Through the bars of his cell, Juan watched as another inmate sliced open his arm with a blade. He wasn’t trying to die — he was trying to get help. In prison, Juan said, the only way to get access to mental health services was to bleed.

Scenes like this were all too common, said Juan, who spent eight years incarcerated and has been diagnosed with bipolar disorder and severe depression. When requests for psychiatric care went unanswered, self-harm or suicidal ideation became the only way to be admitted to the psychiatric unit at the Correctional Medical Center, where an inmate might see a psychiatrist, receive medication, and then be returned to the general prison population.

Juan, whose name has been changed to protect his identity, said his condition deteriorated daily. “Since the first night I knew I needed help,” he recalled. During his entire incarceration, he had only one psychiatric appointment. It lasted less than 10 minutes, was conducted via telemedicine, and ended with prescriptions for Wellbutrin, Elavil, and Zoloft. His follow-up requests were ignored. “No matter how many times you ask, it doesn’t matter,” he said. “They don’t care. As they say, ‘Why did you get yourself into this?’”

The only other times he saw a psychiatrist were after transfers to different facilities, where he underwent “initial evaluations” with no continuity of care. His prescriptions were refilled automatically, without further assessments. Meanwhile, the prison environment compounded his distress. “You don’t sleep. The mind just keeps going, keeps scheming. You realize the damage it’s doing,” he said.

Juan’s experience reflects a broader crisis. Nearly three-quarters of the more than 7,000 incarcerated people in Puerto Rico need mental health care, yet the Department of Corrections and Rehabilitation (DCR) has only the equivalent of five full-time psychiatrists for its adult inmates, according to Senate investigations. The DCR claims there are seven psychiatrists for adults and two for juveniles, but only three work full time: the rest work part time, some as little as 10 hours per week.

Despite this shortage, the government is moving forward with the construction of an $80 million correctional psychiatric hospital, funded through the federal Community Development Block Grant for Mitigation (CDBG-MIT). An investigation by the Centro de Periodismo Investigativo (CPI) found that the project lacks a detailed operational plan, budget or staffing strategy. Puerto Rico has about 200 psychiatrists to serve a population of 3.2 million.

The DCR justified the construction of the medical facility by arguing that a psychiatric institution was needed to house patients with severe disorders who cannot live alongside the general prison population.

Unanswered Questions About the New Hospital

Mental health services are currently offered at the Correctional Medical Center in Bayamón. The facility has a limited number of beds for treating people with mental illnesses, and the area is used for temporary care. The new correctional center for people with mental illnesses will have a continuous program for these inmates, according to a report the agency submitted in 2022 to receive funds from the Department of Housing and Urban Development (HUD) for the new psychiatric hospital.

The Secretary of Corrections and Rehabilitation, Francisco A. Quiñones Rivera, assured in an interview with the CPI that it is not a prison for inmates with severe mental illnesses. However, the project description presented to HUD to obtain the funds indicates that the hospital will provide services to inmates “diagnosed with mental illnesses who cannot be housed in the general prison population.”

“They will be there as long as the medical criteria require,” said Quiñones Rivera, without specifying how long these stays might last.

In the project description, the DCR stated that there are no specialized facilities to provide mental health services to inmates and that mental health services in the correctional system are limited to outpatient services. The Secretary at the time the funds were requested was Ana Escobar Pabón, who declined to comment on the new psychiatric hospital.

The DCR’s assertion in its proposal, however, contradicts what is established in the existing contract between the agency and Physician Correctional, the private provider of health services in the island’s prisons. In the agreement, Physician Correctional states that two units are offering psychiatric care to incarcerated people whose conditions require them to be separated from the general population. The CPI requested an interview with Physician Correctional about mental health services in prisons, but the company referred the questions to the Secretary of the DCR.

Quiñones Rivera said that currently, mental health patients whose conditions require them to be separated from the general prison population are transferred to the Correctional Medical Center, a hospital located in the Bayamón Correctional Complex that has a psychiatric unit, “and they remain [hospitalized] there as long as the condition requires.” The CPI asked the Secretary if the government pushed the new hospital construction project without conducting an adequate analysis of the operational cost it would entail and without securing the necessary resources for its operation. “I can’t say that,” he replied. “It’s a psychosocial unit that is necessary for the prison population,” said Quiñones Rivera.

