1 to 3.9 weeks

6.5

4.0 to 5.9 weeks

4.3

6.0 to 7.9 weeks

2.5

8.0 to 9.9 weeks

1.0

10 weeks or more
Subtotal
Total
1

4.2

202

18.5

1,090

100.0%

For a sample of 200 inmates incarcerated between July 1, 2006, and June 30, 3008, excluding
31 who did not have any documented psychiatry appointments.

Inmates Prescribed Psychotropic Medications
In June 2008,
3,869 inmates were
prescribed psychotropic
medications.

As shown in Table 21, 3,869 inmates were prescribed psychotropic
medications in June 2008. From June 2006 through June 2008,
the percentage of seriously mentally ill inmates (MH-2) prescribed
psychotropic medications remained relatively steady, ranging from
68.9 to 70.9 percent. For inmates with mental health needs (MH-1),
the percentage decreased from 49.3 percent to 43.2 percent. We also
found that 190 inmates, or 1.3 percent, who were coded as not
having mental health needs (MH-0) were prescribed psychotropic
medications. DOC officials indicated that there may have been
delays in assigning or recording mental health codes for these
inmates.

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Table 21
Inmates Prescribed Psychotropic Medications1
June 2008

Mental Health Code
No Mental Health Needs (MH-0)
Mental Health Need (MH-1)

Seriously Mentally Ill (MH-2)

Developmentally Disabled (MH-3)
Code Missing
Total

Inmates

Number Prescribed
Psychotropic Medications

Percentage Prescribed
Psychotropic Medications

14,943

190

4,694

2,030

2,263

1,586

70.1

37.5

479

7.5

22,451

3,869

17.2

1.3%
43.2

Includes inmates who had a prescription for a psychotropic medication filled in the previous month. Excludes inmates
incarcerated on certain temporary holds as well as those at the Milwaukee Secure Detention Facility, for whom limited
mental health information was available.

Inmates with mental illnesses.

Anti-depressants were the
most commonly prescribed
psychotropic medication.

Medications were adjusted
at approximately two-thirds
of psychiatry appointments.

Table 22 shows the 20 psychotropic medications most commonly
prescribed to inmates during June 2008. Six of the top ten most
commonly prescribed psychotropic medications were
anti-depressants, while two were anti-psychotics.
Psychiatrists are expected to monitor medications’ effectiveness and
side effects and adjust them as needed. We found that records for
about two-thirds of psychiatry appointments noted one or more
medication adjustments. For example, new medications were
prescribed at 27.9 percent of the appointments, medications were
discontinued at 22.0 percent of the appointments, and doses were
increased or decreased at 34.9 percent of the appointments.

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Table 22
Psychotropic Medications Most Commonly Prescribed to Inmates
June 2008

Drug Name (Brand)1

Commonly
Prescribed for2

Trazodone (Desyrel)

Depression

694

Fluoxetine (Prozac)

Depression

686

Citalopram (Celexa)

Depression

627

Mirtazapine (Remeron)

Depression

461

Diphenhydramine (Benadryl)

Allergies, Sleep Disorders

441

Risperidone (Risperdal)

Psychotic Disorders

402

Amitriptyline (Elavil)

Depression

333

Quetiapine (Seroquel)

Psychotic Disorders

333

Hydroxyzine (Atarax, Vistaril)

Anxiety

275

Venlafaxine (Effexor)

Depression

259

Bupropion (Wellbutrin)

Depression

249

Lithium (Eskalith, Lithobid)

Bipolar Disorder
Seizure Disorders, Bipolar
Disorder

244

213

Benztropine (Cogentin)
Clonazepam (Klonopin)

Psychotic Disorders
Side effects associated with
antipsychotic medications
Panic Disorders

Buspirone (BuSpar)

Anxiety

171

Sertraline (Zoloft)

Depression, Anxiety

166

Paroxetine (Paxil)

Depression, Anxiety

142

Doxepin (Sinequan)

Depression, Anxiety

105

Valproic Acid (Depakene)
Ziprasidone (Geodon)

Inmates with
Prescriptions3

219

201
172

DOC reports using generic medications when available. Brand names are listed for reference.

Some drugs may also be prescribed for uses other than those listed.

Inmates may be prescribed more than one psychotropic medication.

DOC’s Formulary
A committee of DOC
managers and medical
providers establishes
DOC’s drug formulary.

A committee of DOC managers and medical providers is responsible
for evaluating medication use, reviewing reports of medication
errors, and maintaining a formulary of medications that may be
prescribed without prior approval from DOC’s medical, mental
health, or psychiatry directors. Several factors affect whether a drug
is placed on the formulary, including its intended effect, potential
alternatives, cost, potential for dangerous or severe side-effects,
and whether it is habit-forming or prone to being abused in a
correctional setting.

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Psychiatrists may request nonformulary medications when
medications on the formulary are found to be ineffective or not
well-tolerated by an inmate, or if the formulary does not include an
alternative. For example, all stimulants, which are used to treat
attention deficit hyperactivity disorder, are nonformulary and
require prior approval. However, the psychiatrists with whom we
spoke believe the formulary contains an adequate selection of
medications capable of treating most inmates’ mental health needs.
An advocacy group we interviewed also spoke positively of DOC’s
formulary.
Nearly all requests
for nonformulary
psychotropic medications
were approved.

From FY 2003-04 through FY 2007-08, psychiatrists made
847 requests for nonformulary psychotropic medication, and
96.8 percent were approved. DOC officials note that some requests
are made because the inmates were already prescribed nonformulary
medications when placed in DOC custody. If an inmate is stable on
the medication, the request is typically approved. As shown in
Table 23, the number of requests for nonformulary psychotropic
medication increased from 85 in FY 2003-04 to 246 in FY 2007-08,
which is an increase of 189.4 percent. DOC officials attributed this
increase to more comprehensive formulary policies put in place in
2005, which increased the number of psychotropic medications
requiring approval and added procedures for psychiatrists to follow
before submitting requests. The required procedures also increased
the likelihood that requests would be approved.

Table 23
Requests for Nonformulary Psychotropic Medications

Fiscal Year

Requests

Number
Approved

Percentage
Approved

2003-04

91.8%

2004-05

112

104

92.9

2005-06

105

102

97.1

2006-07

299

295

98.7

2007-08

246

241

98.0

Total

847

820

96.8

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Medication Delivery
A 1977 opinion issued by Wisconsin’s Attorney General indicates
medication delivery by correctional officers does not violate
Wisconsin Statutes. However, NCCHC standards indicate that
personnel who deliver prescription medication should be
appropriately trained and that it is best to have medications
administered by qualified health care professionals.
Most medications are
delivered by correctional
officers rather than
health care staff.

Our 2001 audit of prison health care reported that DOC assigned
correctional officers, rather than professional health care staff, to
deliver psychotropic and other medications at most institutions.
This continues to be the practice. At 8 of the 13 institutions we
visited, correctional officers deliver all psychotropic medications on
the housing units. However, five institutions employ other methods:
at the Milwaukee Secure Detention Facility,
nurses deliver medications in all of the housing
units;
at Green Bay Correctional Institution, health care
staff deliver medications to inmates housed in
general population units, while correctional
officers deliver medications to inmates housed in
the segregation unit and the special housing unit;
at Taycheedah Correctional Institution, health
care staff deliver medications to inmates housed
in the segregation unit and the special
management unit, while correctional officers
deliver medications to inmates housed in general
population units;
at the Chippewa Valley Correctional Treatment
Facility, correctional officers deliver medications
in the health services unit, where inmates report
at designated times and form a “pill line” to
receive their medications; and
at the Wisconsin Secure Program Facility, inmates
in the general population unit report to the health
services unit at designated times to receive
medications delivered by correctional officers.
DOC and DHS managers, mental health staff, and correctional
officers, as well as advocacy groups and union officials, raised a
number of concerns with delivery of medications by correctional
officers, including that:

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medication administration records, which are the
responsibility of the officer distributing the
medication, are not always complete or accurate,
which makes it difficult to maintain a consistent
medication regimen for mentally ill inmates;
under the terms of their collective bargaining
agreement, correctional officers cannot be
disciplined for unintentional errors when
distributing medication, unlike health services
staff;
correctional officers may be less likely than
professional health care staff to encourage
inmates to take their medication on a regular
basis;
institutions do not have adequate controls in
place to prevent staff from misappropriating
inmates’ medication; and
unlike professional health care staff, correctional
officers are often unaware of what the
medications they are delivering are prescribed to
treat, cannot evaluate whether doses appear to be
effective, and may be unprepared to recognize
side effects.
Correctional officer
training on medication
delivery is limited and
not fully documented.

As part of their pre-service training, correctional officers receive
four hours of training on medication delivery, which includes the
procedures for medication delivery, types of psychotropic
medications, and, beginning in 2003, potential side effects. DOC
also offers periodic training updates at the institutions upon request.
The updates do not include information on side effects, and only
4 of the 13 institutions we visited reported having held such training.
No records are available to show when the training was offered
at the other institutions. Similarly, DOC does not maintain records
indicating which officers have received medication-delivery training
or when they received it. It is possible that some officers have worked
at DOC since before it began providing medication-delivery training,
and it is even more likely that not all officers have received the most
recent version of the training, which was updated in 2003 when
information on side effects was added. To effectively deliver
medication and thereby minimize the potential for potentially
dangerous and costly errors, correctional officers should be
adequately trained.

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Recommendation
We recommend the Department of Corrections ensure that all
correctional officers have received updated medication-delivery
training.
Illinois, Iowa, Michigan, and Minnesota all reported that nurses
deliver the majority of inmate medications. While DOC recognizes
that delivery of medication by health care staff would improve
quality of services, address union concerns, and improve risk
management, it estimated in 2006 that discontinuing delivery of
medication by correctional officers at facilities with health services
units would require an additional 102.00 FTE positions at an annual
cost of $5.2 million, plus one-time startup costs of $700,000.
However, we believe DOC could explore less-costly steps to
improve its medication delivery practices by, for example, providing
more extensive training to designated correctional officers who
deliver medication or having correctional officers deliver medication
from within the health services units.

Other DOC Programs
Mentally ill inmates may also participate in other DOC programs,
which include:
AODA programs, which are typically offered
near the end of the incarceration period to help
prepare inmates for release to the community;
adult basic education and high school
equivalency diploma testing;
sex offender programs to help inmates
understand, accept responsibility for, and change
sexually assaultive behavior and seek to reduce
the risk of reoffending;
treatment programs such as anger management,
domestic violence, and parenting;
vocational programs in areas such as data entry,
horticulture, welding, cosmetology, and food
service; and
work-release programs, which allow minimum
security inmates to improve employment skills,
pay financial obligations, and prepare for release.

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Mentally ill inmates were
less likely to complete
educational programs.

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Inmates may participate in multiple programs, and program
involvement is voluntary. We analyzed DOC data on program
participation and completion for mentally ill inmates and inmates
without mental illnesses. As shown in Table 24, we found that
similar percentages of inmates participated, but fewer mentally
ill inmates completed programming. For example, while
30.2 percent of mentally ill inmates and 32.7 percent of inmates
without mental illnesses participated in some form of educational
programming, only 9.7 percent of mentally ill inmates completed
this type of programming, compared to 16.3 percent of inmates
without mental illnesses.

Table 24
Program Participation and Completion
As of June 20081

Program

Inmates Participating2
Mentally Ill
Inmates without
Inmates4
Mental Illnesses

Inmates Completing Program3
Mentally Ill
Inmates without
Inmates4
Mental Illnesses

AODA

10.6%

15.9%

4.2%

8.0%

Education
Sex Offender
Treatment
Other Treatment5

30.2

32.7

9.7

16.3

5.3
25.2

5.0
23.7

1.4
17.1

2.1
18.9

Vocational

17.0

22.8

8.9

15.4

Work Release6

1.4

3.4

n.a.

Other

2.5

4.8

0.8

1.2

Program involvement is based on the most recent information recorded for individual inmates, which may be up to 12 months out
of date because data are typically recorded only as part of a review of placement and service needs.

Inmates who participated in at least one program in the specified category. Inmates may have participated in multiple programs
both within and across categories.

Inmates who completed at least one program in the specified category. Inmates may have completed multiple programs both within
and across categories.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2).

Includes programs such as domestic violence counseling, parenting classes, and anger management.

Work-release programming does not have a completion status.

Capacity and Population
Transfers and Departures
Treatment
Civil Commitments

Wisconsin Resource Center
WRC houses and treats
mentally ill inmates.

WRC was created in 1981 and began housing and treating mentally
ill male DOC inmates in 1983. It is operated by DHS. 1989
Wisconsin Act 31 mandated that WRC provide “psychological
evaluations, specialized learning programs, training, and
supervision for inmates whose behavior presents a serious problem
to themselves or others in state prisons.” We reviewed WRC’s
capacity, utilization, and treatment services.

Capacity and Population
WRC operates 14 living units for DOC inmates, each staffed by
psychological services personnel, as well as a teacher, a social
worker, and a therapeutic services staff person to instruct inmates
in crafts or recreational activities. The 14 units currently have an
operating capacity of 314 inmates and include:
3 units to improve inmate daily living skills, such
as personal hygiene;
3 units to teach more advanced social skills;
3 “high management” security units for
segregation placements;
2 units for inmates with acute psychiatric problems;
1 intake and assessment unit;

W ISCONSIN R ESOURCE C ENTER

1 unit to prepare inmates for transfer back to
DOC facilities; and
1 unit to prepare inmates for release into the
community.
Since September 1994, WRC has also housed and treated sexually
violent persons who are not DOC inmates. Under ch. 980,
Wis. Stats., the courts may order indefinite civil commitment for
persons who have been convicted of sexually violent offenses, or
found not guilty by reasons of mental disease or defect, and are
“more likely than not” to engage in further sexual violence. DHS
currently manages four WRC units for sexually violent persons.
Each has an operating capacity of 29, for a total operating capacity of
116. In addition, the Sand Ridge Secure Treatment Center opened in
2001 to house sexually violent persons. In FY 2007-08, it had an
operating capacity of 288. It is also operated by DHS.
As shown in Table 25, WRC’s inmate capacity—which excludes
units for sexually violent persons—increased from 334 in FY 2003-04
to 344 in FY 2004-05. This increase was achieved by housing two
inmates in some cells that had previously housed one. WRC’s
inmate population has consistently been at or near capacity over the
past five years. However, in March 2008 inmate capacity decreased
by 30 beds, and average daily population decreased to 309, for the
installation of equipment to control humidity and ensure the safety
of inmates taking prescribed psychotropic drugs who are prone to
overheating. This $2.8 million project is expected to be completed in
May 2009. DHS’s facilities investment plan for 2009-2015 anticipates
a similar $3.4 million project in the 2009-2011 biennium and a final
$450,000 project in the 2011-2013 biennium. If these projects are
undertaken, capacity will likely remain near its current level.

