Advocating for ADHD in the Departments of Correction

By Janet Kramer, MD CCHP

ADHD is the most common neurobehavioral disorder in correction facilities, affecting over 25% of offenders. Parents, spouses, friends and professionals have reported that individuals diagnosed with ADHD rarely receive prescribed medication during incarceration, and even while on probation. As an advocate for the ADHD community, this issue is important to ADDA.

ADHD Affects Many Offenders

ADDA and the National Commission on Correctional Health Care (NCCHC), the major correctional health accreditation organization, formed a collaboration to educate correctional professionals concerning the identification and appropriate treatment of ADHD. We hope to make accreditation of correctional institutions hinge on an institution’s appropriate treatment of inmates who are mentally ill, developmentally delayed or who have ADHD.

Jailing citizens for socially unacceptable behaviors, including poverty and mental illness, was once common practice. Despite improvements since the 1920s, “tough on drug crime” policies implemented in the 1970s were a step backward. Under these policies, people experimenting with drugs, self-medicating with street drugs, dealing with untreated impulsive tendencies, or struggling with mental illness often end up in prison. The result? More mentally ill people are in prison today than in all of the United States mental hospitals combined.

Corrections Focus Is Counter-Productive for those with ADHD

In its role of maintaining public safety, the corrections industry shifted its philosophy from rehabilitating offenders to a “not letting offenders use the system to get drugs.” Because of potential abuse, incarcerated drug offenders no longer receive appropriate medications for mental illness, ADHD and autism while incarcerated – medication that oftentimes treats substance abuse and reduces reliance on drugs as a form of self-medication. Furthermore, only recently did substance abuse treatment programs in prisons and jails begin to admit incarcerated offenders who are prescribed medications to treat mental illness or ADHD. This made it impossible for a prisoner with ADHD and/or mental illness to receive substance abuse rehabilitation services and medication for their mental health disorder at the same time. You can see where this may be counter-productive.

ADDA’s Working Group on ADHD and Correctional Health

In 2007, several ADDA members formed the Working Group on ADHD and Correctional Health to work with correctional health professionals concerned with the quality of diagnosis and treatment of offenders with developmental delays, ADHD, and mental illness. Though some correction facilities treat ADHD-diagnosed juveniles with medication and counseling, it is hard to find adult facilities that will treat an inmate with ADHD with medication or coaching, even if other psychiatric co-morbid illnesses are being appropriately treated. We aim to help incarcerated individuals with ADHD get the help they need to follow a path to rehabilitation.

Making Significant Progress

The ADDA Working Group on Correctional Health currently has twenty volunteer members who have worked to raise awareness of ADHD in the correctional system and to promote the recognition, evidence-based diagnosis and treatment of all ADHD offenders. The group has worked tirelessly to accomplish achievements such as: publishing numerous articles in scientific and general interest publications, presenting at national conventions, developing the ADHD Harm Reduction pilot research project that evaluates ADHD prisoners scheduled for release and brings together community resources to provide treatment to reduce re-incarceration, and educating numerous probation officers, law enforcement professionals and correction officers to recognize ADHD symptoms and to interact more therapeutically with ADHD-challenged individuals. Even the judiciary system has expressed interest in incarceration alternatives for low-level offenders with ADHD.

Primary Goal: Corrections Accreditation Hinges on Proper Handling of ADHD

In 2011, we have set a goal to develop an ADDA White Paper on ADHD in Corrections to advocate for national correction accrediting organizations (NCCHC and ACA) to include the diagnosis and full treatment of ADHD and its co-occuring disorders as the standard of care for both adult and juvenile inmates.