The Secretary said a new hospital structure means “additional help for those people who have some mental health issue at all levels, but who have not been declared unfit to stand trial by the court.” A person is considered fit to stand trial if they can understand the judicial process and collaborate with their defense.

Juan was surprised to learn that the DCR is building a new correctional psychiatric hospital, as he says the Correctional Medical Center “was always empty.” “I hope the justification is that they will provide the services as they are supposed to because that’s the only way they should justify it,” he said. The annual report of Physician Correctional for fiscal year 2023 — the most recent available — indicates that the occupancy rate of the Correctional Medical Center’s psychiatric units was 35%. That is, out of 35 available beds, it had a daily average of 13 occupied beds.

A 2023 report by the Senate’s Commission on Community Initiatives, Mental Health, and Addiction found that for fiscal year 2021, Physician Correctional had the equivalent of five psychiatrists in total to attend to 10 DCR institutions. Of these, only one worked at the Correctional Medical Center in Bayamón. The CPI requested updated data from the DCR on the number of Physician Correctional employees in the prisons, but the agency referred the request to the company. Physician Correctional did not respond to the request for information.

The Senate investigation also found that Physician Correctional failed to provide adequate staff to care for mental health patient Shannel Colón Ponce, who, according to authorities, died by suicide in 2022 at the women’s institution in Bayamón.

Colón Ponce’s family questioned her cause of death and filed a lawsuit against the government in 2023.

Quiñones Rivera admitted that the current psychiatrist staffing is insufficient and said the agency would take “necessary measures” to expand services. “If we want to broaden access beyond Bayamón and Ponce, that number has to go up — substantially,” he said.

On July 1, the DCR notified Physician Correctional that it was canceling its contract. A request for proposals for a new provider was issued the same day, with services to begin upon signing and run through June 2029. The contract includes psychiatric and psychological services but makes no mention of the new hospital.

Two weeks later, Physician Correctional sued the DCR, claiming the contract termination lacked valid cause and was politically motivated. The lawsuit, which seeks to block the bidding process and invalidate the cancellation, claims the company was targeted because its executives supported the primary campaign of former Governor Pedro Pierluisi against current Governor Jenniffer González.

A Shortage of Psychiatrists

Puerto Rico is experiencing a significant shortage of health professionals, including psychiatrists. The College of Physicians and Surgeons estimates that only about 200 psychiatrists are actively practicing on the island. Forensic psychiatrist Dr. Raúl López said recruiting for the correctional system is particularly difficult due to poor working conditions and a lack of resources. “There are a lot of needs and very few resources,” he said.

A 2024 Senate investigation found that 74% of the incarcerated population — about 5,350 people — needed mental health care. That amounts to between 764 and 1,000 patients per psychiatrist. The same investigation concluded that at least 71 mental health professionals — psychologists, social workers, and technicians — are needed to meet minimum standards.

The nearly $73.8 million contract between the DCR and Physician Correctional establishes that the company must maintain “adequate” levels of medical and support staff to provide services in accordance with applicable standards. The company assumed the administration of the correctional health program in October 2018. Since 2019, the Committee of Friends and Family of the Confined has denounced that Physician Correctional has reduced the number of psychiatrists, psychologists, and social workers after taking over the management of the correctional health program.

“Every person entering a penal institution is supposed to be evaluated not only physically but also in the mental area,” said the Committee’s spokesperson and social worker, Milagros Rivera Watterson, in an interview with the CPI. “Services are not being provided,” she stated.

Mental Health Issues in Prisons

Physician Correctional reported that mental health conditions account for more than 62% of all diagnosed illnesses among inmates. Meanwhile, according to the DCR, 78% of the inmates have been diagnosed with disorders such as schizophrenia, bipolar disorder, and major depression. Currently, the prison population in Puerto Rico has a daily average of more than 7,500 adults, the agency confirmed.

The Institute of Forensic Sciences recorded 30 suicides among incarcerated people between 2017 and May 2024, according to a report by the Civil Rights Commission. The Department of Corrections and Rehabilitation’s most recent report on the confined population, released in 2019, found that about one in five incarcerated people had been diagnosed with a mental health condition before entering the prison system. Meanwhile, approximately 14% had been diagnosed with a mental health condition after entering prison.