Table 25
WRC Inmate Capacity and Population

Fiscal Year

Operating
Capacity1

Average Daily
Population

Percentage of
Capacity Utilized

2003-04

334

322

96.4%

2004-05

344

342

99.4

2005-06

344

340

98.8

2006-07
2007-08
(Before 3/24/08)
2007-08
(3/24/08 and After)

344

339

98.5

344

329

95.6

314

309

98.4

Operating capacity as of June 30 of each fiscal year.

W ISCONSIN R ESOURCE C ENTER

Transfers and Departures
As shown in Table 26, there were 1,668 inmate transfers to WRC and
1,666 departures from FY 2003-04 through FY 2007-08. Over that time
period, the average length of stay increased from 277.2 days to
392.3 days, or by 41.5 percent. As shown in Table 27, most inmate
treatment stays at WRC were for three months to one year, and
9.2 percent of stays were for two years or more. The longest was
9.5 years.

Table 26
WRC Inmate Transfers and Departures

Fiscal Year

Transfers In

Departures1

Average Length of
Stay (Days)2

2003-04

420

395

277.2

2004-05

354

356

282.9

2005-06

315

312

318.4

2006-07

296

301

374.0

2007-08

283

302

392.3

1,668

1,666

324.5

Total
1

Includes transfers to other DOC institutions and releases to the community.

Based on 1,666 departures from FY 2003-04 through FY 2007-08.

Table 27
Length of Inmate Treatment Stays at WRC1
FY 2003-04 through FY 2007-08
Treatment
Stays

Percentage of
Total

Less than 3 months

366

21.9%

3 months up to 1 year

746

44.8

1 year up to 2 years

401

24.1

2 or more years

153

9.2

Length of Stay

Total
1

1,666

100.0%

Based on 1,666 departures from FY 2003-04 through FY 2007-08.

W ISCONSIN R ESOURCE C ENTER

Slightly more than three-fourths of inmates had only one treatment
stay at WRC from FY 2003-04 through FY 2007-08, as shown in
Table 28.

Table 28
Inmates Completing Treatment Stays at WRC
FY 2003-04 through FY 2007-08
Treatment Stays during
Five-Year Period

Inmates

Percentage of
Inmates

One

1,007

Two

223

17.3

Three

3.3

Four or more

1.5

Total

1,292

77.9%

100.0%

As shown in Table 29, inmates from DOC’s five maximum security
institutions accounted for 991, or 59.4 percent, of the 1,668 transfers
to WRC over the past five fiscal years, including 274 from the intake
facility at Dodge Correctional Institution. Medium security facilities
accounted for 631 transfers, and minimum security facilities
accounted for 24.
Just over one-third of
inmate departures from
WRC were releases to the
community.

As shown in Table 30, just over one-third of inmate departures from
WRC were releases from DOC custody into the community.
However, most inmates returned to DOC facilities.

W ISCONSIN R ESOURCE C ENTER

Table 29
Transfers to WRC by Institution
FY 2003-04 through FY 2007-08
Institution

Transfers

Percentage of Total

Maximum Security
Columbia

310

18.6%

Dodge

274

16.4

Green Bay

204

12.2

Waupun

183

11.0

Wisconsin Secure Program Facility
Subtotal

1.2

991

59.4

Medium Security
Oshkosh

147

8.8

Racine

4.8

Redgranite

4.3

Milwaukee Secure Detention Facility

3.8

Kettle Moraine

3.8

Fox Lake

3.2

Stanley

2.7

New Lisbon

2.4

Jackson

1.9

Prairie du Chien

1.4

Racine Youthful Offender

0.9

631

37.9

0.8

Subtotal
Minimum Security
Oakhill
Wisconsin Correctional Center System

0.4

Chippewa Valley

0.1

Sturtevant Transitional Facility

0.1

Subtotal

1.4

Other2

1.3

Total

1,668

100.0%

Fox Lake Correctional Institution houses medium and minimum security inmates.

Includes DOC inmates transferred from county jails and persons civilly committed as
sexually violent persons who became inmates after court actions.

W ISCONSIN R ESOURCE C ENTER

Table 30
Departures from WRC
FY 2003-04 through FY 2007-08
Destination

Departures

Percentage of Total

568

34.1%

280

16.8

Green Bay

174

10.4

Waupun

160

9.6

1.7

Released from DOC Custody
Maximum Security
Columbia

Dodge
Wisconsin Secure Program Facility
Subtotal

0.3

647

38.8

Medium Security
Oshkosh

173

10.4

Racine

3.2

Milwaukee Secure Detention Facility

2.3

Redgranite

2.3

Kettle Moraine

2.2

Fox Lake1

2.0

Jackson

1.0

Stanley

1.0

New Lisbon

0.6

Prairie du Chien

0.4

Racine Youthful Offender

0.2

426

25.6

0.2

Subtotal
Minimum Security
Wisconsin Correctional Center System
Sturtevant Transitional Facility

0.2

Oakhill

0.1

Subtotal

0.5

1.0

Other2
Total

1,666

100.0%

Fox Lake Correctional Institution houses medium and minimum security inmates.

Includes deaths, transfers to DHS Mental Health Institutes, a sexually violent persons commitment,
and a vacated sentence.

W ISCONSIN R ESOURCE C ENTER

Admissions Process
Transfers to WRC are not
governed by written
policies and procedures.

Inmate transfers to WRC are not governed by written policies and
procedures. Rather, WRC and individual DOC institutions negotiate
most transfers case by case. The admission request begins with a
telephone or e-mail contact from an individual DOC institution to
WRC’s admissions coordinator to discuss the mental health needs of
a particular inmate. If the institution requests a transfer, a WRC
screening committee of two psychologists, a social worker, a
therapist, and a unit manager assesses the inmate’s treatment needs
and potential security risks and advises the WRC admissions
coordinator on the benefits and risks of the transfer. In addition,
WRC occasionally accepts an emergency transfer with minimal
review if, for example, an inmate has made a suicide attempt and
cannot be stabilized by his institution’s mental health staff. DOC
officials also report that transfer decisions for some inmates may be
reviewed by the Better Treatment Options Committee, which is a
group of DOC and WRC mental health professionals.
WRC does not routinely compile information on inmate transfer
requests, but managers stated that most requests are approved.
However, they estimated that approximately 10 percent of all
requests are denied. For example, in FY 2007-08:
16 requests were denied because WRC clinical
staff determined that an inmate who had
previously been treated at WRC would not
benefit from further services;
7 were denied because WRC clinical staff
determined that the inmate did not have a
significant enough mental illness to benefit from
WRC treatment;
8 were denied because WRC did not accept
transfers of inmates who were within two to three
months of their release dates, as more time is
typically needed for treatment to be effective; and
2 were denied because WRC raised security
concerns, such as previous escape attempts or
attacks on WRC staff.

A DOC institution
transferring an inmate to
WRC typically must
accept the return of
another inmate.

When an institution transfers an inmate to WRC, it is typically
required to accept the return of an inmate it previously sent to WRC.
We reviewed transfers from maximum and medium security
institutions and found that 71.3 percent of inmates who returned to
DOC institutions at the same security level were returned to their
original institution. Institution staff told us that they try to be
conservative in how often they request transfers. WRC managers

W ISCONSIN R ESOURCE C ENTER

believe some institutions may delay requesting a new transfer
because they are hesitant to accept the return of a previously
transferred inmate. As a result, both DOC and WRC officials
reported that inmates may stay at WRC longer than clinically
necessary. WRC officials reported that approximately 85 inmates
have typically completed their treatment and are waiting to return
to a DOC institution.
As noted, WRC has operated near its capacity over the past five
years. However, the extent to which the need for WRC services
exceeds capacity cannot be reasonably estimated because WRC does
not maintain a waiting list and there is no systematic process by
which DOC identifies the inmates it believes could most benefit
from WRC services. We also could not determine whether WRC
serves the inmates most in need of its services because there is no
centralized system for prioritizing transfers to WRC. However,
given that some inmates reportedly stay at WRC longer than
necessary and correctional institutions report limiting the frequency
of their transfer requests, it seems likely that there are inmates in
DOC institutions who would be more in need of WRC services.
Clearer policies, decisionmaking, and recordkeeping could help
ensure WRC is used most
effectively.

Managers reported that WRC has chosen not to develop written
criteria to assess transfer requests in order to maintain maximum
flexibility in the transfer of inmates. While some flexibility is needed,
given the diversity of inmate mental health needs and available
services, we believe it is important that limited resources such as
WRC be used as efficiently and effectively as possible. Clearer
policies, more centralized decision-making, and more detailed
record-keeping could help ensure that this is the case.

Recommendation
We recommend the Department of Corrections and the Department of
Health Services report to the Joint Legislative Audit Committee by
January 4, 2010, on their progress in developing written policies that:
outline steps in the transfer application process;
specify the criteria that will be used to assess
inmates for transfer to the Wisconsin Resource
Center;
require documentation of inmate transfer
applications and decisions; and
ensure the timely identification and transfer of
inmates as they complete their treatment at the
Wisconsin Resource Center.

W ISCONSIN R ESOURCE C ENTER

Treatment
WRC managers report that their primary goal is to stabilize mentally
ill inmates so they can return to DOC institutions or be released at
the end of their sentences. All staff at WRC are regarded as part of
the facility’s treatment team. In addition, all staff, including
managers, clinicians, and office support personnel, receive training
in physical and verbal control techniques for managing dangerous
inmates.
We reviewed the types and extent of services provided to DOC
inmates at WRC and conducted a file review of a random sample of
23 DOC inmates who received services at WRC between July 1, 2006,
and June 30, 2008. Of the inmates whose records we reviewed:
nine were transferred to WRC because their
ability to function in prison was impaired by their
mental illnesses;
eight were transferred to WRC for mental health
assessments, which can lead to longer-term
treatment at WRC;
three were transferred because of suicide attempts
or other incidents of serious self-harm; and
three were transferred to have their psychotropic
medications adjusted.
WRC staff develop and
routinely update
treatment plans for all
admitted inmates.

When inmates enter WRC, they are assigned to the facility’s intake
and assessment unit for a two- to three-week period during which
staff assess their needs and develop a treatment plan. We found
these plans are consistently developed and revised on a regular
basis and appear to be used to direct services and assess progress.
Within our sample, inmates had a median of 20.3 documented
mental health appointments annually during their stays at WRC,
which is approximately one appointment every two-and-one-half
weeks. Approximately one-half of the appointments were with
psychologists. One-quarter were with psychiatrists, and one-fifth
were with nurses, social workers, or therapists. The recorded
reasons for appointments varied and included admissions
screenings, therapy, medication reviews, psychological assessments,
and treatment plan reviews.

W ISCONSIN R ESOURCE C ENTER
19 of 23 inmates in our
sample participated in
clinical treatment
programming.

Of the 23 inmates whose files we reviewed, 19, or 82.6 percent,
participated in clinical treatment programs during their stays at
WRC. Three of the four who did not may not have been mentally
stable enough to participate, and one had a relatively short stay of
two months. On average, inmates who participated in clinical
treatment programs were in two programs each during their WRC
stays. The program in which inmates most commonly participated
was mental health education, as shown in Table 31.

Table 31
Inmate Participation in Clinical Treatment Programs at WRC1
Participating
Inmates2

Program Category
Mental Health Education

Percentage
Participating
52.2%

Coping Skills

21.7

Personal Development

21.7

Anger Management

17.4

Self-Reliance

13.0

Mental Health Fundamentals

8.7

Pre-Release

8.7

Cognitive Intervention

4.3

Daily Living Skills

4.3

AODA

4.3

Vocational Workshop

4.3

For a sample of 23 inmates incarcerated at WRC between July 1, 2006, and June 30, 2008.

Some inmates participated in more than one program.

Cognitive intervention therapy teaches inmates to identify the thinking that leads to criminal
behaviors and to understand the consequences of their actions.

WRC offers 17 different
structured mental health
and therapy groups in
addition to clinical
treatment programs.

In addition to clinical treatment programs, WRC offers 17 different
structured mental health and therapy groups that provide support
for inmates with specific mental health issues such as depression,
schizophrenia, alcohol and drug abuse, auditory hallucinations, and
trauma histories. We found that 13 of the 23 inmates in our sample
participated in at least one group. The group in which inmates most
commonly participated was Wellness Recovery Action Planning,
which is designed to encourage responsibility for monitoring mental
health symptoms and handling crisis situations and served six
inmates in our sample.

W ISCONSIN R ESOURCE C ENTER

WRC also operates other classes and work assignments. For
example, of the 23 inmates in our sample:
9 participated in work programs such as food
service or custodial, laundry, or groundskeeping
duties, which paid from $0.12 to $0.42 per hour;
8 participated in activities such as creative
writing, film, current events, music, and arts; and
5 attended classes such as adult basic education or
high school equivalency preparation.
WRC stays most
segregation orders so
that inmates remain in
non-segregated housing.

In order to ensure access to programming, WRC managers minimize
the time inmates spend in isolated cells. Although inmates are
ordered to segregation for disciplinary violations, most segregation
orders are stayed and the inmates remain in a non-segregated
housing unit unless the violation was particularly dangerous or
further violations occur. We found that 11, or 47.8 percent, of the
23 inmates in our sample had segregation placement orders, but we
were unable to determine which inmates had actually been placed in
segregation cells. We also determined that five, or 21.7 percent, of
the inmates in our sample had been placed in observation cells to be
monitored for self-harm. We were unable to determine the reasons
for individual placements or for how long inmates were housed in
observation cells.

Civil Commitments
Under s. 51.20(1), Wis. Stats., DOC may petition a court to compel
inmates to receive psychotropic drug treatments or allow the
transfer of inmates to a state mental health institution for possible
psychotropic drug treatments. Almost all male inmates subject to
these orders are treated at WRC. Female inmates are either treated
at Taycheedah Correctional Institution or transferred to the
Winnebago Mental Health Institute for treatment. Because WRC
does not currently serve female inmates, Winnebago is the only
alternative placement available to provide intensive clinical mental
health services to female inmates.
From 2004 through 2008, 334 civil commitment orders were issued
for inmates, as shown in Table 32. Of those, 268, or 80.2 percent,
were issued for male inmates, all but 9 of whom were treated at
WRC. A total of 66 civil commitment orders were issued for female
inmates, including 35 used to treat female inmates at Taycheedah
and 31 to treat inmates at Winnebago Mental Health Institute.

W ISCONSIN R ESOURCE C ENTER

Table 32
Inmate Civil Commitment Orders
Treatment Location
Male Inmates Treated at WRC

2004

2005

2006

2007

20081

Total

259

Male Inmates Transferred to Mendota
Mental Health Institute

–

Female Inmates Treated at Taycheedah

Female Inmates Transferred to Winnebago
Mental Health Institute 2
Total

334

As of December 11, 2008.

In 2007, two additional Taycheedah inmates were voluntarily transferred to Winnebago Mental Health Institute
for treatment services, increasing the total female inmate transfers to Winnebago Mental Health Institute to 33
over the five-year period.

