About ten years ago, I was diagnosed as having bipolar disorder I. To qualify for a diagnosis of bipolar disorder I, you must have experienced at least one manic episode that was not triggered by medication or substance abuse. Most people with bipolar I experience depression, as well, but depression is not required for a diagnosis of bipolar I.
I have been in a Federal Detention Center (FDC) for the past five months. In accordance with my attorney’s advice, I cannot discuss any details of the case. Recently, I have started corresponding with Joe Kraynak, coauthor of Bipolar Disorder For Dummies. He requested that I share my insights from inside the criminal justice system regarding the way medications are prescribed and administered.
During my time at the FDC I have been on a regular regimen of medications which include Depakote, lithium, Zyprexa, Risperdal, and Lamictal. Each of these medications had been previously prescribed to me prior to my incarceration, except for the Zyprexa which I started here in prison to ease my anxiety.
I learned I was lucky that I arrived at the FDC with prescriptions for my meds. If you are brought into custody at a state or federal prison without a prescription (or current medications in their original prescription container) you have to wait until an in-house doctor can see you and re-diagnose you. At the same time, they (the Feds) do try to obtain your medical records. This process however is very slow.
After a prior arrest, I arrived at an institution with no record of my medications. I was off my meds for ten days when I started to have a manic episode. The prison staff sent me to isolation, which made my problems worse. I had to wait another week after that to finally see a doctor, who then came to the conclusion that I was indeed bipolar; only then did I receive medication.
Not all medications are available to people who are incarcerated. Because medication abuse is so prevalent, many helpful medications are not available. For example, unless you arrive at an FDC with proof of a prescription for Wellbutrin, it will never be prescribed for you. If you actually had a previously standing prescription for Wellbutrin, it will be crushed up at the pill line and given to you. Anyone who takes Wellbutrin knows that extended release versions should never be divided or crushed. This “crushing” is very common for many medications, such as narcotics. Sometimes getting the proper and necessary medications is a hit-or-miss affair.
Getting appropriate medication is a real challenge. Getting to see a prescriber/doctor is even more difficult. In order to adjust the dose of any medications prescribed, you need to see a medical professional. In my case, I am interested in adjusting my Depakote dose. (I am on five different medications and do not feel this is the right arrangement.) I have requested a cop-out (a request to consult with medical staff) and still have yet to be seen after five weeks. Also, because I take lithium and Depakote, I need to get my blood drawn and the level of these medications in my bloodstream tested. (Having blood levels tested is particularly important for lithium, because the therapeutic level is so close to the toxic level.) The last time my blood was drawn and tested was three months ago.
Of course getting medical attention in prison is always a challenge, but getting medical attention for mental health issues is even more challenging. I know of individuals here who have hurt a shoulder or a knee and were seen and had an X-ray taken within a week of injury. But mental healthcare in the criminal justice system is seriously behind the times and is open to many questions and much suffering. Even the medical staff admits things could be done differently.
Seeing a counselor is almost out of the question when you are pre-trial, meaning one has yet to go to trial and has not yet been sentenced. This pre-trial journey of unspecified length is the most stressful and anxious time for anyone, particularly for someone with bipolar disorder. Fortunately for me, I can now talk to a doctor once every few months, but I’d much rather it was more often than that.
I think the Federal Bureau of Prisons (BOP) does not take mental illness, such as bipolar disorder, as seriously as it should or could. Anyone who is bipolar or is close to a person with bipolar, knows how truly serious the illness is. Greater attention and understanding needs to be shed on this illness, particularly within the BOP. Maybe someday there will be a spokesperson for bipolar who will have a louder voice in our justice system. Perhaps then, our correctional infrastructure will be geared to actually help those convicted of a crime that was influenced by their bipolar.
Prison tower image available from Shutterstock.