by C.S. Bryson
In March of this year, a rally was held at the California state capitol building to increase awareness about mental health staff shortages within the California Correctional Health Care System (CCHCS). The shortages of clinicians within California state prisons has had negative impacts that are far-reaching. The term “clinician” is used to refer either to Psychologists or Licensed Clinical Social Workers (LCSWs). Working side-by-side, both are exposed to the same dangerous and challenging work environment as they endeavor daily to provide mental health services to the prison population. Critics of recruitment and retention efforts currently being made point to the salary differentials between the two professions. Director of Governmental Relations with The National Association of Social Workers, California Chapter (NASW-CA), Rebecca Gonzalez stated, “The Recruitment and Retention bonus that explicitly excludes licensed social workers has been demoralizing to the LCSWs in the prison system…”
The disparities are apparent in annual pay scales that have remained inequitable for 15 years, with LCSWs earning between 27-37 thousand dollars less than their Psychologist counterparts. The significance of this statistical data, according to Gonzalez, is, “The higher vacancy rate is directly related to the simple fact that more positions have been created for psychologists in CDCR, not necessarily related to any need for specific services.” This reveals a correlation between the inability to recruit and the current turnover trends for lower paid clinicians working in the prison system. A recent survey of Clinical Social Workers found that 55.9% of respondents were looking for other employment, with salary being the top reason at 61.4%. Throughout the California Department of Corrections (CDCR), administrators from CCHCS are working to increase staffing levels by offering various hiring incentives, and have conducted job fairs in an attempt to attract recruits to work inside a correctional setting. The 
shortages have had a significant impact on their ability to properly address incarcerated patients’ psychosocial issues, such as past trauma, provide client education, and offer social service recommendations to successfully reintegrate individuals into the community upon release from custody.
At Mule Creek State Prison (MCSP) in Ione, California, mental health staff have been redirected since the onset of the Covid-19 pandemic in 2020, increasing the caseloads for the remaining clinicians. Incarcerated patients at the Correctional Clinical Case Management System (CCCMS) level of care within the Mental Health Services Delivery System (MHSDS) were previously seen at a minimum rotation of once every 90 days. However, due to the staff shortages, these individuals are now only seen by their assigned psychiatrist in consultations regarding medication unless a mental health service request, CDCR Form 7362 is submitted. When such a form is submitted, the process triggers a response from a clinician. Incarcerated patients at the prison currently rely on a single clinician, responsible for the treatment of over 1400 incarcerated patients, a combination of those individuals enrolled in the CCCMS program and any non-enrolled incarcerated individual who seeks mental health services. To provide perspective, the clinician’s caseload over the previous years was approximately 175 incarcerated patients.
The issue extends well beyond the confines of a single prison. Similar to the situation at MCSP, staff shortages at Salinas Valley State Prison (SVSP) have resulted in a single clinician being responsible for the care of all of the incarcerated patients on two yards. Clinicians are reported as seeing mostly urgent and emergent issues while attending two huddle meetings daily, as well as conducting initial assessments and Interdisciplinary Treatment Team meetings.
Some incarcerated patients at the facility report having not been seen in nearly a year or more, adding that they are often not even scheduled for routine contact. When these patients attempt to utilize the CDCR Form 7362 to obtain mental health assistance, they receive no response, placing the facility in danger of being out of compliance with Coleman mandates, which ruled that CDCR was not providing the prison population with necessary services.
Personnel changes have impacted access to mental health services under the Coleman mandate that also extend to educational services for incarcerated patients. The Office of Correctional Education discontinued Enhanced Outpatient (EOP) Education statewide in January of 2022. The service provided one-on-one instruction in a learning environment tailored to specifically accommodate their learning needs and mental health diagnosis. The format allowed these students to progress at an independent pace. Some incarcerated student patients suffer from diagnoses that can cause them to have uncontrollable symptoms or reactions to prescription medications. Coleman’s verbiage states that students with symptoms of mental illness shall be given separate but equal education opportunities. Incarcerated student patients are now mainlined into classrooms with over 20 students.
At the California Medical Facility (CMF) in Vacaville, the length of stay for increased level of care programs has been drastically reduced, from 3-6 months to 30-90 days, in order to minimize wait lists for the programs. According to clinicians at the facility, a memorandum was recently filed to close 50 percent of the Acute Level of Care beds at the facility, as the caseloads are significantly higher than in years past. The staffing shortages require Mental Health Specialists, Clinical Supervisors and Chiefs to assist in providing coverage. This, with only a single acting supervisor and single acting chief, rendering the facility five supervisors shorter than that of a typical institution. The facility is able to avoid a backlog of CDCR Form 7362s solely by having the clinicians circulate the housing units daily.
While a seemingly viable solution, this only results in leaving the mental health therapy groups to be run by registered nurses and recreational therapists, rather than the more qualified clinicians themselves.
The broad duties of the clinician include performing psychological assessments to determine patients’ level of mental health functioning, evaluating the presence of mental health or substance abuse disorders, providing individual counseling sessions, and facilitating an increase in life skills for individuals in preparation for Board of Parole Hearings and physical parole. The clinician must also complete an assortment of administrative tasks, such as, authoring treatment plans, documenting files and case notes, and communicating with prison officials regarding incarcerated patients. The CDCR institutions most affected consist of diverse populations of high risk patients with mental health issues, substance abuse issues, transgender patients, as well as an aging population with other significant medical issues.
These patient and staffing issues are only compounded further by the custodial staff shortages that prevent programming access within these institutions, increasing the danger to everyone inside the walls, both staff and residents alike. The concerns arising from within California state prisons also have a direct impact on community safety. An inability to provide rehabilitative care ultimately results in severely mentally ill patients being deprived of treatment, sitting in prison, and simply awaiting release back into society. Incarcerated patients often times are instructed by the Board of Parole Hearings to enroll in self-help and therapy groups to process the issues that underlie their criminality in order to be considered suitable for release on parole, however these staffing issues prevent them from having access to such programs and treatment. They will return to outside communities without having been provided the rehabilitative services necessary for them to avoid recidivism, and, more significantly, the coping skills necessary to avoid allowing their trauma and related mental health diagnoses to lead them to return to harmful behaviors such as substance abuse and criminal lifestyles. In some instances, this lack of coping skills prompts a return to substance abuse before these individuals are even able to parole, evinced by reports of five deaths from drug overdoses in the past 30 days at Richard J. Donovan State Prison in Southern California. A common theme in reports from across California state prisons is incarcerated individuals feeling as though they are having to “fight their battles alone,” and feeling as though they “can’t ask for help” as a result of the mental health staff being overwhelmed, with no clear resolution in sight for either side.