Inmate Self-Harm
Assaults on Staff
Segregation
Enhancing Information and Training

Improving Safety and Discipline
Mentally ill inmates can have a disproportionate effect on the safety
and discipline of a correctional facility, including by harming
themselves, assaulting institution staff, or committing violations that
result in segregation placements. We reviewed DOC’s ability to
monitor and analyze the effect of mentally ill inmates on employee
and inmate safety.

Inmate Self-Harm
Under DOC 311, Wis. Adm. Code, inmates who harm themselves
may be placed in temporary observation confinement, where they
are typically housed in a cell isolated from other inmates, provided
special clothes and bedding that cannot be used as a noose, and
checked by DOC personnel at least every 15 minutes.
More than 90.0 percent
of self-harm incidents
that resulted in
observation placements
involved mentally ill
inmates.

Over the past three fiscal years, there were 1,341 incidents of inmate
self-harm at DOC facilities that resulted in observation placements,
including 1,231 for which we were able to determine the inmate’s
mental health status before placement. As shown in Table 33, more
than one-half of self-harm observation placements were of inmates
identified as seriously mentally ill (MH-2), and more than one-third
were of inmates identified as having mental health needs but not
seriously mentally ill (MH-1).

I MPROVING S AFETY

AND

D ISCIPLINE

Table 33
Self-Harm Observation Placements at DOC Facilities1
FY 2005-06
Percentage
Placements
of Total

Mental Health Classification
before Placement
No Mental Health Needs (MH-0)
Mental Health Need (MH-1)

Seriously Mentally Ill (MH-2)2
Developmentally Disabled (MH-3)
Total

6.8%

FY 2006-07
Percentage
Placements
of Total
35

8.4%

FY 2007-08
Percentage
Placements
of Total
27

7.2%

148

33.6

150

36.0

150

40.2

251

56.9

231

55.4

191

51.2

2.7

0.2

1.4

441

100.0%

417

100.0%

373

100.0%

Excludes inmates at WRC and 110 observation placements for which we could not determine the inmates’ mental health status.

Inmates with mental illnesses.

Mentally ill inmates also remained in observation slightly longer
during this three-year period. Inmates with serious mental illnesses
spent an average of 4.2 days in observation, inmates with mental
health needs spent an average of 4.6 days, and inmates with no prior
mental health needs spent an average of 3.3 days. DOC staff
reported that although some inmates who were not previously
identified as mentally ill may have been misclassified, in other cases
an inmate’s mental health may have deteriorated or the self-harm
incident may have been precipitated by something other than
mental illness, such as a family death or an unsuccessful appeal
of conviction.
Table 34 shows self-harm observation placements by institution. At
nearly every institution, mentally ill inmates represented more than
three-quarters of these placements.
As shown in Table 35, the most common self-harm action by inmates
was biting, cutting, or stabbing, which accounted for 432, or
35.1 percent, of self-harm observation placements over the past
three fiscal years.

I MPROVING S AFETY

AND

D ISCIPLINE

Table 34
Locations of Self-Harm Observation Placements1
FY 2005-06 through FY 2007-08

Institution

Placements

Number Involving
Mentally Ill Inmates2

Percentage
Involving
Mentally Ill
Inmates2

Maximum Security
Taycheedah3

278

269

96.8%

Columbia

162

152

93.8

Waupun

150

136

90.7

Green Bay

127

103

81.1

Dodge

118

112

94.9

93.3

Milwaukee Secure Detention Facility

82.6

Oshkosh

93.7

Racine

94.6

New Lisbon

82.9

Racine Youthful Offender

90.0

Wisconsin Secure Program Facility
Medium Security

Redgranite

88.0

Kettle Moraine

91.7

Jackson

78.9

Stanley

94.7

Fox Lake4

84.6

Oakhill

85.7

Sturtevant Transitional Facility

71.4

Women’s Correctional Centers6

–

Unknown

50.0

1,231

1,121

91.1

Minimum Security5

Total
1

Excludes inmates at WRC and 110 observation placements for which we could not determine the inmates’ mental health status.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2)
before the self-harm observation placement.

Taycheedah Correctional Institution houses maximum and medium security female inmates.

Fox Lake Correctional Institution houses medium and minimum security inmates.

Inmates housed at Wisconsin Correctional Center System facilities are typically sent to nearby institutions for observation
placements.

Includes the three minimum security correctional centers that are part of the Wisconsin Women’s Correctional System.

I MPROVING S AFETY

AND

D ISCIPLINE

Table 35
Types of Self-Harm Resulting in Observation Placements1
FY 2005-06 through FY 2007-08

Placements

Percentage
of Total

Number Involving
Mentally Ill Inmates2

Biting, Cutting, or Stabbing

432

35.1%

408

94.4%

Attempted Hanging

256

20.8

229

89.5

Description of Self-Harm

Percentage Involving
Mentally Ill Inmates2

Medication Overdose

153

12.4

137

89.5

Head Banging

145

11.8

127

87.6

Other or Unknown

125

10.1

116

92.8

Ingesting or Inserting Objects

5.7

90.0

Refusing Food or Liquids

4.1

82.0

1,121

91.1

Total

1,231

100.0%

Excludes inmates located at WRC and 110 observation placements for which we could not determine the inmates’ mental health
status.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2) before the
self-harm observation placement.

Emergency room costs for
self-harm incidents by
mentally ill inmates
totaled $179,400 over
three years.

Inmates in need of emergency medical care are transferred to
emergency rooms at local hospitals. From FY 2005-06 through
FY 2007-08, 157 of the 1,231 self-harm incidents resulted in emergency
room treatment, at a total cost of $200,800. Mentally ill inmates
accounted for 89.3 percent of those costs, or $179,400. These costs do
not include inpatient or outpatient costs associated with these selfharm incidents, nor do they include the costs of follow-up care.

I MPROVING S AFETY

AND

D ISCIPLINE

Inmate Suicides
From FY 2003-04
through FY 2007-08,
29 inmates committed
suicide.

Over the past five fiscal years, 29 inmates committed suicide, as
shown in Table 36. Of the 20 for whom mental health data were
available, 16, or 80.0 percent, had been previously identified as
mentally ill, including 7 with serious mental illnesses.

Table 36
Inmate Suicides

Fiscal Year

Inmate
Suicides

2003-041

Inmates with
Recorded Mental
Health Assessment

Inmates Identified as
Mentally Ill2

Percentage Identified as
Mentally Ill2

–

2004-05

100.0%

2005-06

77.8

2006-07

80.0

2007-08
Total

75.0

80.0

Before FY 2004-05, DOC did not record inmate mental health codes.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2)
before the suicides.

As shown in Table 37, the 29 suicides took place in 15 different
facilities. The most common method employed by inmates to
commit suicide was hanging, which accounted for 25 of the
29 suicide deaths.

I MPROVING S AFETY

AND

D ISCIPLINE

Table 37
Locations of Inmate Suicides
FY 2003-04 through FY 2007-08

Institution

Number

Percentage
of Total1

Maximum Security
Waupun

13.8%

Dodge

10.3

Green Bay

10.3

Columbia

6.9

Taycheedah2

3.4

Wisconsin Secure Program Facility

3.4

Milwaukee Secure Detention Facility

10.3

Oshkosh

10.3

Medium Security

Fox Lake

6.9

Racine

6.9

Jackson

3.4

New Lisbon

3.4

Stanley

3.4

Sturtevant Transitional Facility

3.4

Wisconsin Resource Center

3.4

100.0%

Minimum Security

Total
1

Percentages are rounded.

Taycheedah Correctional Institution houses maximum and medium security female inmates.

Fox Lake Correctional Institution houses medium and minimum security inmates.

I MPROVING S AFETY
Wisconsin’s prison inmate
suicide rate significantly
exceeds those of the
nation and of other
midwestern states.

AND

D ISCIPLINE

Suicide rates are significantly higher in Wisconsin’s prisons than in
those of other states. Although dated, the most recent federal data
available indicate there were 32 suicides per 100,000 inmates in
Wisconsin prisons from 2001 through 2002. By contrast, during that
same period there were 14 suicides per 100,000 inmates in state
prison systems nationally. The rates were 22 per 100,000 in Illinois,
11 per 100,000 in Michigan, 15 per 100,000 in Minnesota, and
9 per 100,000 in Ohio. More recent DOC data show there were
26.5 suicides annually for every 100,000 inmates over the past
five fiscal years.
DOC officials report that since 2006, all staff who have personal
contact with inmates have attended a two-hour annual training
session that discusses the inmate suicide rate and warning signs of
inmates at risk for suicide and that provides detailed instructions for
responding to inmate suicide attempts. In addition, all institutions
schedule quarterly emergency drills on responding to a hanging in a
locked cell. A similar annual training presentation and rescue drill is
performed at WRC.

DOC fully implemented a
suicide prevention policy
in May 2007.

DOC officials recognized that Wisconsin has a higher rate of suicide
than other state prison systems and began implementing a suicide
prevention policy in 2005. Officials report the policy was phased in
over two years and was fully implemented in May 2007. The suicide
prevention policy includes the intake and transfer screening
requirements described earlier, as well as other measures such as:
weekly meetings of multi-disciplinary committees
within institutions, which review the care of
mentally ill inmates and inmates in segregation
and include security, mental health, health
services, and other staff;
“continuous line-of-sight monitoring” by correctional
staff for inmates placed in observation with “imminent
suicide behavior,” as well as frequent examinations by
psychological services staff;
training on cardiopulmonary resuscitation and
automated defibrillator machine operation for an
“adequate” number of staff, defibrillator machine
placement to ensure five-minute access, and
placement of first aid and suicide response tools
in all work and housing areas; and
data collection and investigation of inmate
suicides or serious suicide attempts that require
emergency care by a physician, other medical
staff, an emergency room visit, or hospitalization.

I MPROVING S AFETY

AND

D ISCIPLINE

Assaults on Staff
Mentally ill inmates
accounted for 79.2 percent
of assaults on staff.

Security directors at DOC’s adult institutions and at WRC prepare
monthly reports that summarize all inmate assaults on staff. From
FY 2005-06 through FY 2007-08, there were 785 assaults on staff,
including 755 for which we were able to determine the inmate’s
mental health classification before the assault. As shown in Table 38,
for each of the past three fiscal years approximately one-half of all
staff assaults were committed by inmates with serious mental
illnesses (MH-2). Over the three-year period, a total of 598, or
79.2 percent, of all staff assaults were committed by inmates with
mental health needs (MH-1) or serious mental illnesses (MH-2). This
substantially exceeds their overall representation in the inmate
population, which ranged from 28.2 percent in June 2006 to
31.0 percent in June 2008.

Table 38
Mental Health Status of Inmates Who Assaulted Staff1
FY 2005-06
Percentage
Inmates
of Total

Mental Health Classification
before Staff Assault
No Mental Health Needs (MH-0)
Mental Health Need (MH-1)

Seriously Mentally Ill (MH-2)2
Developmentally Disabled (MH-3)
Total

22.7%

FY 2006-07
Percentage
Inmates
of Total
45

18.8%

FY 2007-08
Percentage
Inmates
of Total
43

15.3%

26.2

33.3

31.9

116

49.8

110

45.8

141

50.0

1.3

2.1

2.8

233

100.0%

240

100.0%

Does not include 30 assaults for which we could not determine the inmates’ mental health status.

Inmates with mental illnesses.

282

100.0%

Table 39 shows the locations of inmate assaults on staff over the past
three fiscal years. Table 40 shows the types of assaults committed.

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Table 39
Locations of Inmate Assaults on Staff
FY 2005-06 through FY 2007-08

Assaults1

Institution

Percentage
of Total

Number Committed by
Mentally Ill Inmates2

Percentage
Committed by
Mentally Ill Inmates2

Maximum Security
Columbia

130

17.2%

Green Bay

105

13.9

81.0

Waupun

13.0

75.5

Dodge

7.9

81.7

5.3

100.0

2.3

52.9

Racine Youthful Offender

4.2

71.9

Milwaukee Secure Detention Facility

3.3

72.0

Racine

3.0

78.3

Oshkosh

2.8

71.4

Kettle Moraine

2.5

52.6

New Lisbon

2.3

52.9

Taycheedah

Wisconsin Secure Program Facility

123

94.6%

Medium Security

Fox Lake

1.7

69.2

Redgranite

1.2

33.3

Stanley

0.7

40.0

Prairie du Chien

0.5

–

1.6

50.0

8
3

1.1
0.4

2
1

25.0
33.3

Wisconsin Resource Center

114

15.1

102

89.5

Total

755

100.0%

598

79.2

Minimum Security
Oakhill
Wisconsin Correctional Center
System5
Chippewa Valley

Does not include 30 assaults for which we could not determine the inmates’ mental health status.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2) before the
assaults.

Taycheedah Correctional Institution houses maximum and medium security female inmates.

Fox Lake Correctional Institution houses medium and minimum security inmates.

Includes inmates at both men’s and women’s correctional centers.

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Table 40
Types of Inmate Assaults on Staff
FY 2005-06 through FY 2007-08

Description of Assault
Striking, Biting, or
Stabbing
Spitting or Throwing
Human Waste
Attempted Assault3

Assaults1

Percentage
of Total

Number
Committed by
Mentally Ill
Inmates2

Percentage
Committed by
Mentally Ill
Inmates2

404

53.5%

303

75.0%

270
38

35.8
5.0

235
31

87.0
81.6

Throwing Object

3.7

85.7

Sexual Assault

2.0

33.3

755

100.0%

598

79.2

Total
1

Does not include 30 assaults for which we could not determine the inmates’ mental health status.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill
(MH-2) before the assaults.

Includes incidents in which an inmate attempted to assault a staff person but did not make contact.

From FY 2005-06
through FY 2007-08,
assaults on staff by
mentally ill inmates
resulted in $874,200 in
worker’s compensation
awards.

Staff who are assaulted by inmates may claim worker’s
compensation for the costs of medical care, lost wages, vocational
rehabilitation, retraining, and compensation for permanent
disabilities. Worker’s compensation awards related to inmate
assaults have declined significantly over the past three years,
although the number of assaults has increased. As shown in
Table 41, the number of awards increased from 56 in FY 2005-06 to
67 in FY 2007-08, but total awards declined from $546,200 in
FY 2005-06 to $156,900 in FY 2007-08. Over the three-year period,
$874,200, or 84.5 percent, of the total awarded resulted from assaults
by mentally ill inmates. The average award was $5,600 for an assault
by a mentally ill inmate and $4,300 for an assault by an inmate with
no identified mental illness. Assaults involving inmates striking,
biting, or stabbing staff accounted for 94.6 percent of all worker’s
compensation awards for inmate assaults.

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Table 41
Worker’s Compensation Awards Related to Inmate Assaults on Staff1

Inmate Mental Health Classification
before Staff Assault
Seriously Mentally Ill (MH-2)2
Mental Health Need (MH-1)

FY 2005-06
Awards
Amounts

FY 2006-07
Awards
Amounts

FY 2007-08
Awards
Amounts

$106,200

$263,800

$114,400

320,900

43,100

25,800

Developmentally Disabled (MH-3)

–

14,000

No Mental Health Needs (MH-0)

119,100

–

24,800

–

2,700

Total

$546,200

$331,700

$156,900

Includes DOC personnel assigned to adult institutions and DOC and DHS personnel assigned to WRC. Excludes 5 awards totaling
$61,632 for which we could not determine the inmates’ mental health status.

