First of two parts: The Courier looks at problems that have long plagued the Iowa Department of Corrections' mental health division. Monday, we look at proposals to address some of these concerns.

DES MOINES -- Bouncing in and out of Iowa prisons and jails, Lisa Dang said, she couldn't get the medication she needed to manage her obsessive compulsive disorder and depression, even though she was screened repeatedly for mental illness.

While serving sentences for crimes including prostitution, Dang wasn't able to meet with a state psychologist regularly -- at times, only once every three months.

And when she met with a psychiatrist, via a closed-circuit television network, the doctor hesitated to prescribe the drug Dang, a Des Moines resident, used to manage her anxiety. Only after repeated requests was she able to secure a lower dosage of the medication, Dang said.

"They told me they didn't see any symptoms. And if they don't see it, they don't do anything," said Dang, 38. "I think they thought I was drug seeking."

Dang's story is not unique.

The Iowa Department of Corrections has struggled to care for the significant proportion of its inmates who have a diagnosed mental illness as need has outpaced services.

The department suffers from a perennial shortage of trained health-care professionals, while the ballooning population taxes existing programs.

"It's a big issue, and there is no easy solution," said Dr. Bruce Sieleni, the department's mental health director.

Gov. Chet Culver has proposed pouring millions into new programs designed to provide better care for the mentally ill, both inside and outside the prison system. Lawmakers haven't decided whether they'll fulfill Culver's requests.

Prison reform advocates support the plans, but say Culver's recommendations fall far short of the money needed to fix what they say is a systemic problem.

A growing need

Part of the problem is the sheer volume of inmates needing services.

Iowa's prison population has skyrocketed over the last two decades -- to about 8,650 this year from 2,635 offenders in 1985, according to the DOC.

About 40 percent of those inmates have been diagnosed with a mental illness, according to DOC figures, including more than 60 percent of Iowa's roughly 735 women inmates.

The state spends $3.8 million each year on inmates' psychiatric medications, department spokesman Fred Scaletta said.

Nearly all of those illnesses are chronic conditions that require ongoing care.

The growth is due, in part, to law and sentencing changes instituted in the Reagan era. The changes have increased the likelihood an individual will be sent to prison for a drug violation and the length of time they will serve, prison experts say. The changes followed a push to deinstitutionalize people with mental illness.

The proportion of drug offenders in the corrections' system -- many of whom have mental diagnoses -- has grown. Such offenders constituted 2 percent of all Iowa inmates in 1987; That figure is closer to 24 percent today, according to the DOC.

More than 90 percent of inmates have had or currently have problems with alcohol or drug use.

Experts have theorized individuals with mental illnesses abuse drugs as a rudimentary method of self-medication.

"They (try) to treat themselves by using street drugs if they can't get their psychotropic drugs, and then they get in trouble with the law," said Jean Basinger, president of the prisoner advocacy group Iowa Citizens United for the Rehabilitation of Errants.

Changing practices

Critics say the Department of Corrections has been slow to respond as the need for treatment grew.

A 2007 commissioned report from the Durrant Group criticized the department for using outdated methods to identify and treat patients. The report, based on observations made the year before, said these antiquated methods prevented some inmates with mental illnesses from moving to less restrictive housing or accessing different treatments.

"Many people who were mentally ill, depressed and suicidal were being treated as if they had a discipline problem," Basinger said. "When they would, say, cut their wrists or attempt to hang themselves … or some kind of behavior like that, the staff would say they were just trying to get attention, and they would treat it as a discipline problem."

And a lack of psychiatric hospital beds for females meant women were placed in the same facility as men when they needed hospital-level care, the report noted.

Sieleni, who took the helm of the DOC's mental health department in February 2006, said he began tackling some these recommendations immediately, before the report was released.

Static resources

The DOC has suffered from a chronic shortage of trained health professionals, especially psychiatrists and psychologists, Sieleni said.

The DOC employs four full-time psychiatrists, including Sieleni; a fifth resigned effective Friday. Sieleni said he would like to have at least 10 on board.

"I'd say we're running at about half-steam," Sieleni said.

A nationwide shortage of psychiatrists appears to be more severe in Iowa, said Rep. Bill Schickel, R-Mason City, who has pushed for the state to study the employee drought. The U.S. Bureau of Labor statistics estimates there were 160 psychiatrists in Iowa in 2006 -- the equivalent of one doctor for 18,000 Iowans.

The dearth has prompted the DOC, like other facilities across the country, to make hiring changes. For example, nurse practitioners often are hired to fill positions once held by psychiatrists, Sieleni said.

Health-care workers appear to be less inclined to join the state's corrections system, Sieleni said, because it doesn't offer the perks private practice does -- like long vacations, flexible hours and higher pay.

"It's hard to get people to come to work in this kind of an environment," said Scaletta, the DOC spokesman.

While the statewide shortage is partially to blame, having more financial resources could help attract more candidates, Sieleni said.

Sieleni said he was once offered a $300,000 job in the private sector -- far better than the roughly $206,000 he made working for the state last year.

The shortage of such mental health workers has ramifications for inmates, who see the same psychologists and develop relationships with them, Sieleni said.

Some mental health workers treat inmates in multiple facilities, through tele-psychiatry. Others juggle administering treatment with other corrections' duties.

"Basically, you add up the bits and pieces of people that we beg, borrow and steal, and that's really how we do it," Sieleni said.

Struggle to improve

Failing to provide better care to the incarcerated will have ramifications for the state, cautioned Basinger. Taxpayers fund the prison system, and people kept behind bars don't contribute to the economy.

But Sieleni said there is no quick fix to the problems.

"I don't expect the governor or any one particular person to suddenly bring about the changes that are necessary," Sieleni said.

Contact Whitney Woodward at (515) 243-0138 or whitney.woodward@lee.net.