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WASHINGTON — The nation's largest prison system has spent more than $36.5 million on psychotropic drugs to treat thousands of offenders in the past four years, according to federal Bureau of Prisons data supplied to USA TODAY.

Nearly 10% of the 216,000 inmates are receiving medications designed to treat an array of illnesses, from depression and bipolar disorder to acute schizophrenia. The BOP's disclosure comes as government officials have raised questions about the costs of confining such large populations, while advocates for the mentally ill argue that prisons and jails have become the new repository for people with mental illness.

The annual drug costs have been declining because of the increasing availability and reliance on generic medications, but federal prison officials say the number of inmates being treated has remained steady.

Nearly 20,000 federal inmates are on psychotropic medications, according to the BOP, which is dealing with increasing overcrowding — the system is about 43% over capacity — and spiraling overall costs. About 25% of the Justice Department budget supports the BOP's operation. In an attempt to ease overcrowding, the U.S. Sentencing Commission last week approved a measure that would make nearly 50,000 inmates eligible for sentence reductions.

Eric Young, national president of the federal prison employees union known as the Council of Prison Locals, said the number of inmates on medication likely represents only a fraction of those with a mental illness or behavioral disorders who have not been diagnosed or have elected not to take medication.

A 2006 Justice Department analysis concluded that 45% of federal inmates had a mental health "problem,'' broadly defined as a recent history of mental illness or symptoms of a disorder.

"We have a problem,'' said Young, who has served as a correctional officer for 20 years. "Other than those who are in designated mental health units, we don't know the health histories of the people who are walking among us because of privacy restrictions.

"At a minimum for safety reasons,'' Young said, "officers should know who is in our unit so that we know who we are dealing with.''

Just Thursday morning, Young said, he was notified of a Wednesday-night assault on a prison nurse by an inmate assigned to a mental health unit in North Carolina. The nurse, who was struck in the mouth, was not seriously injured. Still, he said, the attack highlighted a need for the disclosure of additional information about the prison population beyond the special units where the most troubled are housed.

"There are probably a lot more'' with mental illness in the general prison population, he said.

Kenneth Duckworth, medical director for the National Alliance on Mental Illness, said the 10% of federal inmates who are currently receiving psychotropic medications represented a "a substantial number.''

Yet, he said, the numbers may also reflect that prison authorities are doing a better job getting help to the most severely ill with "increased screening and treatment.''

At the same time, he said the large numbers raise other questions about whether the seriously ill actually belong in prison.

"While they are getting this care in prison, the issue is where people are getting this care,'' Duckworth said. "And that's unacceptable.''

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