Inmates with mental illnesses.

From FY 2005-06 through FY 2007-08, WRC staff received $423,200,
or 40.9 percent of total awards. We also note that a few incidents can
account for the majority of compensation. For example, while WRC
had 27 separate awards, three incidents accounted for 77.5 percent
of all award costs, including $236,500 awarded in FY 2005-06 to a
psychiatric care technician who received head injuries, $61,100
awarded to another technician injured while restraining an inmate,
and $30,500 awarded to a clerical staff person stabbed by an inmate.
Similarly, $179,400 awarded in FY 2006-07 to a correctional officer
who suffered head injuries while preventing an inmate from
assaulting library staff accounted for 85.6 percent of Racine
Correctional Institution’s awards. Appendix 6 lists amounts of
worker’s compensation awards related to inmate-on-staff assaults
by institution.

Segregation
Inmates are placed in
segregation for violations
of prison rules.

Under section 302.10, Wis. Stats., inmates who violate prison rules
“may be confined to a solitary cell, under the care and advice of the
physician.” Chapter DOC 303, Wis. Adm. Code, further describes
segregation as a highly controlled environment within an institution
in which inmates’ property, privileges, and movement are further
restricted. Segregation is one of the disciplinary options for major
conduct violations such as assault, possession of weapons, and
misuse of prescription medications. The maximum length of a
segregation sentence is 360 days. All DOC medium and maximum
security institutions have segregation units, and the Wisconsin
Secure Program Facility consists primarily of segregation inmates.
Housing of mentally ill inmates in segregation has been an area of
concern in recent years. The Supermax lawsuit filed in September 2000

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alleged, in part, that confinement at the institution caused severe
psychiatric suffering because of the isolation and restriction of the
institution’s segregated setting. As noted, the January 2002 settlement
agreement disallowed the placement of seriously mentally ill inmates
at Supermax (now the Wisconsin Secure Program Facility). Although
the settlement agreement is no longer in effect, DOC still excludes
seriously mentally ill inmates (MH-2) from placement at the Wisconsin
Secure Program Facility. However, inmates with mental health needs
(MH-1) may be housed there.
In 2005, DOC’s
Segregation Workgroup
recommended
modifications to the
disciplinary process for
mentally ill inmates.

In April 2003, DOC convened a workgroup to address treating
mentally ill inmates in segregation settings. Members included
DOC staff, WRC staff, and two attorneys for the Wisconsin Coalition
for Advocacy (now known as Disability Rights Wisconsin). The
January 2005 report of the Segregation Workgroup cited a “growing
recognition among mental health professionals, correctional
administrators, and accreditation organizations” across the country
that the health of mentally ill inmates can deteriorate as a result
of the isolation and inactivity of segregation. The Segregation
Workgroup recommended that psychological services staff provide
“formal input” into the disciplinary process for mentally ill inmates
and developed a form that it recommended be used for seriously
mentally ill (MH-2) and developmentally disabled (MH-3) inmates
who commit conduct violations that could result in segregation
placements.
DOC policy does not require use of the Segregation Workgroup’s
form because it is time-consuming to complete. However, the form is
being used at Taycheedah Correctional Institution, and DOC officials
indicated that a pilot program using the form in cases of inmate
self-harm in maximum security institutions is planned for early in
2009. In addition, DOC officials indicated that its administrative code
committee is considering changing administrative code to explicitly
include mental illness as a mitigating factor to be considered by
hearing officers involved in the disciplinary process, as recommended
by the Segregation Workgroup.
Institution staff indicated that inmates’ mental health is sometimes
taken into consideration during the disciplinary process. As noted,
special management units and informal special housing units often
have more flexible disciplinary procedures, such as providing
mentally ill inmates with additional warnings before taking
disciplinary action. In addition, staff at some institutions reported
that mental health staff may provide informal input to hearing
officers. However, staff at two institutions reported that inmates’
mental health has little or no impact on the disciplinary process.

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Segregation Populations
DOC data systems do not allow for ongoing analysis of mentally ill
inmates in segregation because inmate housing locations and mental
health classifications are not recorded in the same data system.
However, each January for the past several years, DOC has
compiled data on segregation inmates with mental illnesses by
manually matching data from two separate sources.
Table 42 shows that in each year from 2005 through 2008, mentally
ill inmates (MH-1 and MH-2) were overrepresented in segregation.
For example, in January 2008, 46.1 percent of inmates in segregation
were mentally ill, compared to 33.0 percent of the population as a
whole.

Mentally ill inmates have
been overrepresented in
segregation.

Table 42
Mentally Ill Inmates in Segregation and in the Total Population1
Percentage of Segregation
Inmates Who Are
Mentally Ill2
January 20053

Percentage of All Inmates
Who Are Mentally Ill2

38.0%

26.8%

35.9

29.5

January 2007

40.3

31.5

January 2008

46.1

33.0

January 2006

Includes only institutions with segregation units.

Includes inmates identified as having mental health needs (MH-1) and inmates identified
as seriously mentally ill (MH-2).

The mental health classification system was implemented in mid-2004; January 2005 data
may understate the number of mentally ill inmates.

Dodge Correctional Institution data were not included in the documents received from
DOC for January 2006.

Institutions varied in their use of segregation for mentally ill
inmates, as shown in Table 43. In January 2008, the percentage of
inmates in segregation who were identified as mentally ill ranged
from a low of 17.6 percent at Oakhill Correctional Institution to a
high of 76.2 percent at Taycheedah Correctional Institution,
reflecting differences in the overall percentages of mentally ill
inmates at those institutions.

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Table 43
Mentally Ill Inmates in Segregation at Individual Institutions
January 2008

Institution1

Mentally Ill
Inmates in
Segregration2

All Inmates in
Segregation

Percentage in
Segregation
Who Are
Mentally Ill

118

72.9%

Percentage in
Institution Who Are
Mentally Ill2

Maximum Security
Columbia

48.0%

Dodge

46.7

32.6

Green Bay

143

55.2

40.4

Taycheedah3

76.2

74.8

Waupun

115

188

61.2

43.4

Wisconsin Secure Program Facility

100

339

29.5

26.1

Subtotal

463

926

50.0

43.4

Fox Lake4

35.5

26.3

Jackson

52.4

34.5

Kettle Moraine

53.8

30.8

New Lisbon

40.0

26.2

Oshkosh

52.1

34.3

31.3

21.7

108

51.9

31.2

Medium Security

Prairie du Chien
Racine
Redgranite

50.0

30.1

Racine Youthful Offender

41.0

31.7

Stanley

115

20.9

18.9

Subtotal

293

694

42.2

28.8

17.6

11.0

762

1,654

46.1

33.0

Minimum Security
Oakhill
Total
1

No information was available for the Milwaukee Secure Detention Facility. The Wisconsin Correctional Center System centers, Chippewa
Valley Correctional Treatment Facility, and Sturtevant Transitional Facility were excluded because they do not have segregation units.
WRC was excluded because of differences in its definition and use of segregation.

Includes inmates identified as having mental health needs (MH-1) and inmates identified as seriously mentally ill (MH-2).

Taycheedah Correctional Institution houses maximum and medium security female inmates.

Fox Lake Correctional Institution houses medium and minimum security inmates.

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Monitoring and Treatment of Mentally Ill Inmates in
Segregation
DOC’s suicide prevention policy requires that psychological services
staff conduct face-to-face interviews and file reviews for all seriously
mentally ill (MH-2) and developmentally disabled (MH-3) inmates
within one working day of segregation placement. We were unable
to verify the extent to which this occurred because neither
automated data systems nor paper-based inmate files clearly
indicated dates and times of segregation placements or the required
interview and file review.
Psychological services
staff see inmates in
segregation one or more
times per week.

Psychological services staff also complete segregation rounds,
which consist of brief encounters with inmates to determine their
mental status and identify any problems resulting from placement
in segregation. NCCHC standards state that inmates in segregation
should be monitored three days per week by medical or mental
health staff, and DOC’s Segregation Workgroup identified
the development of staffing plans to fulfill the NCCHC
recommendations as a long-term goal. DOC policy does not specify
how often rounds should be completed by psychological services
staff. However, a list of psychological services unit priorities
prepared in July 2006 and updated in June 2008 recommended
weekly segregation rounds for mentally ill inmates, and among the
institutions we visited:
seven indicated that psychological services staff
complete segregation rounds once per week;
three indicated that psychological services staff
complete rounds twice per week;
Waupun Correctional Institution does not
complete rounds, but has a psychologist present
on the segregation unit each weekday; and
Racine Correctional Institution indicated that it
planned to hire a new psychologist who would
conduct daily segregation rounds.
DOC policy requires each institution’s Segregation Review
Committee, which may include psychology, psychiatry, health
services, and security staff, to review the status of inmates housed in
segregation at least once every 30 days. The committee discusses
inmates’ psychological, medical, security, and housing issues. Based
on recommendations from the review committee, psychological
services staff, and the institution’s security director, the warden
decides to either remove the inmate from segregation or continue

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the segregation placement. Of the 12 institutions we visited that
have segregation units, 11 reported that these reviews are performed
at 30-day intervals.
Most institutions do not
offer mental health
programming in
segregation.

At all institutions, inmates are seen by psychological services or
psychiatry staff for monitoring and medication management
appointments regardless of their segregation placement, though
these contacts may occur at the cell door while the inmate is in
segregation. However, our interviews with staff indicated that most
institutions offer limited or no programming in segregation.
Taycheedah Correctional Institution reported offering several
programs to inmates in segregation, including anger management
and current events. Waupun Correctional Institution was the only
institution for male inmates that indicated it is currently offering
group programs to inmates in segregation, including a coping skills
group focused on decision-making skills and a psychotherapy group
focused on changing counterproductive beliefs and behaviors. Staff
at Racine Correctional Institution stated that they have offered
group segregation programs in the past but were not doing so at the
time of our interview because of staff vacancies. Staff at Oshkosh
Correctional Institution noted that out-of-cell group programs have
been proposed but not implemented, and staff at Green Bay
Correctional Institution indicated some program materials were
available for inmates to complete in their cells.
Reasons cited by DOC staff for the relative lack of segregation
programs include:
the significant staff time required to move
segregation inmates from their cells, because
often they must be placed in restraints and
require multiple staff escorts;
insufficient psychological services staff time for
group programs and individual therapy; and
the lack of sufficient or appropriate space for
individual therapy or group programs to be held.

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Enhancing Information and Training
As noted, mentally ill inmates have a disproportionate effect on
institution safety and discipline. While they accounted for fewer
than one-third of inmates in DOC custody in recent years, they
accounted for:
more than 90.0 percent of self-harm observation
placements;
80.0 percent of inmate suicides;
nearly 80.0 percent of assaults on staff; and
more than 40.0 percent of segregation placements.
DOC’s management of
information related to
safety and discipline
could be improved.

Although the implementation of the mental health classification
system was a significant step in improving DOC’s ability to identify
and monitor mentally ill inmates, DOC does not yet have the ability
to systematically integrate those data with data on self-harm
incidents, assaults, or segregation placements. We also found other
data limitations in DOC’s information management. For example:
Data on observation placements are maintained in
a centralized database; however, we found
examples of duplicative and inconsistent data.
Inmate assaults are reported on text documents
e-mailed to DOC central office from each
individual institution, rather than recorded
directly by each institution in a centralized
database, which would improve reporting
efficiency and facilitate routine analysis of
the data.
Data on inmate housing locations, including
segregation placements, are maintained only in a
data system that is not specifically designed for that
purpose and cannot be readily used for analysis.
DOC staff have indicated that a new data system
implemented in June 2008 is expected to include
inmate housing locations in the spring of 2010.

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Addressing limitations in information management would improve
DOC’s ability to accurately monitor and analyze incidents related to
safety and discipline, including special concerns involving inmates
with mental illnesses, and could potentially identify trends or more
effective practices for addressing these concerns.

Recommendation
We recommend the Department of Corrections improve its collection
and management of data related to inmate self-harm, assaults on
staff, and segregation placements by:
developing data entry instructions that will reduce
inconsistent data in the observation placement
database;
developing a centralized database for recording
assaults;
including inmate housing locations in its new data
system; and
developing methods for automated matching and
analysis of inmate mental health classifications in
conjunction with information on assaults,
observation placements, and segregation.
Correctional officers are
typically not informed
of inmates’ mental
health status.

Although psychological services and psychiatry staff are primarily
responsible for monitoring and treating mentally ill inmates,
correctional officers have the most day-to-day contact with inmates
and are therefore most involved with safety and discipline.
However, correctional officers are generally not aware of inmates’
mental health classifications. We interviewed 15 correctional officers
at six DOC institutions and found that only 2 were regularly aware
of inmate mental health classifications: 1 because he is informed
when the mental health status of inmates placed in the housing unit
he supervises must be considered in cell assignments, and the other
because he is a member of the institution’s Segregation Review
Committee. Some correctional officers reported that they can
sometimes tell if an inmate is mentally ill based on his or her
behavior, and correctional officers who deliver medications may be
able to infer the type of mental health problem an inmate has.
However, it is unclear whether these assessments are accurate.
As noted, correctional officers receive initial training on mental
health issues. In addition to medication delivery training and annual
suicide prevention training, all new officers receive eight hours of

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training in correctional mental health issues during orientation. The
training covers suicide prevention; descriptions, signs, and
symptoms of various mental illnesses; when to refer inmates to the
psychological services unit; and classes of psychotropic medications,
including what they are designed to treat and potential side effects.
However, we could not determine whether this training is either
sufficient or effective in giving officers the tools and information
they need to interact with mentally ill inmates, particularly because
most training occurs before officers have actually begun working at
institutions.
Increased mental health
training for correctional
officers could
enhance security.

Advocacy groups with whom we spoke believe that mentally ill
inmates sometimes need to be managed differently than other
inmates because traditional approaches are not necessarily effective,
and that in order to effectively manage mentally ill inmates,
correctional officers need to know whether an inmate is mentally ill.
Advocates cited the crisis intervention model as a promising
approach in training correctional officers in how to work with
mentally ill inmates, including strategies for deescalating potentially
dangerous situations and using simulated auditory hallucinations as
a way to increase officers’ understanding and empathy for the
mentally ill. A two-day version of this training was recently offered
at the Milwaukee Secure Detention Facility, and officials there spoke
positively of the training and reported that the response among
officers who attended was positive. Advocates emphasized they
believe that these more flexible approaches to handling mentally ill
inmates enhance security rather than conflict with it.
Some DOC staff have expressed concerns that privacy and
confidentiality issues could prevent disclosure of detailed mental
health information to correctional officers, but knowledge of an
inmate’s mental health code without additional information on the
specific illness or symptoms might not be very useful for
correctional officers. However, given correctional officers’ roles in
interacting with mentally ill inmates, finding a way to resolve these
concerns by providing appropriate information on inmate mental
health, as well as training on how to effectively manage mentally ill
inmates, could improve institution safety and discipline.

