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The BOP is widely regarded as not offering sufficient mental health and care. The fact is, the bureau is not staffed to deliver individual clinical services except in facilities designated for higher levels of mental health care. In those facilities, the BOP offers psychological programming in group and residential therapeutic community (unit) settings. The latter have clinicians stationed on site.
The BOP’s general approach, as well as the roles of staff members, are described in its Psychology Services Manual. A specific description of the agency’s psychiatric services can be found in a separate program statement. And finally, there is a description of mental health programs, ranging from specialized treatment for drug addiction to rehabilitation following trauma.
Each BOP facility is assigned a mental health care level, with 4 being the highest. (Scroll to page 14 in this document to better understand the criteria used to determine care levels.) For example, individuals requiring care level 3 are those who do not currently need psychiatric hospitalization but who:
It is important to know where the care level 3 mental health facilities are within the BOP, because they are staffed with more clinicians. This increases the availability of counseling services.
Too often, judges recommend counseling for people entering the BOP, without realizing that most prisons do not have the staffing needed for this type of frequent clinical contact.
Longer stays in restrictive housing are particularly problematic for individuals with mental health challenges. A 2017 study by the Office of the Inspector General found that:
Drug use is rampant within federal prisons. To help AICs kick the habit, the BOP offeres medication-assisted treatment (MAT).
Medication-assisted treatment (MAT) is the use of drugs such as Suboxone, in combination with counseling and behavior modification, to wean individuals off opioid addiction and maintain that status.
Individuals refer themselves for a psychology screening to determine eligibility for MAT. BOP staff also may make referrals based on a urine test that is positive for opioid use, the need for Naloxone following an overdose, or any conduct associated with opioid use. [Note that we have received reports of individuals who are trying to get into MAT being sent to the SHU after a random urine test came back positive for opioid use. This should be challenged; add PERA on TruLincs ([email protected]) and tell us if this happens.]
Psychology staff look for at least two of 11 symptoms of “clinically significant impairment or distress” from opioid use. They also assess severity of the condition and status/history of addiction.
Buprenorphine, a main component of Suboxone, diminishes the effects of physical dependency, such as withdrawal symptoms and cravings, making it easier to kick the habit.
If you arrive at a prison already on MAT, you should be continued on your routine as if it were any other treatment such as blood pressure medicine, etc. However, we are increasing reports from individuals who want to enroll in MAT for the first time and are not being allowed.
Here is the process for enrolling in MAT, according to the way it should work:
Former BOP doctors tell PERA that Medical at each facility prioritizes individuals who are close to release, because of the high overdose rate among people recently discharged. (However, we hear that even some people close to release are being denied.)
The first action to take if you have been screened and recommended, but ate not receiving the medication is to go to mainline and have a polite conversation with the Health Services Administrator (HSA). If this produces no results, talk to the Associate Warden for Operations. (Note, though, that the next-in-line might vary, since wardens may assign their AWs as they see fit.)
If that conversation produces no results, the warden is the next stop.
If you are still not allowed to start MAT, it is critical to file an administrative remedy to establish a record, including a written response, so you can then go to court.
The BP-8 (Informal resolution) is simple: “I have been screened and approved for the MAT program and I have not been given the medication.”
In the BP-9, you don’t need to say much more, except for a brief statement regarding your addiction and the date you were screened. If drugs are rampant at the prison, we also suggest you state that, to mitigate any incident reports you receive in the future for opioid abuse. Please share with PERA ([email protected]) the response you receive to your BP-9 and 10, so we can help you draft your future filings.
We are reporting on this issue to Congress, the GAO and organizations like the ACLU, in case a class action is necessary.
The BOP medical staff often put MAT participants on Vivitrol because a) it is easier to maintain (since injections are monthly) and b) they believe strips and tablets are too easily diverted for illicit use. However, some adults In custody tell us that they do not like the shots because of discomfort at the injection site and the constipation it can cause. (Note that Suboxone can cause constipation as well. In either case, it is usually temporary.) In addition, another disadvantage of Vivitrol is that users must be opioid-free for least several days before receiving it, to assure they do not go into immediate, painful withdrawal when administered the medication.
The advantages and disadvantages of each medication type requires a thoughtful discussion between recipient and pharmacist before treatment is initiated. The bottom line: According to the BOP’s own clinical guidance, “There is no ‘one size fits all’ approach to opioid-use disorder. Determination of which medication to use should be based on the recipients’ past treatment history, current state of illness and preference [emphasis added], after being informed of risks versus benefits.” If you are required to go on Vivitrol injections and you think you are a better candidate for Suboxone, contact us at [email protected].