Sunday, June 24, 2007

Inmate care declines


Inmate care declines
Turnover, lack of therapists partly to blame

The Atlanta Journal-Constitution
Published on: 06/23/07

Mentally ill inmates in Georgia's prison system — many of whom are eventually released — are not getting enough treatment and care, and in some cases are getting worse due to a host of problems outlined in a recently-conducted independent audit.

Inmates suffer from a lack of therapy and counseling as a result of insufficient staffing, employee turnover, technological glitches and other concerns, problems that persist in spite of previous audits that sounded the same alarm, the report says.

The consequences are grave, according to an Atlanta human rights law firm tracking the issue. Six mentally ill inmates have either been slain, or killed themselves, since October 2005 at three of the 33 Georgia prisons that care for inmates who need specialized mental health treatment.

"From our experience, when you don't have enough mental health professionals to oversee this population, people start dying, people start coming out of prison in body bags," said Sarah Geraghty, a lawyer for the Southern Center for Human Rights.

The report is critical of the "lockdown" of some mentally ill inmates in isolation cells for 23 hours a day, causing them to "clinically deteriorate" or "not clinically improve." Given that roughly 95 percent of inmates are eventually released, it means that thousands of mentally ill criminals return to the street as sick — or sicker — than before.

The 37-page audit, obtained by The Atlanta Journal-Constitution under the state's Open Records Act, calls the problems "serious" and "systemic."

The health of mentally ill inmates isn't the only issue on the line. Taxpayers could again end up footing the bill for costly litigation related to poor mental health care.

Threat of suit looms

The prison system estimates it spent "millions" of dollars complying with a series of consent orders from a 1984 federal class-action lawsuit covering every aspect of prison conditions, including deficiencies in its mental health care system. The system was released from federal supervision in 1998.

The threat of another costly federal lawsuit looms large, because the Southern Center for Human Rights — which specializes in prison and jail conditions — has set its sights on mental health care delivery in Georgia prisons.

Department of Corrections officials acknowledge many of the problems cited by correctional health care expert Dr. Jeffrey L. Metzner, but say some of the most serious results of poor mental health care — violent attacks on inmates and staff — have recently gone down inside of Georgia's prisons even as the number of ill inmates has grown.

"There are cracks in the system," said James DeGroot, supervisor of the Department of Corrections' mental health services division. "The system's not broken, but we do have to tend to the infrastructure now stressed by the rapid growth."

DeGroot provided the AJC with numbers of incidents involving mental health inmates that show suicides dropped from 6 in 2005 to 2 in 2006 and one so far in 2007; assaults on prison staff fell from 371 in 2005 to 308 in 2006; assaults among inmates fell from 971 in 2005 to 821 in 2006.

The number of homicides, however, has grown. There was one homicide in 2005 and one in 2006 among the mentally ill population. But there have been two slayings of mental health inmates so far in 2007. Five of the alleged perpetrators in this year's homicides were also mental health inmates.

Southern Center lawyers are confident they can document at least two more violent deaths among the mental health population, Geraghty said.

DeGroot said the deaths must be put in a broader context.

"I don't want to abdicate responsibility for any homicides, suicides or assaults — one is too many," DeGroot said. "But the incidents are relatively low. "

The report was addressed to Georgia Department of Corrections Commissioner James Donald, who declined an interview request for this article.

Metzner, who was paid $10,000 to conduct the audit at the prison system's request, declined comment and deferred questions to the state Department of Corrections.

More mentally ill inmates

Robin Graham, whose mentally ill son Bryan was hospitalized following a scuffle with guards, said she has had a difficult time getting proper treatment for him.

"They look at them simply as 'they broke the law,' not 'they have a problem,'" said Graham, who has hired a lawyer to look into her son's incident. "And there's hundreds of thousands of cases across the United States of people who have had mental illness and done something [illegal] and are never paid any attention to. Your departments of correction, your police forces, your judicial systems have no clue. Absolutely none"

Prison officials say they are dealing with a potentially volatile, difficult population, some of whom have compounded their illnesses with drug abuse.

About 16 percent of the prison population in Georgia receives mental health services.

Those services range from routine outpatient treatment — medication and therapy similar to what functioning people in private life get — to hospitalization for the sickest. Inmates with more serious problems are segregated from the general population in mental health wings inside prisons. Thirty-three of the state's prisons and probation detention centers offer mental health services.

The number of mentally ill inmates in Georgia's prisons has surged since 1999, the year after the system was released from the supervision of federal court. But as the population of mentally ill inmates has grown, the amount of professional help provided to them has gone down.

In August 1999, there were 132 counselors who provided 2,382 hours of psychiatric and psychological help to 4,425 mentally ill inmates, according to Metzner's report. In December 2006, 188 counselors provided 1,830 hours of care for 8,054 inmates.