Recommendation
We recommend the Department of Corrections report to the Joint
Legislative Audit Committee by January 4, 2010, on its plans for
providing correctional officers with more specific information on
inmates’ mental health needs and enhancing officer training in
managing mentally ill inmates.

General Release Planning Initiatives
Release Planning for Inmates with Mental Illnesses
Community Supervision of Inmates with Mental Illnesses

Release Planning
Connecting inmates to community services through a pre-release
planning process can support their successful reentry into the
community. No state or federal laws require release planning or
guide the provision of release-related services. However, DOC has
in place a release planning program for all inmates, which includes
release planning services of particular relevance to inmates with
mental illnesses.

General Release Planning Initiatives
At 13 of 20 institutions,
one or more social
workers specialize in
release planning.

In recent years, DOC has undertaken three sets of strategies to
improve release planning services for all inmates. First, in 2004, it
directed all correctional institutions to ensure release planning
services were available to inmates. Several institutions responded by
establishing specialized release planning social worker positions and
assigning all inmates closest to release to those workers’ caseloads.
Other institutions developed pre-release housing units for inmates
closest to release, which similarly allow social workers and
other unit staff to focus their services to these inmates. As of
December 2008, five institutions reported operating such units.
Overall, 13 of 20 institutions, including the 5 with pre-release units,
reported that one or more of their social workers maintained a
specialized pre-release caseload, and specialists with whom we
spoke believe they are able to provide more effective release
planning assistance than nonspecialists because of their increased
knowledge and experience.

R ELEASE P LANNING

Second, the Community Reintegration Services Initiative, which was
enacted in 2005 Wisconsin Act 25, provided DOC $3.1 million to fund
release planning services during the 2005-07 biennium and included
$1.51 million to hire probation and parole agents who provide release
planning assistance to inmates nearing release from maximum security
institutions. Currently 11.5 FTE positions with these responsibilities
are filled in DOC’s Milwaukee, Fond du Lac, Green Bay, Racine, and
Kenosha offices. The remaining funding—$1.6 million—was provided
to fund release planning services for three target populations: female
inmates, male inmates at medium security institutions, and inmates
with mental illnesses. DOC was unable to provide complete
information on the amount of funding or types of services directed to
inmates with mental illnesses. However, officials indicated during the
course of our fieldwork that their process for allocating FY 2009-10 and
FY 2010-11 funds has prioritized proposals to provide services to
inmates with mental illnesses.
DOC developed a release
planning curriculum for
all inmates in 2007.

DOC implemented its third general release planning strategy in 2007
with the development of a ten-module pre-release curriculum
designed to provide standardized and comprehensive release
planning assistance to all inmates. The curriculum guides inmates
and staff through a formal release planning process to be conducted
for every inmate beginning at least six months before release. As
part of the process, each inmate completes an inventory of
release-related needs—including housing, medication, and health
care—and meets with an institution social worker and a probation
and parole agent to review the inventory. The social worker and
agent are then responsible for arranging to meet the inmate’s
identified needs. DOC directed all facilities to implement the
curriculum by April 30, 2008; however, as of February 2009, DOC
found only 9 of 20 institutions and 1 of 16 correctional centers
reported full implementation of all modules of the pre-release
curriculum. In our interviews, five facilities cited a lack of resources
as a primary cause of their delays, and others expressed concern
about the volume of additional responsibilities placed on existing
staff by the initiative. DOC indicated that it has worked with
institutions to establish formal time lines for achieving full
implementation.

Recommendation
We recommend the Department of Corrections report to the Joint
Legislative Audit Committee by January 4, 2010, on:
the allocation of Community Reintegration Services
Initiative funds for the 2009-11 biennium; and
its progress in implementing the pre-release
curriculum for all inmates.

R ELEASE P LANNING

Release Planning for Inmates with
Mental Illnesses
Standards published by the American Psychiatric Association and
other professional organizations specify services that should be
included in inmate release plans, including three that are
particularly relevant to inmates with mental illnesses: provision of a
short-term supply of medications upon release; assistance in
obtaining benefits from government programs; and assistance in
obtaining health treatment services in the community, including
mental health treatment.
In FY 2007-08,
2,420 mentally ill
inmates were released
from prison.

Table 44 shows the number of inmates released from DOC facilities
in FY 2007-08. Of the 9,123 inmates released that year, 815, or
8.9 percent, were classified as seriously mentally ill (MH-2) at the
time of their release, and 1,605, or 17.6 percent, were classified as
having mental health needs but not seriously mentally ill (MH-1).

Table 44
Inmates Released from DOC Facilities1
FY 2007-08

Mental Health Classification
No Mental Health Needs (MH-0)
Mental Health Needs (MH-1)
Seriously Mentally Ill (MH-2)

Developmentally Disabled (MH-3)
Code Missing
Total

Released Inmates

Percentage of Total

6,128

67.2%

1,605

17.6

815

8.9

0.2

558

6.1

9,123

100.0%

Excludes inmates incarcerated on certain temporary holds, as well as those at the Milwaukee
Secure Detention Facility, for whom limited mental health information was available.

Inmates with mental illnesses.

To assess release planning services received by mentally ill inmates,
we reviewed the files of 50 randomly selected inmates released
between July 2007 and March 2008, including 24 classified as
seriously mentally ill at the time of their release (MH-2) and
26 classified as having mental health needs (MH-1). Of the
50 inmates, 25 were male and 25 were female.

R ELEASE P LANNING

Release Medications
Upon release, inmates
receive a two-week
supply and a 30-day
prescription for their
psychotropic
medications.

In order to ensure that inmates have a supply of medication
sufficient to last until they can obtain treatment in the community,
DOC policy requires they be provided with a two-week supply of all
their prescription medications upon release, as well as a 30-day
prescription for psychotropic medications. Inmates may also receive
a 30-day prescription for non-psychotropic medications at the
discretion of health care staff. DOC pharmacy data indicate 42 of the
50 inmates we reviewed were entitled to a supply of medication
upon release, and 31 appear to have received those medications. It is
not clear whether the remaining 11 inmates failed to receive
medication or whether they did receive medication but its receipt
was not documented by DOC.
Concerns were reported by DOC staff regarding recently released
inmates’ ability to fill their 30-day prescriptions, particularly if they
have serious mental health needs or are prescribed multiple
medications, in part because of cost. Institution social workers
reported providing inmates with information on pharmacies and
discount programs, but probation and parole agents indicated they
try to arrange access to medications for released inmates before they
exhaust their two-week supply, thereby avoiding the need to fill the
prescription.
Some correctional systems provide inmates with more than a twoweek supply of prescription medications upon release. For example,
Iowa and Michigan provide all released inmates with a 30-day
supply of medication, and Minnesota provides up to a 37-day
supply in some cases. In addition, WRC provides a four-week
supply to released inmates, but no prescription. DOC has
considered modifying its policy to provide released inmates with a
one-month supply of medication and no prescription. While doing
so would provide released inmates a greater supply, some believe it
could increase the likelihood of overdoses, and it increases concern
by institution prescribers about providing medications without
scheduled follow-up. The policy change would also increase DOC’s
pharmaceutical costs.

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Benefits Assistance
DOC policy requires
institution staff to help
inmates apply for Social
Security and Medical
Assistance benefits.

In July 2004, DOC implemented a policy requiring institutions to
help inmates apply for Social Security and Medical Assistance
benefits. Because individuals are ineligible for those benefits while
incarcerated, the goal of the policy is to permit inmates to begin
receiving benefits upon or shortly after their release.
To support this goal, DOC has signed memoranda of understanding
with the federal Social Security Administration (SSA) and DHS,
which administers Wisconsin’s Medical Assistance program, to
permit inmates to submit applications before their release dates. The
memorandum with SSA permits submission of disability benefit
applications 90 days before release, and the memorandum with DHS
permits submission of Medical Assistance applications 23 days
before release. DOC’s benefits assistance policy includes a time line
that is summarized in Appendix 7.
Social workers help inmates prepare Social Security disability
applications and work with treatment staff to obtain necessary
supporting medical documentation. DOC policy requires that
“potentially eligible” inmates be assisted but does not specify which
inmates should be given priority. Institution staff reported they help
all interested inmates classified as seriously mentally ill (MH-2)
apply for Social Security disability benefits, because these inmates
are most likely to qualify as disabled under program criteria. Staff
note they also assist inmates with less-serious mental health needs
(MH-1) when it appears they may be eligible for benefits.

Benefits application
assistance often did not
meet time lines set by
DOC policy.

One-half of the inmates whose files we reviewed were documented
as applying for Social Security disability benefits before release,
including 19 inmates who were seriously mentally ill (MH-2) and
6 inmates who had mental health needs but were not seriously
mentally ill (MH-1). However, the files suggest that DOC’s
application assistance often did not meet the time frames set forth in
the benefits assistance policy. For example, according to policy, SSA
should be contacted 150 days before release to determine the forms
needed to complete the disability benefits application. We found
that only 1 of the 16 files that documented the date of SSA contact
met this requirement, and the average date of contact was 95 days
before release. These delays may have prevented inmates from
receiving their eligibility determinations before release; among the
22 inmates for whom determination dates were documented, only
3 received determinations before their release dates.
Table 45 shows Social Security disability benefit application status
for the 50 inmates whose files we reviewed.

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Table 45
Social Security Disability Application Status1
September 2008
Inmates2

Status
Approved3

Initially Denied, Appeals/Reapplications Pending

Denied, No Appeals/Reapplications Pending

Applied, Status Unclear

No Documented Application

Total

For a sample of 50 inmates released from July 2007 through March 2008.

25 inmates applied for benefits before release and 4 applied after release.

Two of the 13 re-offended near their date of approval and thus appear to
have lost eligibility before benefit payments began.

Documentation of
benefits application
assistance was
incomplete.

In an effort to facilitate the Social Security disability application
process, DOC has developed a tracking form for staff to record each
inmate’s application status and progress through the process.
However, the form was included in the files of only 13 of the
25 inmates who pursued benefits before release, and most of the
forms were only partially complete. In addition, none of the forms
were updated after the inmates’ release dates, even though DOC
policy directs probation and parole agents to continue updating the
forms throughout the application and appeals process.
DOC cited several obstacles affecting its ability to comply with its
benefits assistance policy, including resource constraints. DOC also
noted that social workers lack expertise to effectively assist inmates
with the process, including the ability to identify and obtain the
medical documentation needed for the eligibility determination to
be completed.
From 2004 through 2008, inmates in three DOC correctional
institutions—Columbia, Oshkosh, and Oakhill—received assistance
with Social Security disability benefit applications through Legal
Action of Wisconsin’s Prisoner Disability Assistance Project. The
project, which was funded with approximately $500,000 in federal
grant funding from SSA, employed attorneys to help inmates
referred by institution social workers through the application
process. During the course of the project, which stopped taking

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referrals in March 2008 because of the anticipated expiration of
project funding, attorneys helped 327 inmates submit applications
and appeals. Of the 317 inmates who received initial application
decisions as of August 2008, Legal Action reported that 44.2 percent
were approved, compared to a national initial approval rate of
35 percent. In addition, of the 302 inmates who had completed both
applications and appeals by August 2008, 55.3 percent were
ultimately approved for benefits, partly because of appeal success
rates that also exceeded national averages.
DOC is planning to
implement a form to
better document
disability claims.

Legal Action and DOC staff believe project outcomes were positive
because of project staff’s expertise and time to devote to benefits
assistance. However, project staff reported that their largest obstacle
to providing effective benefits assistance was a lack of
documentation by DOC institutions to support inmates’ disability
claims. Partly in response to project feedback, DOC is currently
developing a standardized form for facility psychological services
staff to complete in support of inmates’ disability claims.
Implementation is expected by mid-2009. Legal Action and others
involved in the disability claims process believe that use of the form
may improve applicants’ chances of successful and timely claims.
Participation in Medical Assistance and other health care benefit
programs can help ensure that released inmates have access to
medications and treatment. Because 11 inmates included in our file
review received Social Security disability payments, they were
automatically enrolled in the Medical Assistance program. We
found an additional seven released inmates were enrolled in other
public health care programs: four in BadgerCare or other Medical
Assistance programs, which require applications for receipt of
benefits; two in the General Assistance Medical Program, a health
coverage program for residents of Milwaukee County; and one in a
tribal insurance program.

DOC’s policy concerning
Medical Assistance
benefit applications
could be improved.

DOC’s policy for assisting inmates with Medical Assistance
applications does not target the inmates most likely to benefit from
application assistance. For example, the policy directs institution
social workers to assist inmates who applied for Social Security
disability benefits but were denied or have not yet been approved.
However, DHS officials noted that when a person has already
applied for Social Security disability benefits, submission of a
separate Medical Assistance application will not expedite either
application. In addition, the policy does not identify or assist other
inmates, with or without mental illnesses, such as custodial parents
of children who may be eligible for non–disability related Medical
Assistance. None of the files we reviewed contained documentation
indicating the inmate submitted a Medical Assistance application
before release or received assistance in preparing one.

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Recommendation
We recommend the Department of Corrections report to the Joint
Legislative Audit Committee by January 4, 2010, on its efforts to
improve inmate benefits assistance, including:
an internal assessment of the use of tracking
forms for Social Security benefits applications and
provisions to ensure more consistent use of the
forms;
its efforts to improve documentation of inmate
disabilities for use in applications for Social
Security disability benefits; and
steps to identify and assist inmates who may
benefit from submitting Medical Assistance
applications before release.

Post-Release Treatment Appointments
Probation and parole
agents are typically
responsible for arranging
post-release mental
health treatment
appointments.

DOC officials, institution staff, and probation and parole agents
report that agents are typically responsible for arranging inmates’
post-release treatment appointments, such as psychiatric
appointments or mental health counseling. DOC employees at 9 of
13 institutions indicated that social workers occasionally make
appointments but that agents are more commonly responsible. A
release planning social worker reported that her specialization gives
her a greater knowledge of available treatment providers than other,
nonspecialized staff.
Some advocates and DOC officials with whom we spoke expressed
concern that DOC’s ability to link inmates to mental health
treatment is constrained by a lack of community treatment
resources, particularly the availability of county mental health
services. For example, they note that Dane County’s waiting list is
more than one year long, and Milwaukee County’s walk-in clinic
serves only 15 clients per day on a first-come, first-served basis.
However, other DOC staff, such as probation and parole agents and
institution social workers, reported that they can usually arrange
treatment appointments. DOC officials report that although counties
are primarily responsible for providing mental health services to
released inmates, DOC pays for some mental health services to
released inmates. For example, from July 2008 through
December 2008, DOC paid $38,400 for contracted psychiatric
services in Madison, $46,600 for psychological services in the
Racine/Kenosha area, and $25,000 for mental health services in

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Outagamie County. In FY 2007-08, DOC also employed 4.5 FTE
psychologists in the Milwaukee region and 4.5 FTE chief regional
psychologists in other areas of the state.
Post-release treatment
appointments were
documented for
62.5 percent of the
inmates in our sample.

