‘Cost-saving’ move requiring prisoners to switch medications puts taxpayer dollars at risk, judges and psychiatric experts say
LANSING – The cash-strapped state’s efforts to save $20 a day on individual prisoners with mental illness will cost taxpayers dearly, forcing once-stable prisoners to go without effective medication and leading to behavior that extends their $140-a-day prison stays even longer.
“It’s unsound and risky psychiatric practice to switch patients who are healthy on one drug to another, cheaper medication just to save money,” said Dr. Oliver Cameron, an Ann Arbor psychiatrist who serves on the advisory board for Michigan Partners in Crisis (PIC), at a Capitol news conference today.
Applied to the 1,400-1,500 prisoners on brand-only antipsychotic medications, the policy is intended to help save $15 million in FY2012. To achieve that, nearly all patients on brand-only antipsychotics – regardless of how well they are doing – must switch to cheaper medications. Behavior changes prompted by the medication switches can cause additional psychiatric crises, greater security threats to inmates and prison staff, and longer incarcerations.
“When the results undermine the whole cost-cutting agenda, it’s obviously time to end the policy and return to a safer, more cost-effective approach to treating prisoners with mental illness,” Cameron said.
Until recently, clinical decisions about prisoners with serious mental illnesses were made by the Department of Community Health, which recognizes the widely held psychiatric principle that individuals with mental illness who are stable on a certain medication should stay on that drug as long as they remain stable. Now, unless corrections officials give special approval, inmates must endure two six-week failure periods on generic medications before re-taking a brand drug– at which point the brand drug may no longer work for them the same way.
PIC officials emphasized that they do not oppose the use of cheaper generic drugs for new cases or for existing cases where a medication is not working. PIC was formed in 2008 to enhance appropriate treatment and regulation regarding mental disorders in the justice system.
In addition to calling on lawmakers and state officials to end the switching policy, PIC called for the state’s Corrections Ombudsman to investigate what has happened under the policy to date. The coalition also questioned the March 2011 Auditor General’s report on state prison pharmaceutical costs. Specifically, the report made inter-state comparisons without providing any context for them, and issued cost-cutting recommendations based on the erroneous assumption that generic versions of Risperdal are, in effect, the same drug as the higher-priced brand-only Seroquel. In fact, federal guidelines for these drugs cite some very different applications for their use.
“We want to set the record straight on the Auditor General’s report, which is being used to defend the drug-switching policy and could be used to advance policies that put prisoners and prison staff at risk,” said Mark Reinstein, CEO and president of the Mental Health Association in Michigan and a PIC advisory board member. “Auditors acknowledged they had no guidance from psychiatric experts, but that’s no excuse for the findings to remain uncorrected.”
Rep. Mark Meadows, D-East Lansing, said he hoped the state would stop the switching policy and take a thorough look at its implications.
“It’s crucial for the state to implement cost-saving policies, but reforms must be based on sound assumptions and proven results,” Meadows said. “The drug-switching policy fails on both counts.”
Peggy Christian, of Lansing, whose son with mental illness is experiencing negative side effects after being withdrawn abruptly from the medication he was stabilized on, said, “My son is being denied medication that has given him stability and capacity to cope with his illness. This new prison policy places him at risk for being imprisoned years beyond his early release date if he continues in a downward spiral.”