Prison officials have been repeatedly warned of the shortcomings.

Geraghty, of the human rights group, called the persistent problems "disturbing." "The mental health caseload is skyrocketing and the number of mental health professionals is plummeting."

While under the supervision of the federal courts, the prison system increased staffing levels to make sure mentally ill inmates were cared for. DeGroot said the prison system "began losing ground" in 2000 because of budget cuts.

As a result, unlicensed counselors — who are allowed in prison — are not receiving clinical supervision, raising "serious risk management issues," Metzner wrote. Turnover and vacancy rates among mental health staff and correctional officers in prisons are also high. At Chatham County's Coastal State Prison alone, the vacancy rate among guards is about 40 percent, according to the report.

DeGroot said 2006 — the year covered by the most recent Metzner report — was particularly bad because of a spike in the number of sentenced inmates transferred from crowded county jails into the prison system. "We've grown so fast in calendar year '06 that without the staff growing now there are cracks in the infrastructure," DeGroot said.

Basic therapy

DeGroot led a tour June 13 for an AJC reporter and photographer of some of the mental health units at Phillips State Prison in north Gwinnett County.

The housing units were clean, and most of the inmates appeared calm while participating in therapeutic exercises. Some stared off into space, some held their heads in their hands and some rocked back and forth or twitched nervously.

Therapists talked to the inmates about the importance of proper hygiene in one class. In another, a therapist asked a group of mentally ill inmates to name their favorite color and their reason for choosing it.

An African-American inmate responded "white." When asked by the therapist why he chose white, he matter-of-factly responded "That's the color I am. I'm just in disguise."

A couple of the inmates who spoke with an AJC reporter said they felt safe and treated well inside the mental health wing by most staff members and guards. They had minor complaints about being forced to take medication, or the occasional surly prison guard.

In contrast, Geraghty of the Southern Center for Human Rights showed the AJC a folder full of photos of mental health inmates who had cut themselves at Phillips State Prison.

Some of the inmates had cut their forearms, throats and chests, spilling blood onto their cell floors and uniforms. The photos were gathered during a 2004 lawsuit against the prison system in which the center claimed an "epidemic of self-injury" among mental health inmates at Phillips.

Graham, who had a son at Phillips (he is now at Georgia State Prison in Reidsville), said she's not surprised by the report's findings. "They're basically nonexistent," Graham said of corrections' mental health services.

Graham said there were a few mental health personnel who have been helpful to her. But mostly, she felt ignored and kept in the dark about her son's needs.

On March 21, her son attacked a female prison guard at Phillips. When asked why, according to a report of the incident, he told authorities "Jesus told him to do it." Graham, who suffers from shizo-affective disorder, landed in an Atlanta hospital with a collapsed lung, cracked ribs and other injuries in the ensuing scuffle with guards who responded to the attack. Graham, who was serving five years for assaulting a Cobb County police officer, now faces additional criminal charges in Gwinnett.

DeGroot said he doesn't think the prison system's mental health system is in crisis.

"We could improve. The staff's hearts, most of them, are in the right place, and doing a good job. I think we're providing help to people who for so long have not received much, if any, help. We're dealing with the most disenfranchised population."

Saturday, June 23, 2007

The criminalization of mental illness under capitalism

Friday, June 22, 2007
By: Crystal Kim

Prisons replace hospital care

The writer is a member of the Party for Socialism and Liberation and research coordinator of a free-standing psychiatric clinic.

Whether it is Cho Seung-Hui and the Virginia Tech killings or Angela Yates and the murders of her young children, mental illness is an underlying factor in many tragedies in the United States. Approximately 1,000 homicides a year are committed by mentally ill individuals who are not receiving proper treatment.

This comes as no surprise. In the United States—the richest country in the world—the healthcare system is not designed to treat the mentally ill. Rather, mental illness is ignored until the problem explodes.

The largest mental health facility in the United States is not a hospital. It is the Los Angeles County Jail, which holds 3,000 mentally ill inmates on any given day.

The more than 10,000 mentally ill inmates incarcerated in New York state prisons surpass the number of patients in the state’s psychiatric hospitals.

About 10 percent of prisoners suffer from mental illness. Most have committed misdemeanors caused either in whole or in part by psychiatric disorders. They need treatment, not incarceration. Yet, the federal government and state authorities use tax dollars to keep them locked up in subhuman conditions, exacerbating the problem.

This alarming trend began in the 1960s. Since then, jails and prisons have become the new psychiatric hospitals for the mentally ill. Driven by corporate greed, the mentally ill in the United States are being punished for their mental ailments.

Working-class people with mental health problems are the most vulnerable to becoming victims of the system.