Of the 50 inmates whose files we reviewed, 2 were released to
jurisdictions outside of Wisconsin. Post-release treatment
appointments were documented in 30, or 62.5 percent, of the
remaining files. However, other inmates who were released in
Wisconsin may have had appointments that were not documented
in their files. Released inmates who had been classified as seriously
mentally ill (MH-2) were more likely to have appointments than
those who had been classified as having mental health needs
(MH-1), 73.9 percent compared to 52.0 percent.
Of the 30 released inmates with documented treatment
appointments, 14 had their first appointment within one month of
release, but 4 did not have their first appointment until more than
three months after release. Most of the 30 released inmates received
treatment beyond their initial appointment, and as many as 20 could
be described as receiving consistent, ongoing treatment following
their initial post-release appointment through the date of our file
reviews in fall 2008.
Based on our file reviews, the percentage of released inmates who
obtained treatment appointments varied by the location to which
they were released:
13 of the 21 inmates released to the Milwaukee
area had treatment appointments;
all 4 inmates released to Madison had
appointments;
3 of the 4 inmates released to Green Bay had
appointments; and
10 of the 19 inmates released to other locations
had appointments.
The treatment provider also varied by location, as shown in
Table 46. Most appointments in Milwaukee and Madison were with
either DOC-funded mental health professionals or community
providers. By contrast, appointments for offenders released to other
locations were more likely to be with county or unspecified
providers, which may support concerns about the limited
availability of county treatment, particularly in areas without
DOC-funded providers or numerous community providers.

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Table 46
Initial Post-Release Treatment Appointments by Provider and Offender Location1

Offender Location
Provider

Milwaukee/Madison

Other Locations2

Total

DOC-Funded Mental Health
Professionals3
County Agency

8
1

0
6

8
7

Community Provider

Other

Not Specified

Total

For a sample of 50 inmates released from July 2007 through March 2008; 30 had documented
post-release treatment appointments.

Includes three offenders released to Green Bay, two offenders released to Kenosha, and one
offender released to each of eight other locations: Balsam Lake, Burlington, Janesville, La Crosse,
Manitowoc, Neenah, Portage, and Sheboygan.

Includes psychiatrists and psychologists employed or contracted by DOC.

DOC is seeking to
improve post-release
appointment scheduling.

In an effort to improve its capacity to link inmates to county mental
health treatment, DOC has developed a form for institution staff to
record the mental health needs and conditions of inmates. The form
is to be directed to county mental health agencies 90 days in advance
of release. DOC officials intend for the form to provide counties time
to schedule a treatment appointment near the inmate’s release date.
DOC plans to pilot use of the form early in 2009 with seriously
mentally ill inmates released from Oakhill and Redgranite
correctional institutions to the Milwaukee area.
As noted, 13 of 20 institutions have specialized social workers who
assist inmates nearing release with benefits assistance, scheduling
treatment appointments, and making other arrangements for postrelease support and services. Given the reported advantages of such
specialization, we believe DOC should consider whether other
institutions could also benefit from reallocating social worker
caseloads to allow for increased specialization in release planning.

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Recommendation
We recommend the Department of Corrections report to the Joint
Legislative Audit Committee by January 4, 2010, on:
an analysis of efforts to improve access to
specialized release planning staff; and
results of its implementation of the treatment form
in the Milwaukee area.

Community Supervision of Inmates
with Mental Illnesses
Upon release from incarceration, offenders are supervised by a DOC
probation and parole agent. As noted, DOC directs all probation and
parole agents to collaborate with facility social workers to provide
release planning for the offenders they supervise as part of the
pre-release curriculum.

Specialized Mental Health Agents
Probation and parole
agents in Milwaukee and
Madison specialize in
supervising mentally
ill offenders.

DOC’s Milwaukee and Madison regions employ specialized mental
health agents whose caseloads are limited to offenders with serious
mental illnesses: a 10-agent Mental Health Unit operates in
Milwaukee, and two agents serve as mental health specialists in
Madison. Mental health agents’ caseload responsibilities match
those of other agents and include enforcement of the conditions of
supervision and support with securing housing and employment.
However, these specialized agents also direct offenders to mental
health providers in the community and monitor and respond to
offenders’ mental health needs. Mental health agents receive
offender referrals from courts, institution staff, and fellow agents
and accept those with the most severe diagnoses and symptoms.
The Milwaukee unit has written criteria that prioritize the
acceptance of offenders with specific serious mental health
diagnoses. However, we note these criteria do not correspond to the
mental health codes used by DOC facilities.

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Mental health agents and other DOC officials agree that supervision
by specialized agents is beneficial for offenders with serious mental
health needs, because those agents are more experienced in
identifying the needs of mentally ill offenders and have established
better working relationships with mental health providers.
However, they expressed concern about the adequacy of existing
specialized supervision. For example, mental health agents report
that they supervise approximately the same number of offenders as
nonspecialized agents, although they believe mentally ill offenders
require more intensive supervision. The specialized agents also
reported that they are unable to accept less severely ill offenders
who could also benefit from specialized supervision.
DOC officials report that regions other than Milwaukee and
Madison do not have designated mental health agents. All agents
receive four hours of training in the supervision of offenders with
mental illnesses, and DOC reports that agents may choose to
informally specialize in supervising inmates with mental illnesses.
While offenders are generally assigned to the eligible agent with the
smallest caseload, DOC notes that individual units may make
arrangements for inmates with mental illnesses to be placed on the
caseload of an informal specialist.

Recommendation
We recommend the Department of Corrections report to the Joint
Legislative Audit Committee by January 4, 2010, on:
its efforts to ensure that offenders with mental
illnesses are supervised by the probation and
parole agents best equipped to meet their needs;
and
the feasibility of aligning policies for assigning
offenders with mental illnesses to specialized
agents with the mental health coding system used
in correctional facilities.

The Conditional Release Model
The Conditional Release
Program supervises
mentally ill individuals
released from state
mental health institutes.

Under s. 971.17, Wis. Stats., individuals charged with crimes but
found not guilty by reason of mental disease or defect are
committed to either Mendota Mental Health Institute or Winnebago
Mental Health Institute. Such individuals may subsequently petition
the committing court to authorize a conditional release from the
Institute. With the court’s approval, a plan for post-release

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supervision and assistance is developed to address the individual’s
participation in the Conditional Release Program operated by DHS.
The Conditional Release Program serves approximately
400 participants each year. It is funded through a GPR appropriation
to DHS, and expenditures totaled approximately $4.4 million in
FY 2006-07. In addition, participants secure Medical Assistance
benefits and help support themselves through any income they earn.
Under contract with DHS, DOC assigns probation and parole agents
to supervise program participants. The specialized mental health
agents in Madison and Milwaukee supervise participants in their
jurisdictions. In addition, DHS contracts with regional service
providers, which usually are nonprofit organizations, for case
management and support services.
DOC officials, advocacy groups, and DHS managers all believe the
Conditional Release Program is a promising model for improving
post-release assistance and outcomes for DOC inmates with mental
illnesses. They also cite the low recidivism rates of program
participants. For example, while DOC reports that 38.2 percent of
released inmates return to DOC custody within three years of
release because of new offenses, available data suggest that only
about 5.0 percent of Conditional Release Program participants
commit a new offense within three years. Some interviewees believe
the program model could be transferable because the clinical
condition and post-release needs of DOC inmates with serious
mental illnesses are similar to those of existing participants.
However, DOC notes that inmates have mandatory release dates,
whereas current program participants are approved for conditional
release only if their mental health conditions are stable, to increase
their chances of successful reentry.
The Inmate Mental Health Services Pilot Program was created in
2005 Wisconsin Act 25 to provide services based on the Conditional
Release Program model to 12 inmates released from WRC during
FY 2006-07. To fund the program, Act 25 decreased a DOC GPR
appropriation by $43,700 and increased the DHS Medical Assistance
benefits appropriation by $104,000, which includes $60,300 in federal
matching funds. However, DOC and DHS jointly decided not to
implement the program because of concerns over the amount and
availability of funds.
Neither DHS nor DOC report current efforts to pursue pilot
program funding, but both expressed interest in pursuing future
funding opportunities. The departments acknowledge that the
program would involve substantial upfront costs, estimated by DOC
at $16,000 per participant in a 2008 grant proposal. However,
supporters note that the low demonstrated recidivism rate for

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participants served by the existing program suggests the prospect of
long-term cost savings. They also believe the Conditional Release
Program model would be an efficient means to enhance assistance
for DOC inmates, because of the opportunity to utilize and expand
upon the existing program’s infrastructure.

Recommendation
We recommend the Department of Corrections report to the Joint
Legislative Audit Committee by January 4, 2010, on the feasibility
of incorporating elements of the Conditional Release Program model
into its supervision of released inmates.

Recent Improvements in the Provision of Services
Changes at Taycheedah Correctional Institution
Setting Priorities for Improving Inmate Mental Health Services

Future Considerations
In recent years, DOC has taken a number of actions in response to
recent litigation, the federal Department of Justice investigation, and
several independent evaluations. As a result, improvements to
inmate mental health services have been made, including capital
expenditures and increased staffing. Setting priorities for the future
will be important as the State continues to seek to improve the
provision of inmate mental health services at a time of significant
budget constraints.

Recent Improvements in the
Provision of Services
DOC has taken steps to
improve the provision of
mental health services.

DOC reports that improved procedures and training, additional
staff, and new facilities have all helped to improve the provision of
inmate mental health services. For example:
DOC hired a mental health director in 2002, a
psychology director in 2004, and a psychiatry
director in 2008 to enhance central oversight and
management of mental health care services.
DOC opened a special management unit at
Taycheedah Correctional Institution in 2002 to serve
female inmates with serious mental health needs.

F UTURE C ONSIDERATIONS

In 2003 and 2004, DOC improved staff training by
adding information on medication types and side
effects to correctional officers’ pre-employment
training, and by developing additional training
on suicide prevention and general mental health
issues.
DOC implemented a mental health classification
system in 2004 to improve its ability to monitor
the number of inmates with mental illnesses,
inform staffing decisions, and make data
collection and tracking easier and more uniform.
In 2007, DOC achieved accreditation for the
Psychology Internship Program.
DOC officials, as well as advocacy group representatives with
whom we spoke, believe these changes represent significant
improvements in DOC’s capacity to provide mental health care
services. However, they note that improving services to inmates at
Taycheedah Correctional Institution has been the focus of DOC’s
recent attention and resources.

Changes at Taycheedah
Correctional Institution
A 2008 settlement
agreement requires
improved mental health
care services at
Taycheedah by 2012.

As noted, the federal Department of Justice began an investigation
of inmate mental health care at Taycheedah Correctional Institution
in 2005. In May 2006, a findings report was issued, citing mental
health care services that did not meet constitutional standards. A
conditional settlement reached in September 2008 provides that the
federal Department of Justice will dismiss its complaint if DOC
ensures mental health care at Taycheedah complies with a set of
negotiated standards by September 2012. If compliance cannot be
demonstrated by that time, the federal Department of Justice
reserves the right to reinstate its complaint in federal court.
The settlement sets specific standards for all major aspects of mental
health care services at Taycheedah Correctional Institution, which
are listed in Appendix 8. For example:
all inmates with mental health needs or serious
mental illnesses must have individualized
treatment plans that are regularly updated;

F UTURE C ONSIDER ATIONS

inmates housed in the special management unit
must participate in at least ten hours per week of
therapeutic activity, including one hour of
individual contact with psychological services staff;
psychiatry staffing levels must be sufficient for
psychiatrists to see all inmates in need of care,
prescribe and monitor medications, help develop
treatment plans, and collaborate with
psychological services staff; and
psychological services staff must review
disciplinary charges for inmates with serious
mental illnesses and provide written information
regarding mental health factors that may have
influenced the inmates’ behaviors.
The agreement also requires that a consultant jointly appointed by
DOC and the federal Department of Justice be given full access to
Taycheedah Correctional Institution in order to assess the State’s
progress in implementing the settlement agreement. The consultant
is required to issue a report four months after the date of the
settlement and every six months thereafter. In October 2008, the
consultant was hired at an estimated annual cost of $27,000 to
monitor DOC’s progress and issue the necessary reports.

Recommendation
We recommend the Department of Corrections report to the Joint
Legislative Audit Committee by January 4, 2010, on the findings
reported by the consultant regarding DOC’s progress in
implementing the settlement agreement with the federal
Department of Justice.
The cost of improvements in mental health care for female inmates
has been substantial. For example, 2007 Wisconsin Act 20, the
2007-09 Biennial Budget Act, authorized $11.1 million in general
obligation bonding to construct a 45-bed addition to WRC specifically
for female inmates. Currently, WRC houses only male inmates. The
project is in the design phase, with groundbreaking anticipated in
July 2009 and completion scheduled for February 2011. 2009 Assembly
Bill 75, the Governor’s 2009-11 biennial budget proposal, requests
$4.7 million in GPR and 113.0 FTE positions to provide services to the
female inmates at WRC once the addition is complete, as well as
$881,500 in GPR and 15.1 FTE security staff positions.

100

F UTURE C ONSIDERATIONS

The Governor’s FY 2009-11
budget proposal includes
additional treatment and
security staff at
Taycheedah.

Meanwhile, improvements continue at Taycheedah Correctional
Institution. In addition to the opening of a special management unit
in 2002, staffing and services increased in the 2007-09 biennium, and
additional increases are requested for the 2009-11 biennium. For
example, 2007 Act 20 appropriated $2.3 million and authorized an
additional 38.0 FTE positions to improve prison health care,
including 11.25 FTE positions specifically authorized to enhance
mental health services at Taycheedah. 2009 Assembly Bill 75
proposes an additional $1.0 million and 20.90 FTE treatment and
security staff for mental health services at Taycheedah. The
Governor’s 2009-11 capital budget request has not yet been
submitted to the Legislature, but DOC has asked for an additional
$7.6 million in GPR bonding to build additional space at
Taycheedah to house enhanced treatment facilities.

Setting Priorities for Improving Inmate
Mental Health Services
DOC’s proposed budget for the 2009-11 biennium requested an
additional $4.6 million in GPR and 31.05 FTE positions for other
facilities in order to make incremental progress toward the level of
care prescribed in the Taycheedah settlement agreement by, for
example:
creating a new medium security special
management unit at Oshkosh Correctional
Institution;
adding psychological services staff to existing
special housing units; and
adding psychiatry staff to provide the equivalent
of 1.0 FTE psychiatrist for every 250 male inmates
on psychotropic medications, to move closer to
the American Psychiatric Association’s
recommended ratio of 1:150.
These proposals were not included in the Governor’s 2009-11
biennial budget proposal because of current budget constraints and
other spending priorities.
Settlements or judgments
against the State in
18 inmate health
care lawsuits totaled
$4.8 million.