López, the forensic psychiatrist, said in some cases, the diagnosis of a mental health condition occurs when a person enters the penal system. Often, he explained, the crimes they commit are related to the development of their mental health conditions and their comorbidities — diseases that arise because of the primary diagnosis. “When you get to prison, they put a magnifying glass on you,” López said. “These people commit crimes, among other many reasons, because they don’t have much social support,” he added.

Clinical psychologist Kalitza Baerga explained that many of the inmates suffered some type of trauma before entering prison, marked by violence or having grown up in families where others were also incarcerated. For women, the situation is even more critical. According to the 2019 profile, more than half of the confined women had been victims of some type of abuse or violence before entering prison, and 63% had a history of substance abuse disorder. Eighty-seven percent of them had a mental health diagnosis. “The inequality she experienced in society and continues to experience within the system is different from what men experience,” Baerga said.

In general, many people, Baerga added, come to prison with mental health conditions that were not treated in the free community due to factors such as poverty, lack of access to mental health professionals, and lack of support services in communities. The confinement itself, she emphasized, can exacerbate existing conditions and generate new problems. Studies have found that incarceration is related to disorders such as depression, anxiety, and bipolar disorder, and factors such as overcrowding, isolation, and exposure to violence have negative impacts on the mental health of inmates, according to the think tank Prison Policy Initiative.

“The reality is that everything related to losing your freedom, losing contact with your family, and losing the ability to make your own decisions — because you are in a place where decisions are made for you all the time — can exacerbate all these symptoms. It can create hypervigilance; it can also create long-term difficulty in making decisions,” said Baerga, former president of the Puerto Rico Psychological Association.

In Juan’s case, adapting to isolation and being separated from his son negatively impacted his mental health. “[In prison], any normal person will be mentally affected because everything changes. You don’t sleep. For the first month, you’re going to be mentally lost,” he said.

In the justification for receiving CDBG-MIT funds for the new hospital, the statistic provided by the DCR on the prevalence of mental health conditions among the confined population corresponds to the 2019 study. “The new facilities will allow the DCR to provide mental health services to the total 35% of the prison population diagnosed with some type of mental condition,” the document states.

The agency does not provide a specific figure for how many people deprived of liberty have mental health conditions that require them to be separated from the general population, despite this being precisely one of the purposes of constructing the new medical facility. The document also indicates that the population that would benefit from the project includes low-income people with mental health conditions “due to having been abused during childhood, being battered partners, being homeless when they were in the free community, having severe disabilities, and being inmates living with AIDS.”

According to the Secretary of the DCR, the new hospital will focus on treating patients with diagnoses such as schizophrenia, bipolar disorder, and problematic substance use, among others. He added that psychological, psychiatric, and therapeutic services will be offered, both individually and in groups. Quiñones Rivera said when a confined person with mental health conditions completes their sentence, the socio-penal services technicians “are trained” to contact agencies such as the Administration of Mental Health and Addiction Services (ASSMCA, in Spanish) to continue treatment once they are in the free community.

But that was not Juan’s experience, who claimed that his release plan did not contemplate the continuity of his psychiatric treatment. “They didn’t even give me the two weeks of medication they were supposed to give me while I found some type of psychiatric service in the free community,” he said. Juan couldn’t sleep the first night he spent at home after being released, without the medications he had taken for almost a decade. “I was very nervous. I didn’t even know what I was going to do. I felt very strange,” he recalled.

The day after, almost exactly 24 hours after leaving prison, Juan’s parents took him to a primary health center to receive psychiatric services. There, they stabilized him and prescribed new medications. Recently, a man convicted of sexual assault was arrested for allegedly assaulting a woman a few days after being released. José Francisco Colón Rosario claimed that upon leaving prison, he did not receive his medications for his mental health condition, according to press reports. The DCR denied leaving him without medication, and ASSMCA claimed that the man refused treatment, the agency heads told the press.

Construction of a New Correctional Hospital

Former Governor Pierluisi announced in 2023 the construction of the new psychiatric hospital, which will have the capacity to house up to 250 inmates. The project is in the design stage, and the inauguration is scheduled for 2028, according to the Secretary of the DCR.

