AUDIT ON PRISON MENTAL HEALTH TREATMENT
Inmate care declines
Turnover, lack of therapists partly to blame
By CARLOS CAMPOS
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.
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."