If the Legislature appropriates additional funding for mental health
services in the future, it may help to reduce costs in other areas. For
example, although the majority of lawsuits are dismissed or result in
judgments in the State’s favor, 18 cases related to inmates’ physical
or mental health have resulted in $4.8 million in payments by the
State since June 2003. These include:

F UTURE C ONSIDER ATIONS

101

$1.4 million in attorneys’ fees paid to the plaintiffs
of the Supermax lawsuit, under the settlement
that resulted in the removal of seriously mentally
ill inmates from the institution;
$475,000 in damages paid under a 2007 settlement
with an inmate who alleged that his seclusion and
harsh treatment by guards at Supermax in 2001
worsened his mental illness; and
$735,000 in damages and attorneys’ fees paid
under a 2008 settlement with the family of an
inmate who committed suicide at Taycheedah
Correctional Institution in 2006.
In addition, the Wisconsin Department of Justice, which typically
defends DOC and other state agencies against lawsuits, estimates
that its staff costs for DOC inmate health care litigation total
approximately $1.1 million annually, with an additional $372,400 in
travel and expert witness expenses for the period from July 2004
through December 2008. DOJ notes that it is difficult to differentiate
between cases pertaining to medical issues and those pertaining to
mental health care issues, in part because many lawsuits address
both. Nevertheless, DOJ has estimated that approximately one-half
of all inmate health care cases relate specifically to mental health.
Improved management of mental illnesses among inmates may also
reduce expenditures for worker’s compensation claims or
emergency room costs, although additional cost reductions are
difficult to calculate. Similarly, recidivism may be reduced by
improved management of mental illnesses and continued emphasis
on release planning. Finally, we note the recommendations made in
this report should improve DOC’s ability to monitor and assess
issues related to mentally ill inmates and provide more effective
services.

Appendix 1

Mental Health Care Expenditures by Institution
Department of Corrections
Institution

FY 2003-04

FY 2004-05

FY 2005-06

FY 2006-07

FY 2007-08

$ 451,300

$ 603,200

$ 728,600

$ 950,500

$1,078,500

Dodge

623,400

681,500

785,300

911,200

930,900

Waupun

337,500

382,500

358,800

564,000

649,900

Columbia

449,300

487,100

551,500

573,600

635,100

Green Bay

302,400

391,000

399,500

480,700

493,300

Wisconsin Secure Program Facility

291,700

279,700

297,900

412,200

453,200

2,455,700

2,824,900

3,121,400

3,892,200

4,240,900

Oshkosh3

812,700

851,800

834,900

912,300

923,600

Racine4

533,600

620,300

653,200

790,500

803,400

Milwaukee Secure Detention
Facility

448,200

575,400

670,800

760,700

711,300

Redgranite

300,600

355,800

446,600

471,000

501,500

486,200

453,500

503,700

566,800

496,500

41,800

332,000

345,100

449,400

474,500

Stanley

278,800

301,900

461,900

500,700

450,600

Kettle Moraine

325,200

368,500

315,100

389,100

433,200

Racine Youthful Offender

323,000

419,100

363,100

306,600

366,000

274,800

298,000

270,500

327,400

340,000

60,400

61,800

70,900

110,100

3,885,300

4,637,800

4,864,900

5,545,500

5,610,800

280,700

299,400

316,600

354,900

358,800

48,800

67,700

81,100

71,600

35,500

96,800

73,300

96,400

124,500

Maximum
Taycheedah1

Subtotal

Medium

Jackson
New Lisbon

Fox Lake

Prairie du Chien
Subtotal

Minimum
Oakhill
8

Chippewa Valley

Women’s Correctional Centers
Wisconsin Correctional
Center System

1,900

12,000

12,100

11,900

12,000

318,100

457,100

469,700

544,500

566,900

Psychotropic Medication10

5,409,500

5,364,600

4,601,500

5,011,400

6,067,500

LTE Psychiatry Expenditures10

1,828,000

2,128,700

2,035,100

2,769,400

3,194,600

359,100

498,800

534,600

595,900

604,900

93,500

84,800

321,500

188,900

264,600

7,690,200

8,077,000

7,492,700

8,565,600

10,131,500

Subtotal2
Bureau of Health Services

Other11
10

Contract Costs
Subtotal

Institution

FY 2003-04

FY 2004-05

FY 2005-06

FY 2006-07

FY 2007-08

DOC Security at WRC12

$ 5,201,000

$ 5,701,000

$ 5,608,300

$ 6,225,600

$ 6,436,600

Total2

$19,550,300

$21,697,700

$21,557,100

$24,773,400

$26,986,700

Taycheedah Correctional Institution houses maximum and medium security female inmates. Expenditures at Taycheedah
include amounts for the institution’s dual diagnosis substance abuse and mental health treatment program, which totaled
$219,000 in FY 2007-08.

Totals may not sum because of rounding.

Expenditures at Oshkosh Correctional Institution include amounts for the institution’s dual diagnosis substance abuse and
mental health treatment program, which totaled $406,200 in FY 2007-08.

Includes expenditures for Sturtevant Transitional Facility.

New Lisbon Correctional Institution opened in April 2004.

Fox Lake Correctional Institution houses medium and minimum security inmates.

Mental health staff from the Wisconsin Secure Program Facility provided treatment to inmates at Prairie du Chien Correctional
Institution in FY 2005-06.

Chippewa Valley Correctional Treatment Facility opened in April 2004.

Includes three minimum security correctional centers that are part of the Wisconsin Women’s Correctional System.

These expenditures result from services provided at institutions. However, DOC records do not allow these expenditures to be
accurately identified by institution.

Includes costs associated with Bureau of Health Services mental health management staff.

DOC correctional officers provide security services at the Wisconsin Resource Center.

1-2

Appendix 2

Prescription Drugs with Highest DOC Expenditures
FY 2007-08
Drug Name (Brand)1

Commonly Prescribed for2

Expenditures

Quetiapine (Seroquel)

Psychotic disorders

$ 1,676,600

Risperidone (Risperdal)

Psychotic disorders

1,504,800

Ziprasidone (Geodon)

Psychotic disorders

1,111,100

Fluticasone/Salmeterol (Advair)

Asthma

1,023,400

Venlafaxine (Effexor)

Depression

723,300

Interferon-Pegylated (Peg-Intron)

Hepatitis C

593,500

Olanzapine (Zyprexa)

Psychotic disorders

588,200

Emtricitabine/Tenofovir (Truvada)

HIV/AIDS

360,200

Insulin Glargine (Lantus)

Diabetes

355,500

Omeprazole (Prilosec)

Ulcers, acid reflux

351,700

Atorvastatin (Lipitor)

Cholesterol

350,000

Epoetin Alfa (Epogen, Procrit)

Anemia

320,900

Aripiprazole (Abilify)

Psychotic disorders

311,000

Efavirenz/Emtricitabine/Tenofovir (Atripla)

HIV/AIDS

310,400

Albuterol

Asthma

269,800

Atazanavir (Reyataz)

HIV/AIDS

249,800

Divalproex (Depakote)

Mood instability/Epilepsy

246,000

Glucometer Strips

Diabetes

234,400

Tamsulosin (Flomax)

Enlarged prostate

231,300

Losartan (Cozaar)

Hypertension

231,100

Total3

$11,043,000

DOC reports using generic medications when available. Brand names are listed for reference.

Some drugs may also be prescribed for uses other than those listed.

Total estimated expenditures for the 20 drugs listed, based on the value of drugs dispensed from Central Pharmacy. Actual
expenditures are lower because of repackaging of unused medications and cost savings from manufacturer refunds.

Appendix 3

Authorized Full-Time Equivalent
Mental Health Positions by Institution1
Department of Corrections
Institution

FY 2003-04

Bureau of Health Services2

FY 2004-05

FY 2005-06

FY 2006-07

FY 2007-08

2.00

3.00

Taycheedah3

10.00

11.50

14.00

Dodge

11.50

11.00

11.50

Green Bay

5.25

6.25

Columbia

7.00

Waupun

5.50

Wisconsin Secure Program Facility

5.50

44.75

44.25

46.75

47.25

49.75

13.50

Racine

7.50

8.00

Milwaukee Secure Detention Facility

6.00

7.00

8.00

7.00

Jackson

6.00

Stanley

7.00

Racine Youthful Offender

6.00

5.00

Redgranite

6.00

New Lisbon

7.00

6.00

Kettle Moraine

4.50

5.00

3.60

1.00

68.10

68.60

68.10

3.50

1.00

3.00

1.50

2.00

Wisconsin Correctional Center System

0.00

Subtotal

5.50

7.50

6.00

6.50

120.35

122.35

123.35

123.85

127.35

Maximum Security

Subtotal
Medium Security
Oshkosh
4

Fox Lake

Prairie du Chien

Subtotal
Minimum Security
Oakhill
7

Chippewa Valley

Women’s Correctional Centers

Total

Taycheedah and Oshkosh Correctional Institutions include positions for each institution’s dual diagnosis substance abuse and mental
health treatment program. In FY 2007-08, Taycheedah employed 2.5 FTE dual treatment staff and Oshkosh employed 6.25 FTE dual
treatment staff.

Includes Bureau of Health Services mental health management staff.

Taycheedah houses maximum and medium security female inmates. A psychologist supervisor at Taycheedah also provides clinical
oversight to psychological services staff at three minimum security correctional centers that are part of the Wisconsin Women’s
Correctional System.

Racine mental health staff also provide treatment for Sturtevant Transitional Facility inmates.

Fox Lake Correctional Institution houses medium and minimum security inmates.

A psychologist supervisor at the Wisconsin Secure Program Facility also provides mental health treatment for inmates at
Prairie du Chien Correctional Institution.

A psychologist supervisor from Stanley Correctional Institution also provides mental health treatment at Chippewa Valley Correctional
Treatment Facility.

Includes the three minimum security correctional centers that are part of the Wisconsin Women’s Correctional System.

Correctional center inmates typically receive mental health treatment at nearby DOC adult institutions.

3-2

Appendix 4

Limited-Term Employees Providing Mental Health Care1
Department of Corrections
Institution

FY 2003-04

FY 2004-05

FY 2005-06

FY 2006-07

FY 2007-08

Bureau of Health Services2

2.21

2.36

3.87

4.38

4.00

Institution Psychiatrists3

7.23

8.41

8.05

10.72

11.49

Taycheedah4

0.00

1.23

1.36

Waupun

0.00

0.20

1.08

0.89

Columbia

0.00

0.35

0.34

Green Bay

0.15

0.48

0.10

0.00

0.16

Dodge

0.05

0.18

0.00

0.05

Wisconsin Secure Program Facility

0.00

0.43

0.48

0.15

0.00

Milwaukee Secure Detention
Facility

0.00

0.25

1.11

2.88

Racine Youthful Offender

0.00

0.10

0.14

Oshkosh

0.00

0.22

0.10

Kettle Moraine

0.18

0.32

0.28

0.31

0.00

Wisconsin Correctional Center
System

0.02

0.10

Total5

9.84

12.28

13.33

19.75

21.51

Maximum Security

Medium Security

Minimum Security

Estimates based on hours worked during the fiscal year.

Includes primarily psychological interns who provide services at institutions.

DOC records do not allow for accurate identification of psychiatrist hours by institution.

Taycheedah Correctional Institution houses maximum and medium security female inmates. Includes 335 hours in FY 2006-07 and
548 hours in FY 2007-08 for Taycheedah’s dual diagnosis substance abuse and mental health treatment program.

Totals may not sum because of rounding.

Appendix 5

Descriptions of Selected Mental Health Disorders
Disorder

Description

Adjustment Disorder

A temporary disorder characterized by a severe emotional reaction to a stressful life
event that impairs a person’s ability to function in daily life.

Anxiety Disorders

Disorders characterized by persistent, excessive, and unrealistic worry.

Attention Deficit
Hyperactivity Disorder

A disorder characterized by pervasive inattention and/or hyperactivity/impulsivity,
which impairs a person’s ability to function in daily life.

Bipolar Disorder

A severe mental illness characterized by dramatic mood swings that fluctuate between
feelings of euphoria, extreme optimism, and inflated self-esteem and feelings of
sadness, anxiety, guilt, and hopelessness.

Depressive Disorders

Depressive disorders, including major depressive disorder and dysthymia, are
characterized by feelings of sadness and a loss of interest in one’s usual activities,
impairing the ability to function in daily life. Major depressive disorder, which is a
severe mental illness, may include feelings of despair, hopelessness, and thoughts
of suicide.

Impulse Control
Disorders

Disorders in which an individual is unable to resist the urge to act on a certain
potentially harmful impulse. Includes intermittent explosive disorder, which is
characterized by repeated episodes of aggressive, violent behavior that are grossly
out of proportion to the situation.

Personality Disorders

Personality disorders are characterized by a rigid, potentially self-destructive way of
thinking, behaving, and relating to others. Includes borderline personality disorder,
which is characterized by a lack of one’s own identity, emotional instability,
impulsivity, and intense, unstable interpersonal relationships.

Post-Traumatic Stress
Disorder

An anxiety disorder that can result following exposure to a terrifying event in which
physical harm occurred or was threatened. Individuals with this disorder may
experience flashbacks, sleep problems, or may be easily startled.

Schizophrenia

A severe mental illness that may be characterized by a variety of symptoms, such
as loss of contact with reality, disorganized thinking and speech, hallucinations,
delusions, decreased emotional expressiveness, and social withdrawal. Individuals
with this disorder may not be able to distinguish reality from imagination.

Substance Abuse
Disorders

Disorders characterized by a maladaptive pattern of substance use resulting in
a failure to fulfill obligations of daily life. Individuals with substance abuse disorders
continue to use the offending substance despite persistent social or interpersonal
problems caused or exacerbated by its effects. Substance abuse often co-occurs with
other psychological disorders.

Appendix 6

Worker’s Compensation Awards Related to
Assaults by Mentally Ill Inmates1
FY 2005-06 through FY 2007-08

Institution

Amount
Awarded2

Percentage
of Total

Amount Related to
Assaults by Mentally Ill
Inmates3

Percentage Related to
Assaults by Mentally Ill
Inmates3

Maximum
Columbia

$77,200

7.5%

$76,500

99.1%

Dodge

45,500

4.4

5,200

11.4

Green Bay

33,500

3.2

25,200

75.2

Waupun
Wisconsin Secure
Program Facility
Taycheedah4

16,000

1.5

14,700

91.9

6,200
4,900

0.6
0.5

4,600
4,900

74.2
100.0

183,300

17.7

131,100

71.5

209,700

20.3

208,100

99.2

Subtotal
Medium
Racine
New Lisbon

79,500

7.7

2,000

2.5

Kettle Moraine

45,800

4.4

43,000

93.9

Stanley
Milwaukee Secure
Detention Facility
Racine Youthful Offender

37,600

3.6

34,600

92.0

32,400
5,100

3.1
0.5

29,900
4,900

92.3
96.1

Fox Lake5

3,900

0.4

3,900

100.0

Oshkosh

3,600

0.3

3,400

94.4

Redgranite
Subtotal

1,700

0.2

1,700

100.0

419,300

40.5

331,500

79.1

8,300

0.8

1,800

21.7

600

0.1

600

100.0

200
9,100

<0.1
0.9

–
2,400

–
26.4

409,200
$874,200

96.7
84.5

Minimum
Oakhill
Chippewa Valley
Wisconsin Correctional
Center System6
Subtotal
Wisconsin
Resource Center
Total

423,200
$1,034,900

40.9
100.0%

Includes DOC personnel assigned to adult institutions and DOC and DHS personnel assigned to WRC.

