Between 15 and 20 percent of the inmates in American prisons have a serious mental illness.
A group of Philadelphia researchers is looking into the ethical issues involved in their treatment.

The pilot project, funded by the Leonard Davis Institute of Health Economics, will examine the ethical issues that surround mental health care behind bars. The effort is headed by University of Pennsylvania medical ethicist Dominic Sisti who said working with prisoners creates ethical challenges for therapists, who often feel torn between loyalty to their patients — and the institution employing them.

"Are they treating their patients as they would patients on the outside who would receive long-term treatment and follow up care?" he said. "Or are they treating them in a way that helps the institution maintain safety and security?"

For example, many prisoners who have schizophrenia receive medications to keep them stable but not the additional therapy and resources that would help them get better in the long run.

Another issue is a lack of follow-up care after release.

"Individuals with mental illness who are in prison are often treated — but when it comes to going back out into the community, they're given a week's worth of medication and sent on their way," said Sisti.

Many end up back in a hospital or back in prison, he said.

The group, which includes ethicists, therapists, and criminologists, is also reaching out to current and former inmates who have received mental health treatment in prison.