STEVE INSKEEP, HOST:
We have a story now on mental health care in prison, or rather the lack of it. The effect is seen in the harm that many inmates inflict on themselves. We should warn you that many people will find the details of this story upsetting. It's about 3 1/2 minutes. Here's Jimmy Jenkins of member station KJZZ in Phoenix.
JIMMY JENKINS, BYLINE: Dustin Brislan's arms are covered with scars. They are physical manifestations of his internal struggle with mental health issues.
DUSTIN BRISLAN: I'm a cutter. I cut veins and arteries. So I just start cutting.
JENKINS: In and out of Arizona prisons for the past 20 years, Brislan hasn't always had access to the mental health care he needs. Alone in his cell, he repeatedly committed acts of self-harm.
BRISLAN: Like if I'm having a bad day or I'm real emotional, then I will cut myself. It could be out of anger.
JENKINS: It could also be done to relieve pain.
YAZHINI SRIVATHSAL: Let's say you cut. What happens is that the pain immediately releases some endorphins. You immediately feel a pleasure, a sense of calmness, of relief. So that's what makes people want to do it over and over again.
JENKINS: Yazhini Srivathsal, a psychiatrist at the Banner Behavioral Health Hospital in Scottsdale, says if self-harm is not properly diagnosed and treated, the behavior can lead to an increased risk of suicide.
SRIVATHSAL: The self-injurious behaviors will increase the capacity to act on the desire when the suicidal thoughts happen.
JENKINS: But that treatment isn't readily available. In the past five years, self-harm incidents have increased by more than 360% in Arizona prisons. In 2019, there were more than 1,000 incidents of cuttings. Inmates also harmed themselves by banging their heads repeatedly into a wall or by ingesting harmful materials. David Fathi is the ACLU's National Prison Project director. He called the self-harm numbers alarming.
DAVID FATHI: It is a sign that something is causing people to be in so much pain, to be so desperate that they're trying to injure or kill themselves, and so that is a very significant and very disturbing indicator.
JENKINS: The Arizona Department of Corrections won't say why this is happening. Their health care contractor, Centurion, wouldn't comment for this story either. The department changed the way it reports on the incidents in October of 2018, breaking down the data into two categories - self-injurious behavior and suicide attempt. However, Dustin Brislan says prison health care workers do not have the training to recognize the difference.
BRISLAN: Like with me, I've hit arteries and almost bled out, and I wasn't trying to kill myself. I was just real angry at the time. And they automatically assumed I was trying to kill myself when I wasn't.
JENKINS: Lindsay Hayes, project director of the National Center on Institutions and Alternatives, specializes in suicide prevention in jails and prisons.
LINDSAY HAYES: It is important to differentiate not only the types of behavior and the intent of the individual, but the severity or the lethality of their behavior so that you can, if necessary, take corrective action.
JENKINS: There are no national statistics on prison self-harm because jurisdictions define it in a variety of ways. The lack of information raises questions about the type of mental health care provided to inmates. The ACLU's David Fathi.
FATHI: We're developing more and more evidence that it really is an exercise in box-checking rather than a serious attempt to treat someone who was in so much desperation and so much pain that they tried to kill themselves.
JENKINS: Dustin Brislan says his treatment didn't improve until he joined a lawsuit challenging overall health care in the prisons. Now he's getting the medication and the therapy he needs. He says other inmates deserve the same, and they shouldn't have to sue to get it.
For NPR News, I'm Jimmy Jenkins in Phoenix.
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