Does not include five awards totaling $61,632 for which we could not determine the inmates’ mental health status.

Includes inmates identified as having a mental health need (MH-1) and inmates identified as seriously mentally ill (MH-2)
before the assaults.

Taycheedah Correctional Institution houses maximum and medium security female inmates.

Fox Lake Correctional Institution houses medium and minimum security inmates.

Includes inmates at both men’s and women’s correctional centers.

Appendix 7

DOC’s Time Line for Benefits Application Assistance
Days before Release

Activity

180 days

Identify offenders who may be eligible for Social Security benefits.
Initiate case tracking of Social Security application process.

150 days

Help offenders complete forms to authorize release of information to SSA.
Contact SSA to determine forms needed for individual cases.

120 days

Assist eligible offenders in completing forms for disability assistance.
Obtain medical/psychological documentation to support disability claims.

90 days

Submit disability claims and supporting documentation to SSA.

60 days

Contact local SSA office if eligibility determinations have not been made.
Review denied claims. Determine whether Medical Assistance application should
be made. Refer offenders to entities that assist with appeals.

45 days

Help offenders complete Social Security applications for nondisability benefits.

30 days

Submit nondisability Social Security applications to SSA.
Help offenders complete Medical Assistance applications.

23 days

Submit Medical Assistance applications to the county/tribal agency where
offender will be living.

10 days

Contact county/tribal agency to determine status of Medical Assistance
applications.
Review Medical Assistance denials. Assist offenders in filing appeals.

Day of Release

Notify SSA and county of offenders’ release. Provide contact information for
offenders and probation and parole agents.

Appendix 8

Standards of Mental Health Care at Taycheedah Correctional Institution1
Department of Corrections

Title

Standard

Key Terms

Serious Mental Health Needs

The State shall provide services to address the
serious mental health needs of all inmates.

Refer to standards below.

Psychiatric Treatment

The State shall retain enough psychiatrists to
ensure that the needs of inmates with serious
mental illness are addressed, and that inmates
on psychotropic medications are seen regularly
for monitoring.

The State shall hire psychiatrists for a sufficient number of hours
per week to see patients, prescribe and monitor medications,
help develop treatment plans, review and respond to test results,
collaborate with psychological services staff, and communicate with
institution staff.

Administration of Mental Health
Medications

Policies, procedures, and practices shall be
implemented to ensure psychotropic
medications are prescribed, distributed, and
monitored properly and safely.

Qualified health care professionals shall administer medications to
inmates in the special management unit and the segregation unit.
Appropriately trained staff shall deliver medications to inmates in
general population housing units.
Corrections staff that administer medications shall receive training
at orientation and annually thereafter.

Serious Mental Illness Training

The State shall conduct training for all security
staff on recognizing and responding to
symptoms of serious mental illness.

Security staff shall be provided eight hours of training when they
begin employment.
Security staff shall be provided three additional hours of training
annually.

Mental Health Screening

All inmates shall receive mental health screenings
from trained staff upon entering the institution.

Nursing staff shall conduct an initial mental health screening
on the day an inmate enters the institution.
Inmates taking psychotropic medications before intake shall be
assessed no later than ten days after intake regarding their need
to continue medications.

Mental Health Assessment and
Referral

All inmates whose screenings or health histories
indicate a need for mental health assessment
shall receive an assessment and ongoing
treatment from mental health staff.

Psychological services staff shall conduct assessments within
72 hours of an inmate’s intake from outside Department custody.
Psychological services staff shall review the file of an inmate on the
mental health caseload within 5 working days of transfer from
another DOC facility.
Inmates shall have access to a confidential system for requesting
non-emergency mental health care.
Inmate requests shall be processed within 24 hours, and urgent
requests shall receive responses immediately.
Non-urgent requests shall receive responses within 3 working days
of receipt.

Title

Standard

Key Terms

Mental Health Treatment Plans

All inmates who require mental health services
shall have an individual treatment plan
developed by a mental health professional and
implemented.

Comprehensive treatment plans shall be developed for all inmates
requiring a special management unit level of care, and updated at
least every six months.
Outpatient treatment plans shall be developed for all inmates
requiring outpatient-level care, and updated annually.

Crisis Services

Crisis services shall be available to inmates
during psychiatric emergencies, and inpatient
psychiatric care shall be available to inmates
when appropriate.

Inmates shall have access to crisis services that include staff contacts,
observation placement, psychiatric intervention, emergency room
care, and inpatient psychiatric care.

Treatment for Inmates with Serious
Mental Illnesses

Therapy, counseling, and other mental health
programming shall be available to all inmates
with serious mental illnesses.

Review of Disciplinary Charges for
Inmates with Serious Mental
Illnesses

Disciplinary charges against inmates with serious
mental illnesses shall be reviewed to ensure that
inmates are not punished for behavior resulting
from their illnesses, and to ensure that inmates’
serious mental illnesses are a mitigating factor in
punishments when appropriate.

Disciplinary charges for inmates with serious mental illnesses will be
reviewed by psychology staff.
Reviewing staff will provide written input regarding mental health
factors that may have influenced the behavior associated with the
disciplinary charges.

Procedure for Inmates with Serious
Mental Illnesses Who Are in
Segregation or Observation Status

Inmates with serious mental illnesses in
segregation shall receive treatment.

All inmates on the mental health caseload shall be evaluated by
psychological services staff within one working day of their placement
in segregation.
Inmates in segregation with a special management unit level of care
shall be provided ten hours per week of therapeutic activity, including
one hour of individual contact with psychological services staff.
Inmates in segregation on the mental health caseload but without
serious mental illnesses shall be provided at least two hours per week
of therapeutic activity, and at least one weekly opportunity to request
individual contact with psychological services staff.
Inmates in segregation or the special management unit who require a
special management unit level of care shall be provided ten hours per
week of recreation.

8-2

Inmates with serious mental illnesses in the special management
unit shall be provided at least ten hours per week of therapeutic
activity, including one hour of individual contact with psychological
services staff.
Staffing shall be sufficient to provide inmates with serious mental
illnesses in general population units with an average of one
individual contact with psychological services staff every four weeks,
and an average of four group therapy programs per year.
Staffing shall be sufficient to provide inmates on the mental health
caseload without serious mental illness with an average of one
individual contact with psychological services staff every six weeks,
and an average of two group therapy programs per year.

Title

Standard

Medical and Mental Health Record
System

A record-keeping system shall be maintained
that makes all documents relating to treatment
of inmates with serious mental illnesses available
to treatment staff.

Psychological services files shall include a complete record of
mental health care documentation.
Psychiatry records and copies of psychological services documents
shall be included in inmates’ health services files.

Medication and Laboratory Orders

Orders for medications and laboratory tests
related to mental health care shall be filled in a
timely manner, and related policies and
procedures shall be periodically evaluated to
ensure delays are prevented.

Psychotropic medication and laboratory test orders shall be
processed within 24 hours of being written.
Staff who administer medications shall notify health services staff if
an inmate refuses or fails to take psychotropic medications for three
consecutive days.

Key Terms

Established under the terms of DOC’s September 2008 settlement agreement with the federal Department of Justice.

8-3

Mailing Address

Jim Doyle
3099 E. Washington Ave.

Governor

Post Office Box 7925

Ricl< Raemisclt
Secretary

State of Wisconsin
Department of Corrections

Madison, WI 53707-7925
Telephone (608) 240-5000
Fax
(608) 240-3300

March 16, 2009

Janice Mueller, State Auditor
Legislative Audit Bureau
22 East Mifflin Street, Suite 500
" Madison, WI 53703
Dear Ms. Mueller:
We have completed our review of the Legislative Audit Bureau's report on mental health
services within the Department ofCorrections and appreciate the oppOliunity to examine and
comment on the content. We believe that such an audit will add value to the discussion of how
we best meet the needs ofimnates with mental illness. We appreciate the care and
professionalism of the Legislative Audit Bureau staffwhile they conducted this audit.
There is a now a broad consensus among correctional administrators and mental "health
advocates that the number of mentally ill u1ll1ates who are in correctional settings is increasing.
As your repOli indicates, we have seen a significant increase in mentally ill inmates within our
department over the last several years. The challenges we face are significant. Providing
effective mental health treatment in a prison environment requires that we prioritize needs, use
our resources wisely, and increasingly value rehabilitation and treatment approaches as we strive
to maintain safe and secure facilities.
In your report you include a brief description of how you employ the telm "mental
illness", defined as those imnates who are classified as either MH-l (having a mental health
need) or MH-2 {having serious mental illness). We believe that this definition deserves to be
highlighted, since "mental illness" can have a variety of meanings depending on the source data
and the definition of illness used. You correctly point out that your definition of mental illness is
an inclusive one and meant to designate u1ll1ates who are on the mental health casel0ad at a given
point in time. Note thatunder this definition, inmates who have mild or tune-limited conditions,
personality-based problems, or conditions that do not rise to the level of a formal diagnosis are
still defined as mentally ill by vUiue of being engaged in treatment at the time of data collection.

Your report correctly states tilat tllere are 110 Special Managelnent Units for olentally ill
inITIates in Inedium securi~y prisons. The Departlnellt has an interest in developing such units~
although recognizes that additional staff resources would be required to l11ake tllis a reality.
Starting ill 2007, the Department developed an alterllative 1110del, Special Housing Units, wllich
are now present within at least five mediuln-security institutions. These Special I-Iousing Ullits
allow for nl0re flexible disciplillat-y approaches as well as. providing some programlning witll0ut
requiring a significant influx of staff resources. We believe that this direction begitls to address
the need for specialized llousing for l11elltally ill alld at the satne tilne recognizes current fiscal
realities.
Your report reviews tIle operations of tIle WiScollsin Resource Center and tIle processes
that govern transfers between tllis facility al1d DOC institutiol1S. We agree that clearer policies
regarding transfers, adlnission criteria alld bed utilization would be beneficial and look forward
to collaborating with the Department of Health Services to develop these.
Your report correctly states that the suicide rate in Wisconsill prisons is significantly
higl1er than the 11ational average for prisons. This issue has been a cause of cOllsiderable concern
for the Department and ill recent years we have developed new policies, procedllres and training .
to address this problem. Suicide llumbers from the past two. fiscal years show a trend towards
lower rates alld we are hopeful that this reduction will continue. Data not published itl your
report also shows a reductioll itl serious, but non-lethal attell1pts since 2005 when new policies
stalted to·· be il11plelnented.
Mucll of the data in your report regarding suicide rates and cOlnparisons was gatllered in
2001-2002. Due to the more relnote time frame, we are concerned that suell data may be
misleading and not reflective of nl0re current trends.
Yout· report outlines the atnount spent by tIle Department on 111ental healtll treatmellt for
released inmates, citing, ~for example, amounts spent .for contracted psyclliatric and psychological
services in various Coul1ties. We note that tl1ese alll0unts reflect Ollly a pOttioll of the resources
devoted to mentally ill itlffiates post release, and do not include services such as transitional
110usillg or treatment for substance abuse prograll1s or other recidivism..based progralns.
Your report describes the Conditional release Inodel ell1ployed by the Departnlent of
Health Services for individuals who are adjudicated Not Guilty by Reason of Mental Disease or
Defect and court.. ordered for release to tIle COlnmUl1ity fronl one of the state melltaillealth
institutes. We value suell an intellsive cOlnmunity treatmel1t approach for itldividuals with
serious ll1ental illness and would welcome the opportunity and resources to develol) tllis furtller.
However, it is important to recognize that tIle ilUllates with serious melltal illness WilO are
c.urrel1tly ill tIle COl1ditionai Release Program represent a lllore stable population of individuals
than ilmlates who would be served from tIle Department of Corrections. Current progralTI
participants who are released fi'om DI-IS facilities 11eed to navigate a process desigl1ed to en.hance
the chance for success, in9luding stability all an inpatiellt Ullit, a positive evaluatioll from an
outside lnental health expert, and concurrence of the court. In contrast, innlates with serious
111ental illness who are released frOll1 the Departll1ent of Corrections gel1erally do so 011 a pre~
determined date regardless of symptonlS, stability, Inotivatioll, or treatment cOlnpliance.

Altll0ugh considerable work: relnahls, the Departnlent has takeillnally strides to improve
Inental health care to inmates. The following are 'highlights of ol1going efforts.

o Developlnellt of Special I-Iandlhlg Units to provide specialized housing for irunates witil serious
l11el1tal illness.
o Stricter oversigilt of tIle psychotropic l11edication formulary to ill1prove quality of care alld
decrease costs.
o Greater titl1e devoted to assisting ll1elltal1y ill iniTIates with re-entry into the COll1111unity.
o

Developmellt of Quality Improvenlent protocols to track treatment outcomes.
Developmellt of additional alld more specific policies and procedures to govern Inelltaillealtil

treatment.
o

Developillg additiollal training for correctional officers in the area of mental illness.

Thank you for the opportunity to provide comments. We look forward to ilnplelnel1ting
tIle recolnlnendations in tIle report.
.

Sillcerely,

~~
Rick Raemiscll
Secretary

State of Wisconsin

Department of Health Services
Jim Doyle, Governor
Karen E. Timberlake, Secretary

March 13,2009

Janice Mueller, State Auditor
Legislative Audit Bureau
Suite 500
22 E. Mifflin Street
Madison, WI 53703
Dear Ms. Mueller:
Thank you for the opportunity to respond to the Audit Bureau's evaluation of mental
health care services in adult correctional facilities. Audit Bureau staff did a good job
collecting and analyzing an extensive amount of complex information on a subject of
considerable importance to our department, which is meeting the mental health needs of
patients we serve.
As the audit notes, the Wisconsin Resource Center (WRC) is the one department facility
that exclusively provides inpatient services to adult inmates with complex mental health
needs. We believe the audit accurately describes WRC resources and operations, and our
working relationship with the Department of Corrections (DOC). We appreciate the
Audit Bureau's recognition that WRC is functioning well, and that the department's
Conditional Release program is widely acknowledged as an effective program for
managing community placements.
In regard to the recommendation to clarify and document the process for transferring
inmates between the WRC and DOC prisons, DRS will work collaboratively with DOC
to address this recommendation and provide a report to the Committee by January 4,
2010.
Sincerely,

Karen Timberlake
Secretary

1 West Wilson Street. Post Office Box 7850 • Madison, WI 53707-7850 • Telephone 608-266-9622 • dhs.wisconsin.gov
Protecting and promoting the health and safety ofthe people of Wisconsin

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