When David Zug started work as a psychologist in the Dauphin County Prison in 1981 he began with a simple mission: provide therapy for a small handful of mentally ill inmates.
In that year, he remembers, about seven inmates were prescribed psychotropic medications.
Last year, on an average day in the Dauphin County Prison, there were 325 - nearly a third of the facility's average daily population.
That dramatic rise in the rate of prescription of psychotropic medication in the prison has been mirrored in correctional facilities across Pennsylvania. In some county prisons, according to PennLive's analysis, roughly half of their average daily population was prescribed psychotropic medication in recent years.
Zug and other mental health workers say those increases are partly due to better diagnosis and treatment but, just as significantly, they also represent a rising tide of mentally ill people entering the criminal justice system. A trend driven, many correctional officials and policy experts believe, by the long-term closure of state hospitals in Pennsylvania and insufficient mental health services in the community.
In the interactive graphic below, readers can explore the rate that psychotropic medications were prescribed in 2014 for county prisons that PennLive was able to obtain data for. Where data is available, readers can also explore how those rates have changed in recent years.
Overall, PennLive's analysis of 31 county prisons in the state, with a total average daily population of 27,565 inmates, shows that nearly a third of them - 27.1 percent - were prescribed psychotropic medication on an average day last year. In addition:
- Among the prisons that PennLive has data for, the total rate of inmates on prescription medication has grown from 21 percent in 2006 to 27 percent in 2014.
- Dauphin County Prison had one of the sharpest increases in prescription rates over the past nine years among the counties analyzed.
- In several small, rural facilities, prescription rates among inmate have been particularly high in recent years. In Jefferson County Prison, 49 percent of the facility's average daily population of 135 inmates were prescribed psychotropic medications last year. In Crawford County Prison in 2013, the rate was 55 percent among its average daily population of 199 inmates.
- In the Philadelphia Prison System - Pennsylvania's largest county prison with a daily average of about 9,000 inmates - prescription rates have inched upwards over the three years that data is available. In 2012, 22 percent of the prison's average daily population was prescribed psychotropic meds. Last year, the rate reached 24 percent.
Because data on mentally ill inmates is often limited in county prisons, PennLive gathered the above data on psychotropic medication as one way of analyzing prevalence.
Of course, it is not a perfect measure: in theory, the rate of mentally ill inmates in a facility should be higher than the number of inmates on psychotropic medications because not every inmate with a mental illness needs medication.
Conversely, not all the inmates on psychotropic medication are necessarily mentally ill. Some inmates may be prescribed psychotropic medication because they are suffering withdrawal from substance addictions. Also, inmates who don't have mental health issues may fake symptoms so they can get medication to abuse it.
Rates suggest rising numbers
For its part, PrimeCare Medical - a prison health care contractor that contracts with 29 county prisons and provided PennLive with the bulk of the data in the above graphic - believes that the rates are a reasonable indication of the disproportionately high number of mentally ill people in Pennsylvania's correctional system.
Todd Haskins, vice president of operations for PrimeCare Medical, said it was less easy to pinpoint why certain counties had higher rates of prescription than others or why there were particular fluctuations between years.
He said those differences may represent the difference in prevalence of mental illness in an individual county prison but they also may represent differences in prescribing practices between psychiatrists. Some psychiatrists have different views about what circumstances are best treated with medication. While his company set general policies for prescribing medication, he said treatment decisions were always in the hands of an individual psychiatrist.
"We can't tell a doctor, 'do this or that,' " he said.
On that note, Haskins and other mental health workers for PrimeCare defended that the rate of prescription represented genuine need among inmates and not a tendency to over-medicate inmates - a charge that has occasionally been leveled at some prisons across the country.
"We are not just putting them into a zombie-like state," said Enos Martin, a PrimeCare psychiatrist at the Dauphin County Prison.
Martin, like Zug, the prison's psychologist, said he had seen the gradual transformation of the prison's inmate population. Today, he said, he sees inmates who are as severely mentally ill as any psychiatric unit.
Perhaps the real irony, Martin added, is that he believes county prisons are now one of the few places in Pennsylvania where a mentally ill person can get the care they need.
"It's a lot easier to get people into jail than into mental health treatment," Martin said. "Working in the community, sometimes we see situations where we almost pray that they do something illegal."