The agency has not yet completed an analysis of the personnel needed for the hospital’s operation or its annual operational cost, Quiñones Rivera acknowledged. The Secretary said that “in the coming months” he expects to have more details about the resources needed to operate the medical facility. “We are in that analysis,” said the Secretary of the DCR. “Now we are finishing the design process to move to the mobilization and construction stage,” he explained.

The allocation of $80 million to cover the construction of the building comes from a $1 billion allocation of CDBG-MIT funds, specifically set aside for medical facilities. In February 2024, the DCR reached an agreement for nearly $2.8 million with the Puerto Rico Infrastructure Financing Authority (AFI, in Spanish) to manage the study and conceptual design of the medical facility. Six months later, AFI awarded a $790,000 subcontract to architecture firm Integra Design Group, chaired by Carlos Báez Dotel, to carry out the hospital’s study and design. The contract was extended until December, and the Secretary of Corrections told the CPI that the design is in the final stage.

According to the contract between AFI and Integra Design Group, the new psychiatric hospital will have two floors. On the first floor, there will be administrative offices, an armory, a visitation room, an employee area, recovery and treatment units — one of which the contract identifies as a “Psychosocial and Residential Treatment Unit” — a barbershop, and a basketball court. Meanwhile, the second floor will house a conference room, a psychosocial recovery unit, and a long-term residential services unit.

The hospital will be located in the Bayamón correctional complex, where the Correctional Medical Center, inaugurated in 2014, is currently located. The contract between AFI and Integra Design Group considers including a “pedestrian and vehicular connection between the existing Correctional Medical Center and the New Psychosocial Correctional Unit.”

According to the documents submitted by the DCR to receive the funds, this location was chosen to enable the transfer of inmates to the Correctional Medical Center in case they need any other medical service. The Correctional Medical Center, with a capacity of 200 beds, has a psychiatric unit, in addition to short-term medical service units and outpatient clinics, including dental and physiatry services.

Regarding how the services currently provided at the Correctional Medical Center differ from those that would be offered at the new hospital, Quiñones Rivera said the additional 200 beds will allow the service to be expanded. “That complex will be dedicated exclusively to attending to this type of inmate and will be separated from the general population. So, the focus is more on mental health, it’s a health-focused approach,” he said.

Discrepancy in Available Bed Count

Physician Correctional’s annual reports show inconsistencies regarding the number of beds available for psychiatric services. According to the documents, the Correctional Medical Center “has a capacity of 185 beds for psychiatric hospitalization.” However, in the breakdown of services that the hospital provides, the company indicates that the 185 beds are used for both mental and physical health services.

The Secretary said there are about 20 spaces available at the Correctional Medical Center to treat inmates   who need acute psychiatric treatment. He also noted that Bayamón has approximately 20 spaces for intermediate treatment, with a similar number available in Ponce.

By contrast, the Correctional Health Services Corporation, the previous private administrator of the correctional health program, reported in its annual filings that the Correctional Medical Center had approximately 87 beds for psychiatric hospitalization. In the fiscal year ending in June 2018, when the Correctional Health Services Corporation was still running the correctional health program, the daily average of inmates in the prisons rose to 9,856.

Private corporations have administered correctional health services in Puerto Rico since 2005, in compliance with a court order in the class action lawsuit known as Morales Feliciano, filed in 1979 in federal court over overcrowding conditions in prisons. The Correctional Medical Center was built as part of the case negotiations.

Correctional Health Services Corporation operated the correctional health system from 2005 until October 2018, when Physician Correctional, corporately registered as Physician HMO, took over the management of services. In 2023, the DCR renewed Physician Correctional’s contract until September 2028.

An audit by UTICORP, a company that does medical audits, found that Physician Correctional failed to meet prison health standards, the stipulations of the Morales Feliciano case, and its contractual obligations with the DCR, according to documents the CPI obtained through a lawsuit against the agency.

In 2024, Physician Correctional faced scrutiny over the release of femicide Hermes Ávila Vázquez, who faked paraplegia to obtain an extended pass for that supposed health condition. A medical panel from the company evaluated Ávila Vázquez’s release request and recommended his release. One year later, he murdered Ivette Joan Meléndez Vega. Ávila Vázquez is now serving a 102-year prison sentence for the crime.

This translation was generated with the assistance of AI and reviewed by our editorial team to ensure accuracy and clarity.