Corporate and government collaboration

In 1955, 560,000 people in the United States were being treated for mental health problems in state hospitals. Adjusting for population increase, we would expect there to be about 930,000 individuals being treated in state hospitals today. This is not the case. Fewer than 55,000 people are being treated in such facilities.

Where then are the hundreds of thousands of people with mental health issues? Most are imprisoned by, or otherwise caught up in, the legal system. Between 170,000 and 300,000 mentally ill individuals suffer today in jails and prisons. Another 500,000 are on court-ordered probation.

Since 1960, more than 90 percent of state psychiatric hospital beds have been eliminated. Mental health professionals and sociologists call this "deinstitutionalization." As a result of this phenomenon, many mentally ill patients who need hospital care are in prison instead.

What’s behind deinstitutionalization? In short, the culprit is capitalism.

In 1952, French surgeon Henri Laborit began experimenting with a drug called chlorpromazine. Chlorpromazine was originally developed to treat allergies, but Laborit tested it to see if it could sedate his patients before surgery. Laborit found that chlorpromazine made his patients feel very relaxed. Laborit convinced his colleagues, psychiatrists Jean Delay and Pierre Deniker, to administer chlorpromazine to schizophrenic patients. To their surprise, the most disturbed patients became calm and placid. This was a major breakthrough in psychopharmacology.

Upon hearing about the success of chlorpromazine as a psychiatric drug, the pharmaceutical company that had developed chlorpromazine, Rhone-Poulec, sold the rights to another pharmaceutical company—Smith Kline & French. Known today as GlaxoSmithKline, it is the second largest pharmaceutical company in the world. In 2006, GSK earned $13billion in profits.

Smith Kline flew Deniker all around the United States to speak with psychiatrists about the psychiatric treatment properties of chlorpromazine. The company hoped it could sell chlorpromazine on the U.S. market. When this plan failed, Smith Kline undertook a new approach.

Smith Kline arranged for Deniker to meet with state legislators. Deniker explained to them that state governments could save millions of dollars by prescribing chlorpromazine to mentally ill patients housed in state hospitals. He argued that this would allow patients to be deemed well enough to be discharged. This, of course, would earn Smith Kline billions in profits.

Without regard for whether a patient could continue to afford the drug after discharge, and ignoring its dangerous side effects, state legislators were thrilled by the prospect of no longer having to fund treatment for the mentally ill. State hospitals were already under fire for cruel and inhumane treatment of mentally ill patients. Such treatment was depicted in the popular novel-turned-film "One Flew Over the Cuckoo’s Nest."

With chlorpromazine, state legislators were able to kill two birds with one stone. They could save millions of dollars by emptying psychiatric hospital beds, while also escaping public criticism for the appalling quality of treatment in state hospitals. The lawmakers enthusiastically accepted Smith Kline’s proposal.

Smith Kline marketed chlorpromazine under the name Thorazine. In the first eight months on the market, it was administered to over 2 million patients. In the first 10 years, it was administered to 50 million people. Within 15 years, Smith Kline’s revenues had doubled three times.

The advent of Thorazine, followed by the establishment of Medicaid and Medicare, led the White House to believe that perhaps state psychiatric hospitals were not necessary at all.

In 1963, President John F. Kennedy signed the Community Mental Health Centers Act. This law authorized Congress to spend up to $3 billion to build a national network of community mental health centers to replace state psychiatric hospitals. Congress proudly stated that the community mental health centers would allow even the most severely ill patients to be near home as long as they were taking Thorazine.

State hospitals began emptying their beds almost immediately. Between 1955 and 1994, the number of patients in state psychiatric hospitals decreased from over 500,000 to less than 100,000. From 1963 to 1980, alone, the inpatient population fell more than 75 percent.

The community mental health centers that were promised by Kennedy and Congress, however, were never built. The promise of $3 billion in funding was a big lie. The government turned its attention to "more pressing" matters, namely prosecuting the war of aggression against the Vietnamese people and covering up the Watergate scandal.

Hundreds of thousands of mentally ill patients were dumped onto the streets. This was due to government collaboration to meet the capitalists’ bottom line. By the 1980s, many former patients began arriving in jails and prisons. This trend is called "transinstitutionalization."

Into the prison system

The U.S. population increased by 16 percent between 1980 and 1995. In that period, the number of incarcerated people rose from 501,886 to 1,587,791—an increase of 216 percent!

Have people in the United States become that much more "criminal?" No. The repressive capitalist state apparatus has been extended. Deinstitutionalization has made jails a "repository" of the mentally ill. Instead of being treated as a medical matter, mental illness is being punished as a criminal matter.

