The first time Dawn Peel tried to get help in the mental health clinic at the Minnesota's women's prison in Shakopee, she brought a stack of papers 8 inches thick, she said. They were records documenting more than 150 appointments she'd had with her psychologist before she went to prison.
"I would like to get some help," she recalled telling the clinician. "And he looked at me and my stack of you know, 8-inch deep pile of medical records and he said, 'We don't have the staff to help you.' And I looked at him and I said, 'what?'"
People in jails and prisons are much more likely than the general public to have a mental illness, and the prevalence among incarcerated women is especially high. Minnesota's corrections commissioner, Paul Schnell, has said dealing with mental illness in the system is a priority for the new administration.
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But formerly and currently incarcerated women in Minnesota say they don't get the care they need.
Peel is serving 13 years in Shakopee for attempted murder; she expects to get out next year. Even before the incident that got her locked up, Peel had been diagnosed with post-traumatic stress disorder. And, like a lot of women in prison, she had a long history of abuse.
But she said when she told the clinician there that she wanted mental health care, he told her she wasn't sick enough to get it.
"'Unless you are high risk right now,'" she said he told her, "'unless you are feeling like you want to hurt yourself or hurt others, I can't really do anything because we're understaffed and we really don't have ... there are 650 other women in the institution that the mental health department has to serve.'"
"And I was heartbroken," she said.
More than half of the women at Shakopee have gotten some mental health services, which is a higher percentage than men incarcerated in Minnesota.
That follows national trends: About half of incarcerated men have been diagnosed with a mental illness; among women, it's an astonishing three-quarters.
"We know that women's pathways to prison are often very very different than incarcerated men's, and that many women who are incarcerated have long histories of trauma, physical and sexual trauma," said Rebecca Shlafer, a University of Minnesota professor of public health whose research focuses on incarcerated women. "They are more likely to have had mental health problems prior to their incarceration than incarcerated men."
Shlafer said being in prison can exacerbate a woman's condition.
For example, if a woman has had to deal with physical or emotional abuse in her life, being ordered around by corrections officers can be especially stressful.
When women first arrive at the prison, they get an initial mental health assessment to try to determine what services they need. If a woman is suicidal, she's put on continuous observation — she's placed in a cell where she is monitored via video. In even more serious situations, a woman may be transferred to Hennepin Healthcare for care.
For women who are less sick, there are a number of options, including group therapy, one-on-one therapy and some specialized housing.
The preference is for the least-restrictive option said Katie Shinnick, associate director of behavioral health at the Minnesota Department of Corrections, who helps oversee mental health care at Shakopee.
"The goal is always to help them to be able to get out to the [general population] because hopefully from there, they're going out to the community," she said.
Shinnick said there's a lot more demand for mental health care than when she first started at Shakopee about 15 years ago, but that the Department of Corrections is making mental health care a priority. Still, even in the outside world, there's a shortage of mental health care workers.
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In interviews, though, a number of people either currently or formerly incarcerated there reported having experiences similar to Peel: needing mental health care and either not getting it or having to wait a very long time for it. Several family members reported the same.
Tina Schleif was at Shakopee on drug charges for 2 1/2 years from May 2012 to November 2014. Like Peel, she was dealing with PTSD. She was also depressed. In her case, she said, it was connected to a car accident she'd been involved in where a pregnant woman was killed. And like Peel, she asked for mental health care, but didn't get what she felt like she needed.
Before she got to Shakopee, she spent several months in the workhouse, where doctors gave her antidepressants. When she got to Shakopee, she said, they took her off of them. It took at least three months, she said, before she got to see somebody.
"They're real curt and abrupt about that. They're just, you know, you're on the list. There's a lot of women here. We'll get to you when we can get to you," she said.
Schleif also ended up getting a job with Women of Wellness, a supportive living program for women with mental health issues. She said there she saw women with serious mental illness who weren't getting the care they needed. She remembered one woman with what Schleif thinks was schizophrenia who got sent to solitary confinement because she was acting out. Schleif said it wasn't until the woman began spreading feces and menstrual blood on the walls of her cell that she was sent to HCMC for inpatient care.
Naomi Gaines-Young served 12 years, including jail time that she got credit for, for murder. During a psychotic episode, she threw her twin sons off a bridge in St. Paul and then jumped. She and one of the boys were rescued by passersby; the other boy died. Gaines-Young had been diagnosed with depression before the incident. She was later diagnosed with postpartum psychosis, bipolar disorder and schizophrenia.
During her intake at Shakopee, she told the clinician that she was suicidal and she was taken directly to the mental health unit. Later, she spent a year at St. Peter's hospital.
But at Shakopee, medication was the extent of her treatment. "Their treatment at the time, at least for me, was just ... medications," she said. "And as we all know, that's just like somebody getting chemo, but they're not getting ... changes to their diet or something to handle the other symptoms. ... It's kind of like treating the wound, but not treating the reason I have the wound in the first place."
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At one point while she was at Shakopee, she remembered, her condition deteriorated significantly and she threw a chair through a glass window. She was charged with destruction of property and sentenced to 45 days in solitary. She said that was the only time she was sent to solitary for breaking a rule. But she said she was sent to solitary a lot of time for decompensating mentally.
"If you have a mental health episode," she said, "you go to segregation. That's all they do for you is lock you up in a room with a suicide jacket."
Over the course of 12 years in Shakopee, she said she ended up in segregation at least six times.
But Gaines-Young was released several years ago. Katie Shinnick, from the Corrections Department, said backlogs and waits to get mental health serves are a thing of the past.
"Right now we are actually up to date," she said. "We are scheduling the women sooner than what is their recommended follow-up."
Each woman at Shakopee is assigned a primary care provider. Shinnick said if a woman needs mental health care, all she has to do is send that primary care provider a "kite" — prison-speak for a note.
"They would send that kite to their primary," she said, "who would then meet them or based on the kite information, they might send them a packet of coping skills or exercises in your room or just whatever their current issue is. So, some type of services is being offered."
Dawn Peel said she had been locked up for more than five years before she got any mental health care. Last year, after a disagreement with the chaplain, she was sent to solitary confinement. When being in solitary triggered more mental health issues for her, she said, she finally got to see a therapist: five half-hour sessions over the last six months.
She said she needs more, but still hasn't gotten it.
This reporting is part of Call to Mind, an MPR initiative to foster new conversations about mental health.
If you or someone you know has experience getting mental health care — or trying to get mental health care — in prison or jail, we want to hear from you. Send an email to MPR News reporter Alisa Roth at email@example.com.