A 1973 study of Santa Clara County in California shows that the county jail population rose 300 percent in four years. This jump followed the closure of Agnews State Psychiatric Hospital, located in the same county. (L.A. Teplin, "Journal of Hospital & Community Psychiatry," 1983)

A 1992 Public Citizen survey showed that 29 percent of jails in the United States incarcerate people who have no charges against them but are simply waiting for a psychiatric evaluation, a hospital bed, or transportation to a psychiatric hospital.

Moreover, most severely mentally ill people in jail are incarcerated because they have been charged with a misdemeanor due to an underlying psychiatric disorder. (E.F. Torrey, "Out of the shadows: Confronting America’s mental illness crisis." John Wiley & Sons, 1997)

For example, one mentally ill prisoner in Miami was arrested 26 times in six years for minor crimes such as panhandling and being a "sanitary nuisance." A schizophrenic prisoner in Denver was jailed over 28 times in two years for causing disturbances. In his lifetime, he had been jailed over 100 times.

On average, the mentally ill are jailed six times longer than other inmates charged with the same crime.

Case in point: Miami

What are the conditions like for the mentally ill in U.S. jails and prisons?

Former Washington Post reporter Pete Earley got an unprecedented look at Miami’s main jail—Miami-Dade Pretrial Detention Center. Earley’s investigation was prompted when his own son was thrown into the criminal "justice" system due to a severe mental illness. Earley described his observations of the Miami jail in "Crazy: A Father’s Search Through America’s Mental Health Madness." (G.P. Putnam’s Sons, 2006)

Earley’s description is purely observational, not analytical. Nonetheless, he gives valuable insight into the plight of the mentally ill.

According to Earley, on an average day Miami-Dade Pretrial Detention Center has 700 inmates on antipsychotic drugs. Most of these inmates get locked up on the ninth floor, officially known as the "primary psychiatric unit" but referred to as the "forgotten floor." Inmates are held in large group cells with as many as 50 persons in each cell.

The guards on the ninth floor do not receive special training on how to handle mentally ill inmates. Nurses on the ninth floor earn $2,000 less per year than nurses in Miami hospitals.

The ninth floor has three wings, one of which is reserved for suicidal inmates. Mentally ill inmates who have attempted suicide are held in solitary confinement in cells that have shatter-resistant glass fronts. They are kept naked, and the temperature of the entire wing is kept at around 50 degrees F (10 degrees C) to deter "trouble."

Each cell has a plastic bed built so the prisoner can be strapped to it spread-eagled. Suicidal inmates are not given sheets, blankets or pillows. They are not allowed to have any sort of entertainment, including radio, magazines and books. They have nothing to do but sleep or look out the glass front. Under these sadistic conditions, a suicidal individual’s mental health can only further deteriorate.

There is only one psychiatrist for the entire ninth floor, which allows him to spend an average of 12.7 seconds with each inmate on any given day. He has no authority or time to perform comprehensive mental exams. There is no doctor-patient confidentiality.

The psychiatrist is required to prescribe cheaper drugs to mentally ill inmates even if they report responding well to a different drug. Switching drugs can cause a mentally ill person’s condition to rapidly deteriorate. But this is a risk that Miami’s decision-makers are willing to take to cut down on expenses.

This is a snapshot of what life is like for hundreds of thousands of mentally ill people in the United States today.

Crisis rooted in capitalism

Until the early 19th century, the mentally ill were regularly imprisoned. The work of activists like Dorothea Dix forced legislators to build psychiatric hospitals so that the mentally ill could be treated.

Two hundred years later, the gains have been negated by the inexhaustible greed of capitalists and the politicians they keep in their pockets.

The U.S. mental health system is one example of the wanton greed enforced by the capitalist system. Capitalism upholds the ownership of private property by a few rich capitalists, while the rest of us are exploited in varying degrees. Capitalism is geared toward generating profit, not attending to people’s needs.

Capitalism has made illness into a source of billions in profits for pharmaceutical giants like Pfizer and GlaxoSmithKline each year.

It is cheaper for the state, and more profitable for private corporations, to imprison mentally ill people than to treat them. State governments pay private companies that run psychiatric hospitals regardless how much care they provide their patients and how good or bad that care is. Keeping beds empty increases the owners’ profit margins. Therefore, hospitals push toward prematurely discharging patients rather than ensuring them sufficient treatment.

It does not have to be this way.

The healthcare system must be stripped of its profit motive. This would ensure that patient care is the very top priority. Funding could be used for research and better training of healthcare workers, so that the deplorable conditions common in state psychiatric hospitals of the past are not repeated. Without the profit motive governing health care, aggressive, community-based, long-term follow-up care and treatment could become a reality.

This can only happen through a monumental struggle to reorganize health care so that it benefits people and not predatory drug companies, insurance companies and private hospitals. The healthcare system, along with capitalism itself, must be overturned to meet the needs of all people, especially those with mental illnesses who need help the most.